Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin
Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin
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DOI：
10.1016/s2215-0366(19)30290-1
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发表时间：
2020-01-01
影响因子：
64.3
通讯作者：
Bechter, Karl
中科院分区：
文献类型：
--
作者：
Pollak, Thomas A.;Lennox, Belinda R.;Bechter, Karl
在神经病学和精神病学文献中，越来越多的人认识到，所谓的孤立性精神病患者（即没有或只有很少的神经学特征），他们的神经自身抗体（主要是n -甲基- d -天冬氨酸受体抗体）检测呈阳性，并对免疫疗法有反应。尽管这些个体有时被描述为具有非典型、轻度或减重形式的自身免疫性脑炎，但一些作者认为，这些病例与典型的自身免疫性脑炎有足够的不同，可以建立所谓的自身免疫性精神病的新类别。我们简要回顾了背景，讨论了自身免疫性精神病的现有证据，并提出了一种新的、保守的方法来识别可能的、可能的和明确的自身免疫性精神病，以供精神病学实践使用。我们还概述了对自身免疫性精神病的可能和明确病例所需要的调查和适当的治疗方法，包括精神病学和免疫学，并讨论了这一具有挑战性的诊断类别所带来的伦理问题。
There is increasing recognition in the neurological and psychiatric literature of patients with so-called isolated psychotic presentations (ie, with no, or minimal, neurological features) who have tested positive for neuronal autoantibodies (principally N-methyl-D-aspartate receptor antibodies) and who have responded to immunothera pies. Although these individuals are sometimes described as having atypical, mild, or attenuated forms of autoimmune encephalitis, some authors feel that that these cases are sufficiently different from typical autoimmune encephalitis to establish a new category of so-called autoimmune psychosis. We briefly review the background, discuss the existing evidence for a form of autoimmune psychosis, and propose a novel, conservative approach to the recognition of possible, probable, and definite autoimmune psychoses for use in psychiatric practice. We also outline the investigations required and the appropriate therapeutic approaches, both psychiatric and immunological, for probable and definite cases of autoimmune psychoses, and discuss the ethical issues posed by this challenging diagnostic category.