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Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin.
The Lancet Psychiatry ( IF 64.3 ) Pub Date : 2019-10-24 , DOI: 10.1016/s2215-0366(19)30290-1
Thomas A Pollak 1 , Belinda R Lennox 2 , Sabine Müller 3 , Michael E Benros 4 , Harald Prüss 5 , Ludger Tebartz van Elst 6 , Hans Klein 7 , Johann Steiner 8 , Thomas Frodl 8 , Bernhard Bogerts 8 , Li Tian 9 , Laurent Groc 10 , Alkomiet Hasan 11 , Bernhard T Baune 12 , Dominique Endres 6 , Ebrahim Haroon 13 , Robert Yolken 14 , Francesco Benedetti 15 , Angelos Halaris 16 , Jeffrey H Meyer 17 , Hans Stassen 18 , Marion Leboyer 19 , Dietmar Fuchs 20 , Markus Otto 21 , David A Brown 22 , Angela Vincent 23 , Souhel Najjar 24 , Karl Bechter 25
Affiliation  

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 immunotherapies. 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.



中文翻译:

自身免疫性精神病:关于疑似自身免疫性精神病的诊断和管理方法的国际共识。

在神经病学和精神病学文献中越来越多地认识到具有所谓的孤立性精神病表现(即没有或只有很少的神经病学特征)的神经元自身抗体(主要是 N-甲基-D-天冬氨酸受体抗体)检测呈阳性的患者以及对免疫疗法有反应的人。尽管这些人有时被描述为患有非典型、轻度或轻型自身免疫性脑炎,但一些作者认为这些病例与典型的自身免疫性脑炎有很大不同,可以建立一个新的类别,即所谓的自身免疫性精神病。我们简要回顾了背景,讨论了一种自身免疫性精神病的现有证据,并提出了一种新颖、保守的方法来识别可能的、很可能的、和明确的自身免疫性精神病用于精神病学实践。我们还概述了可能和确定的自身免疫性精神病病例所需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。

更新日期:2019-10-24
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