Autoantibody-associated psychiatric syndromes: a systematic literature review resulting in 145 cases.

Abstract

BACKGROUND:

Autoimmune encephalitis (AE) is an important consideration during the diagnostic work-up of secondary mental disorders. Indeed, isolated psychiatric syndromes have been described in case reports of patients with underlying AE. Therefore, the authors performed a systematic literature review of published cases with AE that have predominant psychiatric/neurocognitive manifestations. The aim of this paper is to present the clinical characteristics of these patients.

METHODS:

The authors conducted a systematic Medline search via Ovid, looking for case reports/series of AEs with antineuronal autoantibodies (Abs) against cell surface/intracellular antigens combined with predominant psychiatric/neurocognitive syndromes. The same was done for patients with Hashimoto encephalopathy/SREAT. Only patients with signs of immunological brain involvement or tumors in their diagnostic investigations or improvement under immunomodulatory drugs were included.

RESULTS:

We identified 145 patients with AE mimicking predominant psychiatric/neurocognitive syndromes. Of these cases, 64% were female, and the mean age among all patients was 43.9 (±22.1) years. Most of the patients had Abs against neuronal cell surface antigens (55%), most frequently against the NMDA-receptor (N = 46). Amnestic/dementia-like (39%) and schizophreniform (34%) syndromes were the most frequently reported. Cerebrospinal fluid changes were found in 78%, electroencephalography abnormalities in 61%, and magnetic resonance imaging pathologies in 51% of the patients. Immunomodulatory treatment was performed in 87% of the cases, and 94% of the patients responded to treatment.

CONCLUSIONS:

Our findings indicate that AEs can mimic predominant psychiatric and neurocognitive disorders, such as schizophreniform psychoses or neurodegenerative dementia, and that affected patients can be treated successfully with immunomodulatory drugs.

• Authors: Dominique Endres, Viktoria Maier, Frank Leypoldt, Klaus-Peter Wandinger, Belinda Lennox, Thomas A Pollak, Kathrin Nickel, Simon Maier, Bernd Feige, Katharina Domschke, Harald Prüss, Karl Bechter, Rick Dersch, Ludger Tebartz van Elst
• Journal: Psychological medicine (Psychol Med) Vol. 52 Issue 6 Pg. 1135-1146 (04 2022) ISSN: 1469-8978 [Electronic] England
• PMID: 32892761 (Publication Type: Systematic Review, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Autoantibodies
• Immunomodulating Agents

Topics

• Humans
• Female
• Young Adult
• Adult
• Middle Aged
• Aged
• Male
• Autoantibodies
• Immunomodulating Agents
• Syndrome
• Dementia