TY - JOUR
T1 - Autoimmune psychosis
T2 - Psychopathological patterns and outcome after immunotherapy
AU - Ramirez-Bermudez, Jesus
AU - Espinola-Nadurille, Mariana
AU - Restrepo-Martinez, Miguel
AU - Martínez-Ángeles, Victoria
AU - Martínez-Carrillo, Francisco
AU - Cascante, Lissy
AU - Valdeiglesias, Paloma
AU - Mondragón, Monserrat
AU - Armenta, Jazmín
AU - Almánzar, Josué García
AU - Rivas-Alonso, Verónica
AU - Flores-Rivera, José
AU - Arias-Carrión, Oscar
AU - Pollak, Thomas A
N1 - Copyright © 2025 Elsevier B.V. All rights reserved.
PY - 2025/4/29
Y1 - 2025/4/29
N2 - Background: The diagnostic criteria for “autoimmune psychosis” have been proposed to identify patients presenting with psychotic symptoms of autoimmune origin. Here, we aim to characterize the psychopathological features and outcomes of patients diagnosed with autoimmune psychosis. Methods: We describe a cohort study conducted at the National Institute of Neurology and Neurosurgery of Mexico, including patients with psychotic symptoms exhibiting features of possible autoimmune psychosis: a) catatonia, b) dyskinesia, c) seizures, d) signs of neuroleptic malignant syndrome or clinical worsening after use of antipsychotics, or e) severe cognitive impairment. Results: Of 195 psychotic patients under assessment, 164 patients were diagnosed as having psychosis of autoimmune origin and received immunotherapy. Hallucinations were present in 83 %, delusions in 77 %, and disorganized speech in 64 % of the cases. Severe cognitive dysfunction was present in 75 % while 64 % were diagnosed with catatonia. Seizures were the most common neurological feature (63 %), followed by movement disorders and autonomic abnormalities. Most patients (71%) were diagnosed as having definite anti- NMDAR encephalitis. A significant proportion of the cases (39 %) had been previously misdiagnosed as having a primary psychiatric disorder. After immunotherapy, most patients with anti-NMDA receptor encephalitis, or with a negative determination of NMDA receptor antibodies, experienced cognitive and functional improvement, and a significant reduction in psychotic symptoms.
AB - Background: The diagnostic criteria for “autoimmune psychosis” have been proposed to identify patients presenting with psychotic symptoms of autoimmune origin. Here, we aim to characterize the psychopathological features and outcomes of patients diagnosed with autoimmune psychosis. Methods: We describe a cohort study conducted at the National Institute of Neurology and Neurosurgery of Mexico, including patients with psychotic symptoms exhibiting features of possible autoimmune psychosis: a) catatonia, b) dyskinesia, c) seizures, d) signs of neuroleptic malignant syndrome or clinical worsening after use of antipsychotics, or e) severe cognitive impairment. Results: Of 195 psychotic patients under assessment, 164 patients were diagnosed as having psychosis of autoimmune origin and received immunotherapy. Hallucinations were present in 83 %, delusions in 77 %, and disorganized speech in 64 % of the cases. Severe cognitive dysfunction was present in 75 % while 64 % were diagnosed with catatonia. Seizures were the most common neurological feature (63 %), followed by movement disorders and autonomic abnormalities. Most patients (71%) were diagnosed as having definite anti- NMDAR encephalitis. A significant proportion of the cases (39 %) had been previously misdiagnosed as having a primary psychiatric disorder. After immunotherapy, most patients with anti-NMDA receptor encephalitis, or with a negative determination of NMDA receptor antibodies, experienced cognitive and functional improvement, and a significant reduction in psychotic symptoms.
UR - http://www.scopus.com/inward/record.url?scp=105003603467&partnerID=8YFLogxK
U2 - 10.1016/j.schres.2025.04.024
DO - 10.1016/j.schres.2025.04.024
M3 - Article
C2 - 40306141
SN - 0920-9964
VL - 281
SP - 10
EP - 19
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -