Autoantibody-associated psychiatric symptoms and syndromes in adults: A narrative review and proposed diagnostic approach

Niels Hansen; Michael Lipp; Jonathan Vogelgsang; Ruth Vukovich; Tristan Zindler; Daniel Luedecke; Stefan Gingele; Berend Malchow; Helge Frieling; Simone Kühn; Johannes Denk; Jürgen Gallinat; Thomas Skripuletz; Nicole Moschny; Jens Fiehler; Christian Riedel; Klaus Wiedemann; Mike P Wattjes; Inga Zerr; Hermann Esselmann; Stefan Bleich; Jens Wiltfang; Alexandra Neyazi; CAP (Cerebrospinal Fluid Analysis in Psychiatry) Consortium

doi:10.1016/j.bbih.2020.100154

Autoantibody-associated psychiatric symptoms and syndromes in adults: A narrative review and proposed diagnostic approach

Brain Behav Immun Health. 2020 Oct 1:9:100154. doi: 10.1016/j.bbih.2020.100154. eCollection 2020 Dec.

Authors

Niels Hansen¹, Michael Lipp², Jonathan Vogelgsang¹, Ruth Vukovich¹, Tristan Zindler³, Daniel Luedecke², Stefan Gingele⁴, Berend Malchow¹, Helge Frieling³, Simone Kühn², Johannes Denk², Jürgen Gallinat², Thomas Skripuletz⁴, Nicole Moschny³, Jens Fiehler⁵, Christian Riedel⁶, Klaus Wiedemann², Mike P Wattjes⁷, Inga Zerr^{8

9}, Hermann Esselmann¹, Stefan Bleich³, Jens Wiltfang^{1

9

10}, Alexandra Neyazi³; CAP (Cerebrospinal Fluid Analysis in Psychiatry) Consortium

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Von-Siebold-Str. 5, 37075, Goettingen, Germany.
² Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
³ Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
⁴ Department of Neurology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
⁵ Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
⁶ Department of Neuroradiology, University of Goettingen, Robert-Koch Str. 40, 37075, Goettingen, Germany.
⁷ Department of Neuroradiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
⁸ Department of Neurology, University of Goettingen, Robert-Koch Str. 40, 37075, Goettingen, Germany.
⁹ German Center for Neurodegenerative Diseases (DZNE), Von-Siebold-Str. 3a, 37075, Goettingen, Germany.
¹⁰ Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.

Abstract

Background: Autoimmune-mediated encephalitis is a disease that often encompasses psychiatric symptoms as its first clinical manifestation's predominant and isolated characteristic. Novel guidelines even distinguish autoimmune psychosis from autoimmune encephalitis. The aim of this review is thus to explore whether a wide range of psychiatric symptoms and syndromes are associated or correlate with autoantibodies.

Methods: We conducted a PubMed search to identify appropriate articles concerning serum and/or cerebrospinal fluid (CSF) autoantibodies associated with psychiatric symptoms and syndromes between 2000 and 2020. Relying on this data, we developed a diagnostic approach to optimize the detection of autoantibodies in psychiatric patients, potentially leading to the approval of an immunotherapy.

Results: We detected 10 major psychiatric symptoms and syndromes often reported to be associated with serum and/or CSF autoantibodies comprising altered consciousness, disorientation, memory impairment, obsessive-compulsive behavior, psychosis, catatonia, mood dysfunction, anxiety, behavioral abnormalities (autism, hyperkinetic), and sleeping dysfunction. The following psychiatric diagnoses were associated with serum and/or CSF autoantibodies: psychosis and schizophrenia spectrum disorders, mood disorders, minor and major neurocognitive impairment, obsessive-compulsive disorder, autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), anxiety disorders, eating disorders and addiction. By relying on these symptom clusters and diagnoses in terms of onset and their duration, we classified a subacute or subchronic psychiatric syndrome in patients that should be screened for autoantibodies. We propose further diagnostics entailing CSF analysis, electroencephalography and magnetic resonance imaging of the brain. Exploiting these technologies enables standardized and accurate diagnosis of autoantibody-associated psychiatric symptoms and syndromes to deliver early immunotherapy.

Conclusions: We have developed a clinical diagnostic pathway for classifying subgroups of psychiatric patients whose psychiatric symptoms indicate a suspected autoimmune origin.

Keywords: Autoantibodies; Autoimmune psychosis; Autoimmunity; Psychiatric symptoms; Psychiatric syndrome.