Frequency of autoimmune-associated exogenous psychoses in routine clinical care
Background: Psychosis occurs in a wide spectrum of mental and somatic disorders, with autoimmune processes being a potentially underdiagnosed cause. Clinical warning-signs can help identifying autoimmune encephalitis (AIE) or psychosis (AIP). Here we evaluated warning-signs and biomarkers in patient...
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Elsevier
2025-08-01
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| Series: | Brain, Behavior, & Immunity - Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666354625000912 |
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| author | Maria Buthut David Haslacher Surjo R. Soekadar Felix Machleid Jakob Kaminski Philipp Reber Johanna Schoener Anna Pichler Moritz Thiele Jochen Michely Helle Foverskov-Rasmussen Irina Baskow Verena Rösgen-Petzold Harald Prüss Matthias Endres Lasse Brandt Andreas Heinz |
| author_facet | Maria Buthut David Haslacher Surjo R. Soekadar Felix Machleid Jakob Kaminski Philipp Reber Johanna Schoener Anna Pichler Moritz Thiele Jochen Michely Helle Foverskov-Rasmussen Irina Baskow Verena Rösgen-Petzold Harald Prüss Matthias Endres Lasse Brandt Andreas Heinz |
| author_sort | Maria Buthut |
| collection | DOAJ |
| description | Background: Psychosis occurs in a wide spectrum of mental and somatic disorders, with autoimmune processes being a potentially underdiagnosed cause. Clinical warning-signs can help identifying autoimmune encephalitis (AIE) or psychosis (AIP). Here we evaluated warning-signs and biomarkers in patients experiencing acute psychotic episodes who were admitted to inner-city sectorized care with a focus on identifying autoimmune causes of psychosis. Methods: We analyzed data obtained from routine clinical care, including blood, urine, CSF, EEG, and MRI when available. CSF-analysis included screening for antineuronal autoantibodies using commercial antibody screening (CAS) and indirect immunofluorescence (IFT). Origin of psychosis was defined according to patients’ discharge diagnosis (ICD-10 criteria). Results: Within 39 months, 352 participants were included, 114 of them experienced their first episode of psychosis (FEP). In 139 patients, psychotic symptoms were attributed to exogenous origin (F0: N = 90; F1: N = 48), the others were diagnosed with categories F2, F3 and F4. Among the 139 patients, 3 patients had pleocytosis or other CSF abnormalities. CAS was positive in two patients in CSF, leading to a confirmed diagnose of AIP in only one case while evaluated as unspecific in the other. IFT determined the prevalence of IgG-autoantibodies in CSF in four patients, who had FEP. Symptoms improved following immunotherapy in three of the four diagnosed patients. Conclusion: CSF analysis suggested four cases with AIP, with only one detected through commercial assays. Despite the rather low prevalence of AIP in this community sample, the availability of specific treatment options underscores the importance of further research regarding in-depth diagnostic evaluation for autoimmune processes in patients with acute psychosis. |
| format | Article |
| id | doaj-art-2cd94029d96d44829b80a2b13061ab08 |
| institution | Kabale University |
| issn | 2666-3546 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain, Behavior, & Immunity - Health |
| spelling | doaj-art-2cd94029d96d44829b80a2b13061ab082025-08-20T03:31:34ZengElsevierBrain, Behavior, & Immunity - Health2666-35462025-08-014710103310.1016/j.bbih.2025.101033Frequency of autoimmune-associated exogenous psychoses in routine clinical careMaria Buthut0David Haslacher1Surjo R. Soekadar2Felix Machleid3Jakob Kaminski4Philipp Reber5Johanna Schoener6Anna Pichler7Moritz Thiele8Jochen Michely9Helle Foverskov-Rasmussen10Irina Baskow11Verena Rösgen-Petzold12Harald Prüss13Matthias Endres14Lasse Brandt15Andreas Heinz16Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany; Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Corresponding author.Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany; Department of Psychiatry and Psychotherapy, St. Hedwig-Hospital, Berlin, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, GermanyDepartment of Psychology, University of California, Berkeley, CA, USADepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Charité – Universitätsmedizin Berlin, Berlin, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Charité – Universitätsmedizin Berlin, Berlin, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, GermanyDepartment of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; German Center for Mental Health (DZPG), Partner Site Berlin-Potsdam, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, GermanyDepartment of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, GermanyDepartment of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany; Center for Stroke Research Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; ExcellenceCluster NeuroCure, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; German Center for Mental Health (DZPG), Partner Site Berlin-Potsdam, GermanyDepartment of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Department of Psychiatry and Psychotherapy, St. Hedwig-Hospital, Berlin, Germany; German Center for Mental Health (DZPG), Partner Site Berlin-Potsdam, Germany; ExcellenceCluster NeuroCure, Berlin, GermanyBackground: Psychosis occurs in a wide spectrum of mental and somatic disorders, with autoimmune processes being a potentially underdiagnosed cause. Clinical warning-signs can help identifying autoimmune encephalitis (AIE) or psychosis (AIP). Here we evaluated warning-signs and biomarkers in patients experiencing acute psychotic episodes who were admitted to inner-city sectorized care with a focus on identifying autoimmune causes of psychosis. Methods: We analyzed data obtained from routine clinical care, including blood, urine, CSF, EEG, and MRI when available. CSF-analysis included screening for antineuronal autoantibodies using commercial antibody screening (CAS) and indirect immunofluorescence (IFT). Origin of psychosis was defined according to patients’ discharge diagnosis (ICD-10 criteria). Results: Within 39 months, 352 participants were included, 114 of them experienced their first episode of psychosis (FEP). In 139 patients, psychotic symptoms were attributed to exogenous origin (F0: N = 90; F1: N = 48), the others were diagnosed with categories F2, F3 and F4. Among the 139 patients, 3 patients had pleocytosis or other CSF abnormalities. CAS was positive in two patients in CSF, leading to a confirmed diagnose of AIP in only one case while evaluated as unspecific in the other. IFT determined the prevalence of IgG-autoantibodies in CSF in four patients, who had FEP. Symptoms improved following immunotherapy in three of the four diagnosed patients. Conclusion: CSF analysis suggested four cases with AIP, with only one detected through commercial assays. Despite the rather low prevalence of AIP in this community sample, the availability of specific treatment options underscores the importance of further research regarding in-depth diagnostic evaluation for autoimmune processes in patients with acute psychosis.http://www.sciencedirect.com/science/article/pii/S2666354625000912 |
| spellingShingle | Maria Buthut David Haslacher Surjo R. Soekadar Felix Machleid Jakob Kaminski Philipp Reber Johanna Schoener Anna Pichler Moritz Thiele Jochen Michely Helle Foverskov-Rasmussen Irina Baskow Verena Rösgen-Petzold Harald Prüss Matthias Endres Lasse Brandt Andreas Heinz Frequency of autoimmune-associated exogenous psychoses in routine clinical care Brain, Behavior, & Immunity - Health |
| title | Frequency of autoimmune-associated exogenous psychoses in routine clinical care |
| title_full | Frequency of autoimmune-associated exogenous psychoses in routine clinical care |
| title_fullStr | Frequency of autoimmune-associated exogenous psychoses in routine clinical care |
| title_full_unstemmed | Frequency of autoimmune-associated exogenous psychoses in routine clinical care |
| title_short | Frequency of autoimmune-associated exogenous psychoses in routine clinical care |
| title_sort | frequency of autoimmune associated exogenous psychoses in routine clinical care |
| url | http://www.sciencedirect.com/science/article/pii/S2666354625000912 |
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