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. 2022 Apr;52(6):1135-1146.
doi: 10.1017/S0033291720002895. Epub 2020 Sep 7.

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

Dominique Endres  1   2 , Viktoria Maier  1   2 , Frank Leypoldt  3 , Klaus-Peter Wandinger  3 , Belinda Lennox  4   5 , Thomas A Pollak  6 , Kathrin Nickel  1   2 , Simon Maier  1   2 , Bernd Feige  1   2 , Katharina Domschke  2   7 , Harald Prüss  8   9 , Karl Bechter  10 , Rick Dersch  11 , Ludger Tebartz van Elst  1   2
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Autoantibody-associated psychiatric syndromes: a systematic literature review resulting in 145 cases

Dominique Endres et al. Psychol Med. 2022 Apr.

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.

Keywords: Autoantibody; autoimmune encephalitis; autoimmune psychosis; dementia; immunological encephalopathy; schizophrenia.

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Conflict of interest statement

DE: None. VM: None. FL: Consulting activities/lecture fees for/from Biogen, Grifols, Teva, Roche, Merck, Fresenius. KPW: None. BL: None. TAP: None: KN: None. SM: None. BF: None. KD: Steering Committee Neurosciences, Janssen. HP: None. KB: None. RD: Lecture fees from Roche and travel grants from Biogen. LTvE: Advisory boards, lectures, or travel grants within the last 3 years: Roche, Eli Lilly, Janssen-Cilag, Novartis, Shire, UCB, GSK, Servier, Janssen, and Cyberonics.

Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram. Abbreviations: CS, case series; CR, case report. *References of screened reviews: (Al-Diwani, Pollak, Langford, & Lennox, ; Al-Diwani, Pollak, Irani, & Lennox, ; Bien & Bauer, ; Castillo et al., ; Chong et al., ; Dalmau, ; Dalmau et al., ; Dalmau, Geis, & Graus ; Dalmau & Rosenfeld, ; Dalmau & Vincent, ; Ehrenreich, ; Graus et al., ; Herken & Prüss, ; Kayser, Kohler, & Dalmau ; Kayser & Dalmau, , , ; Lancaster, ; Laurent et al., ; Lewerenz, Jarius, Wildemann, Wandinger, & Leypoldt, ; Leypoldt, Armangue, Dalmau, ; Menon et al., ; Najjar & Pearlman, ; Prüss & Lennox, ; Tebartz van Elst, Stich, & Endres, ; Titulaer & Dalmau, ; Zandi, Lennox, & Vincent, ; Zuliani, Graus, Giometto, Bien, & Vincent, 2012).
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References

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