Table 1 Etiological subclassification of autoimmune psychosis
Autoimmune Psychosis Subclass | Autoantibodies and proposed inflammatory mechanisms | Associated neurological and neuropsychiatric symptoms |
|---|---|---|
Autoimmune encephalitis associated with synaptic and neuronal cell membrane proteins antibodies | NMDAR antibodies [IgG against NR1 (Glu1) subunit] | Cognitive decline, memory loss, speech fragmentation, seizures, dyskinesias, catatonia, autonomic instability, and central hypoventilation. Delta brush on EEG. |
AMPAR antibodies (IgG against GluR1/2 subunits) | Cognitive decline, memory loss, affective changes, confusion, agitation, delirium, and seizures | |
GABAßR antibodies (IgG against B1 subunit) | Seizures, memory loss, and confusion | |
VGKC-protein complex antibodies: LGI1 antibodies | Amnesia, confusion, disorientation, autonomic dysfunction, apathy, irritability, faciobrachial dystonic seizures, and hyponatremia | |
CASPR2 antibodies | Neuromyotonia, muscle spasm, fasciculation, neuropathic pain dysautonomia, confusion, amnesia, insomnia, and seizures | |
Psychosis associated with autoimmune and inflammatory disorders | ||
1. Classical systemic autoimmune disorders: | ||
Neuropsychiatric systemic lupus erythematosus | NMDAR antibodies [IgG against NR2 (Glu2) subunit] Ribosomal P antibodies | Cognitive changes, affective disorders, anxiety, delirium, seizures, and neurovascular disease |
2. Neuroinflammatory disorders: | ||
Inflammatory demyelinating disorders (MS, ADEM) | OCB antibodies Anti-myelin antibodies: MBP-antibodies MOG-antibodies | Focal symptoms and neurological deficits, optic neuritis; characteristic CSF analysis and brain imaging findings |
3. Hashimoto’s encephalopathy | Antithyroid antibodies: TPO- and Tg-antibodies Autoimmune vasculitis Immune complex deposition | Encephalopathy, memory loss, confusion, altered level of consciousness, seizures, stroke-like symptoms, and myoclonus |
4. Autoimmune encephalitis associated with antibodies targeting intracellular antigens | Onconeural antibodies (HU, MA2, CRMP5, Amphyphisin | Cognitive decline, short-term memory impairment, affective disorders, anxiety, seizures, neuropathy, cerebellar ataxia, and cranial neuropathy |
GAD antibodies; often associated with GABAß antibodies | Cognitive decline, short-term memory impairment, affective disorders, anxiety, seizures, neuropathy, ataxia, weight loss, cerebellar ataxia, stiff person syndrome | |
Seronegative but probable autoimmune encephalitis (SPAP) | Unknown autoantibodies Innate- or T-cell autoimmunity? | Encephalopathy, cognitive decline, memory impairment, affective disorders, and seizures |