Skip to main content

Advertisement

Table 1 Etiological subclassification of autoimmune psychosis

From: A clinical approach to new-onset psychosis associated with immune dysregulation: the concept 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
  1. Abbreviations: NMDAR N-methyl-d-aspartate receptor, AMPAR a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, GABAuR gamma-aminobutyric acid beta receptor, VGK.C voltage-gated potassium channel, LGI1 leucine-rich-glioma inactivated 1, CASPR2 contactin-associated protein-like 2, MS multiple sclerosis, ADEM acute disseminated encephalomyelitis, OCB oligoclonal band, MBP myelin basic protein, MOG myelin oligodendrocyte glycoprotein, TPO thyroid peroxidase, Tg thyroid globulin, GAD glutamic acid decarboxylase