Muddying the waters? A false positive case of autoimmune psychosis

Objective: To discuss challenges with the diagnosis of autoimmune psychosis (AP) in people with chronic psychotic disorders. Method: We present a case of a 23-year-old man with an exacerbation of treatment-refractory psychosis after receiving intravenous immunoglobulin (IVIG) for suspected AP, diagn...

Full description

Saved in:
Bibliographic Details
Published in:Australasian psychiatry : bulletin of the Royal Australian and New Zealand College of Psychiatrists 2021-06, Vol.29 (3), p.278-281
Main Authors: Ketheesan, Sarangan, Bertram, Georgia, Adam, Robert, Stark, Anne, Scott, James G
Format: Article
Language:English
Subjects:
Autoantibodies - blood
Autoantibodies - cerebrospinal fluid
Encephalitis
Humans
Immunoglobulins, Intravenous - administration & dosage
Immunoglobulins, Intravenous - adverse effects
Male
Psychoses, Substance-Induced - drug therapy
Psychotic Disorders - diagnosis
Psychotic Disorders - drug therapy
Psychotic Disorders - therapy
Receptors, N-Methyl-D-Aspartate
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective: To discuss challenges with the diagnosis of autoimmune psychosis (AP) in people with chronic psychotic disorders. Method: We present a case of a 23-year-old man with an exacerbation of treatment-refractory psychosis after receiving intravenous immunoglobulin (IVIG) for suspected AP, diagnosed 4 years after the onset of psychosis. We highlight the diagnostic and management challenges in such cases. Results: The diagnosis of AP in people with long-standing illness relies on the interpretation of non-specific clinical and laboratory findings in individuals with psychosocial problems and challenges of acceptance and adherence to complex medical investigations and treatments. Equivocal results from investigations undertaken without logical clinical reasoning can lead to inappropriate interventions that are costly and can cause iatrogenic harm. Conclusion: Psychiatrists should restrict screening for antineuronal antibodies in people with chronic psychosis to those with higher risk features such as persistent treatment refractory symptoms with concurrent neurological signs and symptoms. Further research informing the clinical circumstances for antineuronal antibody testing is needed.
ISSN:1039-8562
1440-1665
DOI:10.1177/1039856220965041