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A causality algorithm to guide diagnosis and treatment of catatonia due to autoimmune conditions in children and adolescents

机译：一种因果关系算法指导儿童和青少年自身免疫条件引起的诊断和治疗

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摘要

ObjectivesPediatric catatonia is a rare and life-threatening syndrome. Around 20% of juvenile catatonia is associated with organic condition (Consoli et al., 2012). Autoimmune conditions represent a diagnostic and therapeutic challenge since specific antibodies can be missed. To facilitate decision making, we recently formulated a causality assessment score (CAUS) using a stepwise approach and an immunosuppressive therapeutic challenge (Ferrafiat et al., 2016). Our objectives were to validate retrospectively CAUS and to define its threshold for an accurate distinction between organic catatonia and non-organic catatonia, and specifically between autoimmune catatonia and non-organic catatonia. MethodTo obtain a sufficient number of cases with organic catatonia, we pooled two samples (N=104) – one from a child psychiatry center, the other from neuro-pediatrics center – expert in catatonia and autoimmune conditions. Organic conditions were diagnosed using a multidisciplinary approach and numerous paraclinical investigations. Given the binary classification needs, we used receiver operating characteristic (ROC) analysis (Peacock and Peacock, 2010) to calculate the best classification threshold. ResultsThe cohort included 67 cases of non-organic catatonia and 37 cases of organic catatonia. ROC analysis showed that the CAUS performance in discriminating both organic catatonia vs. non-organic catatonia, and autoimmune catatonia vs. non-organic catatonia was excellent (Area Under the Curve=0.99). In both analyses, for a CAUS threshold≥5, accuracy equaled to 0.96. ConclusionRegarding juvenile catatonia, the use of the CAUS score algorithm combining a therapeutic challenge and a threshold≥5 may help to diagnose and treat autoimmune conditions even without formal identification of auto-antibodies.
机译：象征性的Catatonia是一种罕见和危及生命的综合征。大约20％的青少年catatonia与有机状况（Consoli等，2012）有关。自身免疫条件代表诊断和治疗性挑战，因为可以错过特异性抗体。为了促进决策，我们最近使用逐步方法和免疫抑制治疗挑战制定了因果关系评估评分（原因）（Ferrafiat等，2016）。我们的目标是验证回顾性的原因，并定义其有机催腺催化和非有机强迫性的准确区别的阈值，特别是自身免疫性催腺催化和非有机强迫性。方法获得足够数量的有机强迫性的病例，我们汇集了两个样品（n = 104） - 来自儿童精神病程，另一个来自神经小儿科中心 - Catatonia和自身免疫条件的专家。利用多学科方法和许多旁立板调查诊断有机条件。鉴于二进制分类需求，我们使用接收器操作特征（ROC）分析（孔雀和孔雀，2010）来计算最佳分类阈值。结果队队列包括67例非有机强迫性和37例有机强迫性。 ROC分析表明，在鉴别有机Catatonia与非有机Catatonia和自身免疫催化与非有机强迫性的情况下的表现优异（曲线下的面积= 0.99）。在两种分析中，对于导致阈值≥5，精度等于0.96。结束了少年强迫性少年强迫性，使用治疗挑战的成因算法和阈值≥5可能有助于诊断和治疗自身免疫病症，即使没有正式鉴定自动抗体。

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  • 来源
    《Schizophrenia research》 |2018年第2018期|共9页
  • 作者

    Vladimir Ferrafiat; Marie Raffin; Elena Freri; Tiziana Granata; Nardo Nardocci; Federica Zibordi; Nicolas Bodeau; Xavier Benarous; Bertrand Olliac; Elise Riquin; Jean Xavier; Sylvie Viaux; Julien Haroche; Zahir Amoura; Priscille Gerardin; David Cohen; Angèle Consoli;

  • 作者单位

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

    Department of Pediatric Neuroscience Foundation I.R.C.C.S. Neurological Institute “C. Besta”;

    Department of Pediatric Neuroscience Foundation I.R.C.C.S. Neurological Institute “C. Besta”;

    Department of Pediatric Neuroscience Foundation I.R.C.C.S. Neurological Institute “C. Besta”;

    Department of Pediatric Neuroscience Foundation I.R.C.C.S. Neurological Institute “C. Besta”;

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

    Pediatric Psychiatry Department H?pital Universitaire d'Angers;

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

    French National Reference Center for Rare Systemic AutoImmune Disorders E3M Institute Universit;

    French National Reference Center for Rare Systemic AutoImmune Disorders E3M Institute Universit;

    Department of Child and Adolescent Psychiatry Université de Rouen H?pital Charles Nicolle;

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

    Department of Child and Adolescent Psychiatry Université Pierre et Marie Curie H?pital Pitié-Salp;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 神经病学与精神病学;
  • 关键词

    Catatonia; Autoimmune condition; Immunosuppressive treatment; Encephalitis;

    机译：catatonia;自身免疫条件;免疫抑制治疗;脑炎;

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