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Autoimmune Encephalopathy for Psychiatrists: When to Suspect Autoimmunity and What to Do Next

机译：精神病学家的自身免疫性脑病：何时犯怀疑自身免疫和下一步该做什么

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Objective: To provide a critical review of autoimmune encephalopathy broadly defined as neuropsychiatric features directly related to an autoimmune process relevant for psychiatric practice. Methods: We consulted rheumatology textbooks to define the scope of autoimmune conditions and identified recent reviews of rheumatic conditions, autoimmune vasculitis, and autoimmune encephalitis. We integrated these with primary reports to provide a clinically relevant overview of autoimmune encephalopathy. We focus on clinical features that should raise suspicion for auto immunity. Results: Despite outlying conditions, 2 categories of autoimmune encephalopathy are described: (1) neuropsychiatric symptoms associated with rheumatic conditions and (2) antibody-associated autoimmune encephalitis. Rheumatic conditions principally include connective tissue disease and other vasculitides. These may present variously such as with unexplained delirium, cognitive decline, or depression. Autoimmune encephalitis may be diffuse or localized as in limbic, brainstem, or basal ganglia encephalitis. Unexplained delirium, psychosis, catatonia, strokes, and seizures are among common presenting symptoms. Conclusions: Prompt identification and management of autoimmunity are critical for optimal outcomes. The fact that undiagnosed and, therefore, untreated autoimmunity leads to debilitation demands vigilance for these conditions. Close attention to the unusual nature and course of neuropsychiatric symptoms, associated neurological features, and review of systems as reviewed here should guide the skillful clinician.
机译：目的：提供对自身免疫性脑病的关键评论，广泛定义为与对精神审查相关的自身免疫过程直接相关的神经精神功能。方法：我们咨询了风湿病学教科书，定义了自身免疫条件的范围，并确定了近期风湿病症，自身免疫性血管炎和自身免疫性脑炎的近期审查。我们将这些与主要报告集成，以提供自身免疫性脑病的临床相关概述。我们专注于应引起自动免疫的怀疑的临床特征。结果：尽管偏远的条件，但2类类别的自身免疫性脑病描述：（1）与风湿条件相关的神经精神症状和（2）抗体相关的自身免疫脑炎。流动性条件主要包括结​​缔组织疾病和其他血管抑制。这些可能不同地呈现，例如未解释的谵妄，认知衰退或抑郁症。自身免疫性脑炎可以在肢体，脑干或基底神经节脑炎中弥漫或局部局部。无法解释的谵妄，精神病，强迫性，抚摸和癫痫发作是常见的呈现症状。结论：及时识别和自身免疫管理对于最佳结果至关重要。未确诊的自身免疫导致虚无于而知，未经治疗的自身免疫要求对这些条件进行警惕的事实。密切关注神经精神症状，相关神经学特征的不寻常性和过程，以及在此评论的情况下，审查的系统应该引导熟练的临床医生。

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