Steroid-responsive autoimmune psychosis with cerebrospinal fluid-restricted oligoclonal bands and positive tissue-based assay findings: a case series of three patients.

BACKGROUND

Partial psychotic disorders such as autoimmune psychosis do not respond adequately to conventional antipsychotic drugs or psychotherapy. Autoimmune psychosis presents with isolated psychiatric symptoms, responds to immunotherapy, and differs from typical autoimmune encephalitis. Previous study has proposed an approach to identifying autoimmune psychosis, however, further research remains necessary to enhance our understanding of this condition.

CASE PRESENTATION: We describe 3 patients presenting with acute or recurrent psychiatric symptoms (patient 1, 2 and 3), accompanied by cognitive impairment (patient 1), autonomic dysfunction (patient 2), and/or abnormal electroencephalogram (patient 1). Brain magnetic resonance imaging results and autoimmune antibodies in cerebrospinal fluid testing were normal. However, the cerebrospinal fluid-restricted oligoclonal bands were detected in patient 1 and patient 2, while patient 3 showed positive tissue-based assay results in cerebrospinal fluid. Combined steroid therapy could enhance the limited improvement in patient 1, who had been treated with blonanserin, valproate and modified electroconvulsive therapy, and could also prevent symptom recurrence in patient 2, who received antipsychotic treatment. In contrast, in the absence of combined steroid therapy, patient 3 had only partial improvement with risperidone and valproate.

CONCLUSIONS

Cerebrospinal fluid-restricted oligoclonal bands and tissue-based assay in cerebrospinal fluid could both provide sufficient evidence for autoimmune psychosis in the absence of clear neurological symptoms. For patients with mild psychiatric symptoms, low-dose of steroids may also be a treatment option. Autoimmune psychosis should be considered when antipsychotic drugs or modified electroconvulsive therapy are not effective in patients with psychotic disorders.