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Cerebrospinal fluid findings in patients with psychotic symptoms-a retrospective analysis.
Rattay, Tim W; Martin, Pascal; Vittore, Debora; Hengel, Holger; Cebi, Idil; Tünnerhoff, Johannes; Stefanou, Maria-Ioanna; Hoffmann, Jonatan F; von der Ehe, Katrin; Klaus, Johannes; Vonderschmitt, Julia; Herrmann, Matthias L; Bombach, Paula; Al Barazi, Hazar; Zeltner, Lena; Richter, Janina; Hesse, Klaus; Eckstein, Kathrin N; Klingberg, Stefan; Wildgruber, Dirk.
  • Rattay TW; Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany. tim.rattay@uni-tuebingen.de.
  • Martin P; German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany. tim.rattay@uni-tuebingen.de.
  • Vittore D; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany. tim.rattay@uni-tuebingen.de.
  • Hengel H; Center for Rare Diseases (ZSE), Tübingen, Germany. tim.rattay@uni-tuebingen.de.
  • Cebi I; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
  • Tünnerhoff J; Department of Epileptology, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany.
  • Stefanou MI; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
  • Hoffmann JF; Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany.
  • von der Ehe K; German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany.
  • Klaus J; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
  • Vonderschmitt J; Center for Rare Diseases (ZSE), Tübingen, Germany.
  • Herrmann ML; Department of Neurodegenerative Disease, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany.
  • Bombach P; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
  • Al Barazi H; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
  • Zeltner L; Department for General Neurology and Stroke, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany.
  • Richter J; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
  • Hesse K; Department for General Neurology and Stroke, Hertie-Institute for Clinical Brain Research, and Center for Neurology, University of Tübingen, Tübingen, Germany.
  • Eckstein KN; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
  • Klingberg S; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
  • Wildgruber D; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.
Sci Rep ; 11(1): 7169, 2021 03 30.
Article in English | MEDLINE | ID: covidwho-1160544
ABSTRACT
In current international classification systems (ICD-10, DSM5), the diagnostic criteria for psychotic disorders (e.g. schizophrenia and schizoaffective disorder) are based on symptomatic descriptions since no unambiguous biomarkers are known to date. However, when underlying causes of psychotic symptoms, like inflammation, ischemia, or tumor affecting the neural tissue can be identified, a different classification is used ("psychotic disorder with delusions due to known physiological condition" (ICD-10 F06.2) or psychosis caused by medical factors (DSM5)). While CSF analysis still is considered optional in current diagnostic guidelines for psychotic disorders, CSF biomarkers could help to identify known physiological conditions. In this retrospective, partly descriptive analysis of 144 patients with psychotic symptoms and available CSF data, we analyzed CSF examinations' significance to differentiate patients with specific etiological factors (F06.2) from patients with schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F2). In 40.3% of all patients, at least one CSF parameter was out of the reference range. Abnormal CSF-findings were found significantly more often in patients diagnosed with F06.2 (88.2%) as compared to patients diagnosed with F2 (23.8%, p < 0.00001). A total of 17 cases were identified as probably caused by specific etiological factors (F06.2), of which ten cases fulfilled the criteria for a probable autoimmune psychosis linked to the following autoantibodies amphiphysin, CASPR2, CV2, LGl1, NMDA, zic4, and titin. Two cases presented with anti-thyroid tissue autoantibodies. In four cases, further probable causal factors were identified COVID-19, a frontal intracranial tumor, multiple sclerosis (n = 2), and neurosyphilis. Twenty-one cases remained with "no reliable diagnostic classification". Age at onset of psychotic symptoms differed between patients diagnosed with F2 and F06.2 (p = 0.014), with the latter group being older (median 44 vs. 28 years). Various CSF parameters were analyzed in an exploratory analysis, identifying pleocytosis and oligoclonal bands (OCBs) as discriminators (F06.2 vs. F2) with a high specificity of > 96% each. No group differences were found for gender, characteristics of psychotic symptoms, substance dependency, or family history. This study emphasizes the great importance of a detailed diagnostic workup in diagnosing psychotic disorders, including CSF analysis, to detect possible underlying pathologies and improve treatment decisions.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Psychotic Disorders Type of study: Diagnostic study / Etiology study / Observational study / Prognostic study / Qualitative research Limits: Adolescent / Adult / Aged / Child / Child, preschool / Humans / Middle aged / Young adult Language: English Journal: Sci Rep Year: 2021 Document Type: Article Affiliation country: S41598-021-86170-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Psychotic Disorders Type of study: Diagnostic study / Etiology study / Observational study / Prognostic study / Qualitative research Limits: Adolescent / Adult / Aged / Child / Child, preschool / Humans / Middle aged / Young adult Language: English Journal: Sci Rep Year: 2021 Document Type: Article Affiliation country: S41598-021-86170-w