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Acute psychosis in children: do not miss immune-mediated causes

Afnan S AlHakeem1, Mohamed S Mekki, Saad M AlShahwan

  • 1Division of Pediatric Neurology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.

Neurosciences (Riyadh, Saudi Arabia)
|July 1, 2016
PubMed

Insights

Pediatric psychosis may stem from immune-mediated causes. Early diagnosis and treatment of autoimmune encephalitis are crucial for children presenting with first-episode psychosis.

Area of Science:

  • Pediatric Neurology
  • Neuroimmunology
  • Child Psychiatry

Background:

  • New-onset psychosis in children is a complex symptom with diverse etiologies.
  • A subset of pediatric psychosis cases may be immunemediated.
  • Autoimmune encephalitis is increasingly recognized in children with psychiatric manifestations.

Observation:

  • This study presents three cases of immune-mediated encephalopathy/encephalitis in children with prominent psychiatric symptoms at initial presentation.
  • Key antibodies identified include those against N-methyl-D-aspartate receptor, Leucine-rich glioma-inactivated 1, and other CNS antigens.
  • Clinical presentations involved significant psychiatric symptoms preceding or accompanying neurological signs.

Findings:

  • Immune-mediated encephalopathies can manifest with acute psychosis in children.
  • Antibodies to specific neuronal surface antigens are implicated in these conditions.
  • Systematic etiological investigation is essential for accurate diagnosis.

Implications:

  • Physicians should consider immune-mediated causes in all pediatric first-episode psychosis cases.
  • Early identification and treatment of autoimmune encephalitis can improve outcomes.
  • A practical diagnostic and treatment framework is proposed for immune-mediated psychosis in children.

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