One Brain, Two Specialties, Converging Mechanisms: Neuronal Autoantibodies as a Rare Cause of Postpartum Psychosis.

摘要: The onset of severe psychotic and affective symptomswithin the first 4–6 weeks after childbirth, termed postpartum or puerperal psychosis, is one most striking phenotypes in psychiatry neurology (1). typically abrupt, decline rapid Postpartum psychosis a psychiatric emergency can be incredibly disruptive to mother, child, family alike. Sadly, also destructive via maternal self-harm (2) and, very rarely, infanticide (3). In this issue Journal, Bergink et al. (4) identify neuronal autoantibodies linked autoimmune encephalitis as specific, albeit rare, cause period. authors collected serum samples from 96 consecutive women with evaluated specialized mother child inpatient unit Netherlands between 2005 2012. Antibodies against GluN1/NR1 subunit N-methyl-D-aspartate (NMDA) receptor were identified two (2%) including who had experienced prior episode psychosis. Neither woman an ovarian teratoma, neither exhibited other classic features anti-NMDA encephalitis, such seizure, amnesia, autonomic instability, coma. However, observed antibody reactivitywas typical ofwhat seen anti-NMDAreceptorencephalitis,anautoimmuneencephalitis syndrome prominent (5). An additional abnormal neuropil staining indicative autoantibody reactivity unidentified extracellular antigen(s). By contrast, none 64 healthy cellsurface antibodies on testing. conclude that NMDA likely causative contributory these select cases testing for should become part diagnostic evaluation (4). emerging recognition target cell-surface synaptic CNS antigens brain dysfunctionhas revolutionized clinical (6, 7). Autoantibodies patients have been several receptors, NMDA, AMPA, GABAa, GABAb, mGluR5, glycine, well ion channel associated membrane proteins, LGI1 CASPR2. practical implication many at timemight called “viral” “idiopathic” are now recognized origin generally responsive immunosuppression. classical “paraneoplastic” disorders intracellular antigens, Hu CRMP-5, highly correlated presence tumor, tend respond poorly immunosuppression, exhibit pan-neuronal destruction T-cell infiltration. Unlike antibodies, paraneoplastic syndromes probably not directly pathogenic but rather humoral markers antitumoral immune response (8). Anti-NMDA isanarchetypical syndrome. It disease young; 95%of occur under age 45 37% children 18 There femalepredominance Patients characteristic heralded by vague prodrome headache, fever, nausea, vomiting, upper respiratory infectiontype symptoms, followed acute agitation, anxiety, disordered thinking, hallucinations, delusions, unusual behavior (9). Some patientswith encephalitismay even gettriagedinitially toapsychiatricservice.Thesyndromeusually progresses within days include language dysfunction, seizures A subset will rapidly dysfunction reduced level consciousness point coma, requiring extended stays intensive care sometimes months end Abnormal movements common. CSF examination usually reveals pleocytosis andoligoclonal banding (5, 9). BrainMRI normal nonspecific show focal T2/fluid-attenuated As endeavors reconverge ... it increasingly important psychiatrists aware available