Cerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis

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 psych...

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Autores principales: Tim W. Rattay, Pascal Martin, Debora Vittore, Holger Hengel, Idil Cebi, Johannes Tünnerhoff, Maria-Ioanna Stefanou, Jonatan F. Hoffmann, Katrin von der Ehe, Johannes Klaus, Julia Vonderschmitt, Matthias L. Herrmann, Paula Bombach, Hazar Al Barazi, Lena Zeltner, Janina Richter, Klaus Hesse, Kathrin N. Eckstein, Stefan Klingberg, Dirk Wildgruber
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spelling oai:doaj.org-article:cf0456f8e57040f6b7125be98595951c2021-12-02T14:23:05ZCerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis10.1038/s41598-021-86170-w2045-2322https://doaj.org/article/cf0456f8e57040f6b7125be98595951c2021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-86170-whttps://doaj.org/toc/2045-2322Abstract 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.Tim W. RattayPascal MartinDebora VittoreHolger HengelIdil CebiJohannes TünnerhoffMaria-Ioanna StefanouJonatan F. HoffmannKatrin von der EheJohannes KlausJulia VonderschmittMatthias L. HerrmannPaula BombachHazar Al BaraziLena ZeltnerJanina RichterKlaus HesseKathrin N. EcksteinStefan KlingbergDirk WildgruberNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Tim W. Rattay
Pascal Martin
Debora Vittore
Holger Hengel
Idil Cebi
Johannes Tünnerhoff
Maria-Ioanna Stefanou
Jonatan F. Hoffmann
Katrin von der Ehe
Johannes Klaus
Julia Vonderschmitt
Matthias L. Herrmann
Paula Bombach
Hazar Al Barazi
Lena Zeltner
Janina Richter
Klaus Hesse
Kathrin N. Eckstein
Stefan Klingberg
Dirk Wildgruber
Cerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis
description 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.
format article
author Tim W. Rattay
Pascal Martin
Debora Vittore
Holger Hengel
Idil Cebi
Johannes Tünnerhoff
Maria-Ioanna Stefanou
Jonatan F. Hoffmann
Katrin von der Ehe
Johannes Klaus
Julia Vonderschmitt
Matthias L. Herrmann
Paula Bombach
Hazar Al Barazi
Lena Zeltner
Janina Richter
Klaus Hesse
Kathrin N. Eckstein
Stefan Klingberg
Dirk Wildgruber
author_facet Tim W. Rattay
Pascal Martin
Debora Vittore
Holger Hengel
Idil Cebi
Johannes Tünnerhoff
Maria-Ioanna Stefanou
Jonatan F. Hoffmann
Katrin von der Ehe
Johannes Klaus
Julia Vonderschmitt
Matthias L. Herrmann
Paula Bombach
Hazar Al Barazi
Lena Zeltner
Janina Richter
Klaus Hesse
Kathrin N. Eckstein
Stefan Klingberg
Dirk Wildgruber
author_sort Tim W. Rattay
title Cerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis
title_short Cerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis
title_full Cerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis
title_fullStr Cerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis
title_full_unstemmed Cerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis
title_sort cerebrospinal fluid findings in patients with psychotic symptoms—a retrospective analysis
publisher Nature Portfolio
publishDate 2021
url https://doaj.org/article/cf0456f8e57040f6b7125be98595951c
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