Case report: Psychosis and catatonia in an adolescent patient with adipsic hypernatremia and autoantibodies against the subfornical organ

Frontiers in Psychiatry

Psychiatry

Takeshi Y. Hiyama¹  Akari Nakamura-Utsunomiya²  Julien Caccia³  Christoph Hamann³  Sibylle Tschumi³  Michael Rebsamen⁴  Roland Wiest⁴  Sebastian Walther⁵  Jochen Kindler⁶  Luisa von den Driesch⁶  Patrick Köck⁶  Matthias Liebrand⁶  Michael Kaess⁷ 

[1] Department of Integrative Physiology, Graduate School and Faculty of Medicine, Tottori University, Tottori, Japan;Department of Medical Genetics and Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan;Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland;University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland;University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland;Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany;

关键词: psychosis;    schizophrenia;    encephalitis;    autoimmune;    adipsic hypernatremia;    case report;    catatonia;   

DOI  :  10.3389/fpsyt.2023.1206226

 received in 2023-04-15, accepted in 2023-07-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

This is the first description of a patient in which adipsic hypernatremia, a rare autoimmune encephalitis, presented in combination with complex psychiatric symptomatology, including psychosis and catatonia. Adipsic hypernatremia is characterized by autoantibodies against the thirst center of the brain. These autoantibodies cause inflammation and apoptosis in key regions of water homeostasis, leading to lack of thirst and highly increased serum sodium. To date, the symptoms of weakness, fatigue and drowsiness have been associated with adipsic hypernatremia, but no psychiatric symptomatology. Here, we showcase the first description of an adolescent patient, in which severe and complex psychiatric symptoms presented along with adipsic hypernatremia. The patient experienced delusion, hallucinations, restlessness and pronounced depression. Further, he showed ritualized, aggressive, disinhibited and sexualized behavior, as well as self-harm and psychomotor symptoms. Due to his severe condition, he was hospitalized on the emergency unit of the child and adolescent psychiatry for 8 months. Key symptoms of the presented clinical picture are: childhood-onset complex and treatment-resistant psychosis/catatonia, pronounced behavioral problems, fatigue, absent thirst perception, hypernatremia and elevated prolactin levels. This case report renders first evidence speaking for a causal link between the autoimmune adipsic hypernatremia and the psychotic disorder. Moreover, it sheds light on a new form of autoimmune psychosis.

【 授权许可】

Unknown   
Copyright © 2023 Liebrand, Rebsamen, Nakamura-Utsunomiya, von den Driesch, Köck, Caccia, Hamann, Wiest, Kaess, Walther, Tschumi, Hiyama and Kindler.