title: Acute psychosis in children: do not miss immune-mediated causes.
abstract: New-onset psychosis in children represents a complex presenting symptom. Psychosis can be attributable to a combination of factors and etiologies, and all possible causes must be systematically examined. There is growing evidence that a proportion of psychosis/ psychiatric manifestations in children may be immunemediated, and physicians should consider this etiology in each presentation of first-episode psychosis. Immunemediated encephalopathies/encephalitis are increasingly being recognized in children with antibodies to N-methyl-D-aspartate receptor, Leucine-rich gliomainactivated 1 or other central nervous system antigens such as Contactin-associated protein-like 2, glutamic acid decarboxylase, alpha-amino-3-hydroxy-5-methyl-4isoxazolepropionic acid or Gamma-aminobutyric acid B. In this study, we describe 3 cases of immune-mediated encephalopathy/encephalitis with prominent psychiatric symptoms at presentation, and suggest a practical diagnostic and treatment approach for children with acute psychosis of an immune-mediated cause.
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Afnan S
authors.initials: AS
authors.lastname: AlHakeem
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Mekki
authors.forename: Saad M
authors.initials: SM
authors.lastname: AlShahwan
authors.forename: Brahim M
authors.initials: BM
authors.lastname: Tabarki
mesh_terms: D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D000927:Anticonvulsants / Q000627:therapeutic use; D001323:Autoantibodies / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D005260:Female; D050031:Hashimoto Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D047908:Intracellular Signaling Peptides and Proteins; D008297:Male; D011506:Proteins / Q000276:immunology; D011618:Psychotic Disorders / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000628:therapy
chemical_list: D000927:Anticonvulsants; D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D047908:Intracellular Signaling Peptides and Proteins; C116499:LGI1 protein, human; D011506:Proteins