Abstract
Introduction: Secondary schizophrenia spectrum disorders (SSDs) have clearly identifiable causes. The Department for Psychiatry and Psychotherapy at the University Hospital Freiburg has continued to expand its screening practices to clarify the organic causes of SSDs. This retrospective analysis was carried out to analyze whether a comprehensive organic diagnostic procedure could be informative in patients with SSDs. Methods and Participants: The “Freiburg Diagnostic Protocol in Psychosis” (FDPP) included basic laboratory analyses (e.g., thyroid hormones), metabolic markers, pathogens, vitamin status, different serological autoantibodies, rheumatic/immunological markers (e.g., complement factors), cerebrospinal fluid (CSF) basic and antineuronal antibody analyses, as well as cranial magnetic resonance imaging (cMRI) and electroencephalography (EEG). The findings of 76 consecutive patients with SSDs (55 with paranoid–hallucinatory; 14 with schizoaffective; 4 with hebephrenic; and 1 each with catatonic, acute polymorphic psychotic, and substance-induced psychotic syndromes) were analyzed. Results: Overall, vitamin and trace element deficiency was identified in 92%. Complement factor analyses detected reduced C3 levels in 11%. Immunological laboratory alterations were detected in 76%. CSF analysis revealed general alterations in 54% of the patients, mostly with signs of blood–brain barrier dysfunction. cMRI analyses showed chronic inflammatory lesions in 4%. Combination of EEG, cMRI, and CSF revealed alterations in 76% of the patients. In three patients, autoimmune psychosis was suspected (4%). Discussion: On the basis of these findings, we conclude that a comprehensive diagnostic procedure according to the FDPP in patients with SSD is worthwhile, considering the detection of secondary, organic forms of SSDs, as well as alterations in “modulating factors” of the disease course, such as vitamin deficiency. Larger studies using comprehensive diagnostic protocols are warranted to further validate this approach.
Highlights
Secondary schizophrenia spectrum disorders (SSDs) have clearly identifiable causes
The authors presented the concept of the Freiburg Diagnostic Protocol in Psychosis” (FDPP) screening, a comprehensive, multimodal diagnostic screening approach that includes broad laboratory testing in blood and cerebrospinal fluid (CSF), as well as cranial magnetic resonance imaging (cMRI) and EEG investigations, designed to exclude secondary, organic causes in patients with SSDs
In contrast to the recommendations of most international guidelines, FDPP screening includes comprehensive diagnostic screening measures that generally are only sought in cases with clear clinical evidence of such secondary disorders
Summary
Secondary schizophrenia spectrum disorders (SSDs) have clearly identifiable causes. The Department for Psychiatry and Psychotherapy at the University Hospital Freiburg has continued to expand its screening practices to clarify the organic causes of SSDs. Schizophrenia spectrum disorders (SSDs) are characterized by delusions, hallucinations, disorganized speech, affective flattening, and cognitive deficits that are linked to significant disability and psychosocial impairment. They are associated with psychosocial stigma and discrimination [1,2,3]. Secondary schizophrenia spectrum disorders (SSSDs) have clearly identifiable organic causes and can occur in the context of central autoimmune (e.g., autoimmune encephalitis, autoimmune psychosis) or systemic autoimmune (e.g., systemic lupus erythematosus), infectious (e.g., neuroborreliosis, neurosyphilis), endocrine (e.g., hyperthyroidism, hyperparathyroidism), metabolic (e.g., Wilson’s disease, metachromatic leukodystrophy), epileptic (e.g., temporal lobe epilepsy), cerebrovascular (e.g., strategic infarcts), genetic (e.g., velocardiofacial syndrome, Niemann—Pick disease type C), tumor-related (e.g., gliomas), neurodegenerative (e.g., Huntington’s disease), substance-related (e.g., cannabis, phencyclidine), or dietary-related (e.g., vitamin B12 deficiency) diseases [6]. The most frequently used are blood analyses (for testing antineuronal antibody or hormone levels, karyotyping, etc.), urine examinations (drug screening, markers for porphyria, etc.), structural imaging (cranial magnetic resonance imaging (cMRI), etc.), electroencephalography (EEG; routine/sleep EEG, etc.), and cerebrospinal fluid (CSF)
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