Psychiatric correlates in deficit of immunoglobulins

Abstract

Introduction Many neurological, oncological and autoimmune diseases may have psychiatric symptoms; these diseases sometimes start with these symptoms, so the diagnosis may be confused and the treatment is delayed. Objective Review the relationship between the secondary immune deficiency and increased predisposition to infectious processes and the psychopathological conditions which manifest themselves in some cases in these situations. Methods A 17-year-old male patient, who began psychiatry consultations when he was 3 years old due to psychomotor delay and behavior disorders. He was diagnosed with ADHD and mild mental retardation. Medical history: Viral encephalitis; Perthes disease; recurrent urinary tract infections; intestinal giardiasis; Alport syndrome. He's being treated with aripiprazole 5mg (1/2-0-0). The patient presents an episode of perplexity, psychotic anguish, auditory hallucinations and paranoid delusion. The patient presented an infectious process with general malaise, diarrhea and vomiting during previous days. Results The patient was assessed by the Departments of internal medicine, neurology and psychiatry. A cerebral TAC, lumbar puncture, EEG and urine porphyrins were requested. The secondary immune deficiency makes the patient more vulnerable in an infectious process. Discussion The diagnosis of psychotic disorder due to medical condition may be transient or recurrent. Treating of the medical condition often gets resolution of psychosis, although the symptoms can persist in some cases. There is often a prodomo of viral syndrome weeks before the rest of symptoms appear. The differential diagnosis should be made with primary psychotic disorders, affective disorders, confusional syndromes, impulse control disorder or sleep disorders, neuroleptic malignant syndrome, serotonin syndrome and substance-induced psychotic disorders.