神经精神系统性红斑狼疮患者的科塔德妄想症:自身免疫性精神病的挑战。

IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Cognitive and Behavioral Neurology Pub Date : 2024-09-01 DOI:10.1097/WNN.0000000000000375
Alexis García-Sarreón, Angel Escamilla-Ramírez, Yasmin Martínez-López, Kevin A García-Esparza, Nora Kerik-Rotenberg, Jesús Ramírez-Bermúdez
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引用次数: 0

摘要

神经精神系统性红斑狼疮(NPSLE)的临床特征多种多样。此外,非系统性红斑狼疮的治疗决策取决于对尚未得到充分研究的临床综合征的识别。本报告描述了一名36岁女性非系统性红斑狼疮患者的病例,她表现出严重的认知功能障碍和情感性精神病,并伴有持续的虚无主义妄想,如科塔妄想中描述的那些妄想。患者数月来一直坚持认为自己已经死亡。脑脊液分析显示抗核糖体P抗体水平升高,寡克隆抗体阳性。此外,18F-FDG PET/CT 成像显示双侧额叶代谢严重低下,提示脑部炎症和枕叶代谢低下。系统性红斑狼疮疾病活动指数2000和系统性红斑狼疮疾病活动评分的结果与免疫疾病的活动状态一致。然后,我们通过算法确定,这一神经精神事件可归因于潜在免疫疾病的活动。尽管进行了免疫抑制和对症治疗,但患者的认知能力只得到了部分改善。发病 4 个月后,科塔德妄想症的精神病理特征仍未改变。然而,我们观察到,在接受电休克治疗后,情感性精神病迅速缓解,认知能力显著提高。随后的随访检查显示病情持续缓解。本病例描述了科塔德妄想症的一种长期形式、在系统性红斑狼疮背景下出现的诊断难题,以及需要神经内科、精神科和风湿免疫科通力合作的治疗困境。
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The Cotard Delusion in a Patient With Neuropsychiatric Systemic Lupus Erythematosus: The Challenges of Autoimmune Psychosis.

The clinical features of neuropsychiatric systemic lupus erythematosus (NPSLE) are heterogeneous. Furthermore, therapeutic decision-making for NPSLE depends on the recognition of clinical syndromes that have not been sufficiently studied. This report describes the case of a 36-year-old woman with NPSLE who exhibited severe cognitive dysfunction and affective psychosis with persistent nihilistic delusions such as those described in the Cotard delusion. The patient insisted for several months that she was already dead. CSF analysis showed elevated levels of anti-ribosomal P antibodies and a positive determination of oligoclonal bands. Additionally, 18F -FDG PET/CT imaging revealed severe bilateral frontal hypermetabolism suggestive of brain inflammation and occipital hypometabolism. Results from the Systematic Lupus Erythematosus Disease Activity Index 2000 and the Systemic Lupus Erythematosus Disease Activity Score were consistent with an active state of the immunological disease. We then determined by an algorithm that this neuropsychiatric event could be attributed to the activity of the underlying immunological disease. Despite immunosuppressive and symptomatic treatment, only a partial improvement in cognition was achieved. The psychopathological features of the Cotard delusion remained unchanged 4 months after onset. However, we observed rapid remission of affective psychosis and significant improvement in cognition following electroconvulsive therapy. Subsequent follow-up examinations showed a sustained remission. This case describes a protracted form of the Cotard delusion, the diagnostic challenges that arise in the context of SLE, and treatment dilemmas that necessitate collaboration between neurology, psychiatry, and rheumatology.

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来源期刊
CiteScore
2.40
自引率
7.10%
发文量
68
审稿时长
>12 weeks
期刊介绍: Cognitive and Behavioral Neurology (CBN) is a forum for advances in the neurologic understanding and possible treatment of human disorders that affect thinking, learning, memory, communication, and behavior. As an incubator for innovations in these fields, CBN helps transform theory into practice. The journal serves clinical research, patient care, education, and professional advancement. The journal welcomes contributions from neurology, cognitive neuroscience, neuropsychology, neuropsychiatry, and other relevant fields. The editors particularly encourage review articles (including reviews of clinical practice), experimental and observational case reports, instructional articles for interested students and professionals in other fields, and innovative articles that do not fit neatly into any category. Also welcome are therapeutic trials and other experimental and observational studies, brief reports, first-person accounts of neurologic experiences, position papers, hypotheses, opinion papers, commentaries, historical perspectives, and book reviews.
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