Acute Psychosis in Children: Do Not Miss Immune-Mediated Causes

Neurosciences (Riyadh). 2016 Jul; 21(3): 252–255.


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 immune-mediated, and physicians should consider this etiology in each presentation of first-episode psychosis. Immune-mediated encephalopathies/encephalitis are increasingly being recognized in children with antibodies to N-methyl-D-aspartate receptor, Leucine-rich glioma-inactivated 1 or other central nervous system antigens such as Contactin-associated protein-like 2, glutamic acid decarboxylase, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic 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. Read more…


Immune-mediated encephalopathy/encephalitis can present with pure psychiatric features. Autoimmune mechanisms have been recently implicated in a number of neuropsychiatric disorders, classically linked to a pure psychiatric disease. Delay in diagnosis and treatment with immunomodulatory drugs can lead to permanent sequelae. In cases of acute psychosis in children, a multidisciplinary approach to diagnosis and management is needed.