PDF(Pubmed)
Abstract：
BACKGROUND: First episode of psychosis (FEP) is a clinical condition that usually occurs during adolescence or early adulthood and is often a sign of a future psychiatric disease. However, these symptoms are not specific, and psychosis can be caused by a physical disease in at least 5% of cases. Timely detection of these diseases, the first signs of which may appear in childhood, is of particular importance, as a curable treatment exists in most cases. However, there is no consensus in academic societies to offer recommendations for a comprehensive medical assessment to eliminate somatic causes.
METHODS: We conducted a systematic literature search using a two-fold research strategy to: (1) identify physical diseases that can be differentially diagnosed for psychosis; and (2) determine the paraclinical exams allowing us to exclude these pathologies.
RESULTS: We identified 85 articles describing the autoimmune, metabolic, neurologic, infectious, and genetic differential diagnoses of psychosis. Clinical presentations are described, and a complete list of laboratory and imaging features required to identify and confirm these diseases is provided.
CONCLUSIONS: This systematic review shows that most differential diagnoses of psychosis should be considered in the case of a FEP and could be identified by providing a systematic checkup with a laboratory test that includes ammonemia, antinuclear and anti-NMDA antibodies, and HIV testing; brain magnetic resonance imaging and lumbar puncture should be considered according to the clinical presentation. Genetic research could be of interest to patients presenting with physical or developmental symptoms associated with psychiatric manifestations.
METHODS: We conducted a systematic literature search using a two-fold research strategy to: (1) identify physical diseases that can be differentially diagnosed for psychosis; and (2) determine the paraclinical exams allowing us to exclude these pathologies.
RESULTS: We identified 85 articles describing the autoimmune, metabolic, neurologic, infectious, and genetic differential diagnoses of psychosis. Clinical presentations are described, and a complete list of laboratory and imaging features required to identify and confirm these diseases is provided.
CONCLUSIONS: This systematic review shows that most differential diagnoses of psychosis should be considered in the case of a FEP and could be identified by providing a systematic checkup with a laboratory test that includes ammonemia, antinuclear and anti-NMDA antibodies, and HIV testing; brain magnetic resonance imaging and lumbar puncture should be considered according to the clinical presentation. Genetic research could be of interest to patients presenting with physical or developmental symptoms associated with psychiatric manifestations.
摘要：
背景：第一次精神病发作（FEP）是一种临床疾病，通常发生在青春期或成年早期，通常是未来精神疾病的征兆。然而,这些症状并不具体，在至少5%的病例中，精神病可能是由身体疾病引起的。及时发现这些疾病，最初的迹象可能出现在童年，特别重要，作为一种可治愈的治疗存在于大多数情况下。然而,学术界没有达成共识，为消除躯体原因的全面医学评估提供建议。
方法：我们使用双重研究策略进行了系统的文献检索，以：（1）确定可以鉴别诊断为精神病的身体疾病；（2）确定允许我们排除这些病理的临床旁检查。
结果：我们确定了85篇描述自身免疫，新陈代谢，神经学，传染性,和精神病的遗传差异诊断。描述了临床表现，并提供了识别和确认这些疾病所需的实验室和成像特征的完整列表。
结论：本系统评价显示，在FEP的情况下，应考虑大多数精神病的鉴别诊断，并且可以通过提供包括氨血症在内的实验室检查的系统检查来确定。抗核和抗NMDA抗体，和HIV检测；应根据临床表现考虑脑磁共振成像和腰椎穿刺。遗传研究可能对表现出与精神病表现相关的身体或发育症状的患者感兴趣。
方法：我们使用双重研究策略进行了系统的文献检索，以：（1）确定可以鉴别诊断为精神病的身体疾病；（2）确定允许我们排除这些病理的临床旁检查。
结果：我们确定了85篇描述自身免疫，新陈代谢，神经学，传染性,和精神病的遗传差异诊断。描述了临床表现，并提供了识别和确认这些疾病所需的实验室和成像特征的完整列表。
结论：本系统评价显示，在FEP的情况下，应考虑大多数精神病的鉴别诊断，并且可以通过提供包括氨血症在内的实验室检查的系统检查来确定。抗核和抗NMDA抗体，和HIV检测；应根据临床表现考虑脑磁共振成像和腰椎穿刺。遗传研究可能对表现出与精神病表现相关的身体或发育症状的患者感兴趣。
