{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T12:50:35Z","timestamp":1782305435385,"version":"3.54.5"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>This is the first description of a patient in which adipsic hypernatremia, a rare autoimmune encephalitis, presented in combination with complex psychiatric symptomatology, including psychosis and catatonia. Adipsic hypernatremia is characterized by autoantibodies against the thirst center of the brain. These autoantibodies cause inflammation and apoptosis in key regions of water homeostasis, leading to lack of thirst and highly increased serum sodium. To date, the symptoms of weakness, fatigue and drowsiness have been associated with adipsic hypernatremia, but no psychiatric symptomatology. Here, we showcase the first description of an adolescent patient, in which severe and complex psychiatric symptoms presented along with adipsic hypernatremia. The patient experienced delusion, hallucinations, restlessness and pronounced depression. Further, he showed ritualized, aggressive, disinhibited and sexualized behavior, as well as self-harm and psychomotor symptoms. Due to his severe condition, he was hospitalized on the emergency unit of the child and adolescent psychiatry for 8 months. Key symptoms of the presented clinical picture are: childhood-onset complex and treatment-resistant psychosis\/catatonia, pronounced behavioral problems, fatigue, absent thirst perception, hypernatremia and elevated prolactin levels. This case report renders first evidence speaking for a causal link between the autoimmune adipsic hypernatremia and the psychotic disorder. Moreover, it sheds light on a new form of autoimmune psychosis.<\/jats:p>","DOI":"10.3389\/fpsyt.2023.1206226","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T10:17:18Z","timestamp":1689761838000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Case report: Psychosis and catatonia in an adolescent patient with adipsic hypernatremia and autoantibodies against the subfornical organ"],"prefix":"10.3389","volume":"14","author":[{"given":"Matthias","family":"Liebrand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rebsamen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akari","family":"Nakamura-Utsunomiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"von den Driesch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"K\u00f6ck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Caccia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Hamann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Wiest","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kaess","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Walther","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibylle","family":"Tschumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi Y.","family":"Hiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Kindler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1016\/j.neuron.2010.04.017","article-title":"Autoimmunity to the sodium-level sensor in the brain causes essential hypernatremia","volume":"66","author":"Hiyama","year":"2010","journal-title":"Neuron."},{"key":"B2","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1111\/bpa.12409","article-title":"Adipsic hypernatremia without hypothalamic lesions accompanied by autoantibodies to subfornical organ","volume":"27","author":"Hiyama","year":"2017","journal-title":"Brain Pathol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1111\/cen.14737","article-title":"Identification of clinical factors related to antibody-mediated immune response to the subfornical organ","volume":"97","author":"Nakamura-Utsunomiya","year":"2022","journal-title":"Clin Endocrinol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1038\/nrn.2017.71","article-title":"Neural circuits underlying thirst and fluid homeostasis","volume":"18","author":"Zimmerman","year":"2017","journal-title":"Nat Rev Neurosci."},{"key":"B5","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1001\/jamapsychiatry.2021.0096","article-title":"Caring for the patient with catatonia","volume":"78","author":"Heckers","year":"2021","journal-title":"JAMA Psychiatry."},{"key":"B6","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/S2215-0366(18)30474-7","article-title":"Structure and neural mechanisms of catatonia","volume":"6","author":"Walther","year":"2019","journal-title":"Lancet Psychiatry."},{"key":"B7","doi-asserted-by":"publisher","first-page":"4804","DOI":"10.1002\/hbm.25159","article-title":"Direct cortical thickness estimation using deep learning-based anatomy segmentation and cortex parcellation","volume":"41","author":"Rebsamen","year":"2020","journal-title":"Hum. Brain Mapp."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.26117","article-title":"Reliable brain morphometry from contrast-enhanced T1w-MRI in patients with multiple sclerosis","author":"Rebsamen","year":"2022","journal-title":"Hum. Brain Mapp."},{"key":"B9","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1007\/s00406-020-01113-2","article-title":"Autoimmune encephalitis as a differential diagnosis of schizophreniform psychosis: clinical symptomatology, pathophysiology, diagnostic approach, and therapeutic considerations","volume":"270","author":"Endres","year":"2020","journal-title":"Eur Arch Psychiatry Clin Neurosci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1016\/S1474-4422(19)30244-3","article-title":"An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models","volume":"18","author":"Dalmau","year":"2019","journal-title":"Lancet Neurol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1017\/S0033291719003283","article-title":"Psychiatric management of anti-NMDAR encephalitis: a cohort analysis","volume":"51","author":"Warren","year":"2021","journal-title":"Psychol Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1038\/s41582-019-0174-4","article-title":"Immunoneuropsychiatry \u2014 novel perspectives on brain disorders","volume":"15","author":"Pape","year":"2019","journal-title":"Nat Rev Neurol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e01495","DOI":"10.1002\/brb3.1495","article-title":"Early and very early-onset schizophrenia compared with adult-onset schizophrenia: French FACE-SZ database","volume":"10","author":"Coulon","year":"2020","journal-title":"Brain Behav."},{"key":"B14","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1007\/s11920-011-0212-4","article-title":"Childhood-onset schizophrenia: the challenge of diagnosis","volume":"13","author":"Gochman","year":"2011","journal-title":"Curr Psychiatry Rep."},{"key":"B15","doi-asserted-by":"publisher","first-page":"174383","DOI":"10.1016\/j.ejphar.2021.174383","article-title":"Ameliorating schizophrenia-like symptoms in vasopressin deficient male Brattleboro rat by chronic antipsychotic treatment","volume":"909","author":"T\u00f6r\u00f6k","year":"2021","journal-title":"Eur J Pharmacol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1017\/neu.2014.20","article-title":"Oxytocin and vasopressin levels are decreased in the plasma of male schizophrenia patients","volume":"26","author":"Jobst","year":"2014","journal-title":"Acta Neuropsychiatr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1093\/schbul\/sbu027","article-title":"Reduced levels of vasopressin and reduced behavioral modulation of oxytocin in psychotic disorders","volume":"40","author":"Rubin","year":"2014","journal-title":"Schizophr Bull."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e01355","DOI":"10.1002\/brb3.1355","article-title":"Expression of vasopressin mRNA in the hypothalamus of individuals with a diagnosis of schizophrenia","volume":"9","author":"Busch","year":"2019","journal-title":"Brain Behav."},{"key":"B19","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1016\/j.euroneuro.2014.02.001","article-title":"Intranasal desmopressin as an adjunct to risperidone for negative symptoms of schizophrenia: a randomized, double-blind, placebo-controlled, clinical trial","volume":"24","author":"Hosseini","year":"2014","journal-title":"Eur Neuropsychopharmacol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"102348","DOI":"10.1016\/j.autrev.2019.102348","article-title":"Autoimmunity in psychotic disorders. where we stand, challenges and opportunities","volume":"18","author":"Man\u00e9-Damas","year":"2019","journal-title":"Autoimmun Rev."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1206226\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T10:17:23Z","timestamp":1689761843000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1206226\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":20,"alternative-id":["10.3389\/fpsyt.2023.1206226"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2023.1206226","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,19]]},"article-number":"1206226"}}