Thyroid Disease as a Cause of Psychosis: Hashimoto's Encephalopathy

I make the argument in this talk that clinicians should seriously consider adding a simple antibody screen to their standard medical workup for psychosis because some cases of Hashimoto’s Encephalopathy present with symptoms that very much resemble schizophrenia.

Hashimoto’s Encephalopathy is diagnosed by the presence of psychiatric symptoms and/or neurological symptoms in the context of autoimmune thyroiditis. Antibodies against thyroid peroxidase are present in more than 90% of cases. Hashimoto’s Encephalopathy is frequently accompanied by EEG abnormalities. These can be detected in about 90% of cases.

The argument for routine screening for Hashimoto’s Encephalopathy is that it can be effectively treated — but not with antipsychotic medications.
Treatment of Hashimoto’s Encephalopathy is focused on the immune system. Glucocorticoid steroids like prednisone are the first-line treatment for the psychosis associated with Hashimoto’s Encephalopathy. First-line antipsychotic medications might make symptoms worse, according to some reports.

This lecture was given at the August 29, 2020 meeting of the SZconsult learning community.

SZconsult is a free consultation + education service offered by Northeast Ohio Medical University. It’s open to any clinician who wants to learn more about schizophrenia-spectrum illness, or who wants to tap into the collective wisdom of the learning community to find answers to clinical problems.

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#askapsychiatrist # Psychosis