A Case Series of Young People Receiving Adjunctive Immunotherapy for Neuroimmune-Mediated Major Mood or Psychotic Syndromes, 2025, Scott et al.

[InitialConditions]

Background​

Neuroimmune processes are often implicated in young people with atypical neuropsychiatric disorders, yet treatment implications remain controversial. This case series details young people with primary psychiatric disorders who received adjunctive immunotherapy after thorough investigation and extensive conventional treatments.

Methods​

We evaluated 45 individuals (93% female, ages 12–30 years) with atypical psychiatric presentations suggesting potential neuroimmune involvement. Participants underwent clinical phenotyping, laboratory investigation, cerebrospinal fluid (CSF) analysis, neuroimaging, and/or electroencephalography. We tracked outcomes after personalized immunotherapy through global clinical improvement (Clinical Global Impressions-Global Improvement) and changes in social-occupational functioning (Social and Occupational Functioning Assessment Scale [SOFAS]), education/employment status (not in education, employment, or training [NEET]), psychiatric hospitalization, and medication use. Treatment response was assessed post-intervention, at 6 to 12 months, and at a long-term follow-up (78.2 ± 31.3 months).

Results​

Participants presented with severe depression (80%), psychotic features (56%), treatment resistance (82%), and/or neurological symptoms (96%). Illness duration before immunotherapy was often prolonged (mean = 4.8 ± 4.7 years, median = 3 years). Autoantibodies were detected in serum or CSF in 64% of participants, while 91% showed elevated inflammatory markers. Of 43 individuals receiving immunotherapy, 88% experienced clinical improvement posttreatment, with 79% maintaining long-term benefits. Functional outcomes improved significantly: SOFAS scores increased from 43.2 ± 11.8 to 69.2 ± 9.8, while NEET rates declined from 81% to 14%. Psychiatric hospitalization dropped from 93% to 7%, and psychotropic medication use decreased from 84% to 9%. Earlier treatment predicted better outcomes (p = .025). Adverse effects occurred in 79% of participants, with 21% experiencing moderate-to-severe complications.

Conclusions​

These findings suggest the importance of early identification and specialist assessment of atypical psychiatric presentations in young people. New guidelines need to support appropriate screening, personalized management, and long-term treatment and monitoring protocols.

https://www.sciencedirect.com/science/article/pii/S2667174325001181

 

[bobbler]

Wow that results section for those 43 individuals receiving immunotherapy. What a life difference.

 

[Utsikt]

Wow that results section for those 43 individuals receiving immunotherapy. What a life difference.

The graphs do look like a world of difference.

It also looks like there was a high relapse rate:

However, the high relapse rate following discontinuation of immunotherapy (72%) contrasted markedly with the stability that was observed in individuals who maintained treatment, suggesting that ongoing immune modulation may be necessary for many NIMNPS cases. Treatment cessation resulted from various factors, including completed planned treatment courses, preferences for simpler therapies, concerns over long-term health consequences, high health care services utilization, and alternative diagnostic considerations.

And not an insignificant amount of serious adverse events:

The significant adverse event rate (21% experiencing moderate to serious effects—although this may underestimate the true incidence because systematic long-term monitoring programs for both standard psychiatric treatments and adjunctive immunotherapy were not consistently implemented across all individuals) underscores the need for vigilant long-term monitoring to balance the risks of immunotherapy with those associated with prolonged exposure to psychotropics such as antipsychotics, including clozapine (32).

They frame it as both a quality improvement project and a case series.

I also think the scales are rated by the clinicians and not the patients.

Come to think of it, 43 cases is a lot for an experimental treatment. They should probably have set up a proper trial way sooner. I can’t say I’m a fan of the treat first, ask questions later approach.

 

[rvallee]

Wow that results section for those 43 individuals receiving immunotherapy. What a life difference.

Wow you're not kidding. This is at least 100x as meaningful as the best non-pharmaceutical treatments have ever shown. The biopsychosocial model doesn't have a single achievement even 1% of this, and even if you add them all up they don't even add up to just this one study.

But, sure, let's keep obsessing over the delusional fantasy that one day it will deliver something.