Psych · Consultation-liaison psychiatry
Autoimmune encephalitis and organic psychosis
Also known as Anti-NMDA receptor encephalitis · NMDAR encephalitis · Autoimmune psychosis · Antibody-mediated encephalitis · Organic psychosis · Secondary psychosis · Paraneoplastic encephalitis · Limbic encephalitis
Exam-exhaustive fellowship topic on autoimmune encephalitis presenting as organic psychosis — red flags, Graus AE and Pollak autoimmune-psychosis criteria, anti-NMDAR staged course, MRI/EEG/CSF/autoantibody work-up, immunotherapy principles, paraneoplastic search, FEP interface, and cautious symptomatic psychotropics. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
Target exams
Red flags
Meet the patient
A 22-year-old university student is brought to the emergency department by her housemates. Ten days ago she had a flu-like illness. Six days ago she stopped sleeping. Three days ago she became convinced her housemates were being replaced. Today she barely speaks, and her lips and jaw move in slow, purposeless circles.[1][7]
The MRI is reported normal. The overnight team have written first-episode psychosis and asked for a bed and intramuscular olanzapine.[4][6]
Two questions decide her next two years. How fast did this happen? And why is her face moving like that? Nothing on this page matters more than those.[1][2][6]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
References18Show ledgerHide ledger
- [1]Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies Lancet Neurol, 2008.PMID 18851928
- [2]Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study Lancet Neurol, 2013.PMID 23290630
- [3]Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis Lancet Neurol, 2016.PMID 26906964
- [4]Dalmau J, Graus F Antibody-Mediated Encephalitis N Engl J Med, 2018.PMID 29490181
- [5]Pollak TA, Lennox BR, Müller S, et al. Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin Lancet Psychiatry, 2020.PMID 31669058
- [6]Herken J, Prüss H Red Flags: Clinical Signs for Identifying Autoimmune Encephalitis in Psychiatric Patients Front Psychiatry, 2017.PMID 28261116
- [7]Al-Diwani A, Handel A, Townsend L, et al. The psychopathology of NMDAR-antibody encephalitis in adults: a systematic review and phenotypic analysis of individual patient data Lancet Psychiatry, 2019.PMID 30765329
- [8]Irani SR, Michell AW, Lang B, et al. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis Ann Neurol, 2011.PMID 21416487
- [9]van Sonderen A, Petit-Pedrol M, Dalmau J, et al. The value of LGI1, Caspr2 and voltage-gated potassium channel antibodies in encephalitis Nat Rev Neurol, 2017.PMID 28418022
- [10]Dubey D, Pittock SJ, Kelly CR, et al. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis Ann Neurol, 2018.PMID 29293273
- [11]Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis Lancet Neurol, 2018.PMID 30049614
- [12]Abboud H, Probasco JC, Irani S, et al. Autoimmune encephalitis: proposed best practice recommendations for diagnosis and acute management J Neurol Neurosurg Psychiatry, 2021.PMID 33649022
- [13]Scott JG, Gillis D, Swayne A, et al. Testing for antibodies to N-methyl-d-aspartate receptor and other neuronal cell surface antigens in patients with early psychosis Aust N Z J Psychiatry, 2018.PMID 29923413
- [14]Cohn SL, Mohan A, Lappin JM, et al. Anti-N-Methyl-d-Aspartate Receptor Antibody Testing in First-Episode Psychosis: Universal or Targeted Testing J Neuropsychiatry Clin Neurosci, 2023.PMID 36128677
- [15]Lennox BR, Palmer-Cooper EC, Pollak T, et al. Prevalence and clinical characteristics of serum neuronal cell surface antibodies in first-episode psychosis: a case-control study Lancet Psychiatry, 2017.PMID 27965002
- [16]Lee WJ, Lee ST, Moon J, et al. Tocilizumab in Autoimmune Encephalitis Refractory to Rituximab: An Institutional Cohort Study Neurotherapeutics, 2016.PMID 27215218
- [17]Guasp M, Dalmau J Searching for Neuronal Antibodies in Psychiatric Diseases: Uncertain Findings and Implications Neurology, 2023.PMID 37353340
- [18]Nosadini M, Thomas T, Eyre M, et al. International Consensus Recommendations for the Treatment of Pediatric NMDAR Antibody Encephalitis Neurol Neuroimmunol Neuroinflamm, 2021.PMID 34301820