Autoimmune encephalitis and organic psychosis — structured clinical viva

Reject primary schizophrenia as a premature label. Nine-day multistage course with mutism, dyskinesias, and fluctuating alertness is a textbook AE red-flag package despite normal MRI.[1][6]

Frameworks. Map to Graus possible/probable AE and Pollak possible/probable autoimmune psychosis. Treatment can proceed for probable disease while Abs pend.[2][4]

Work-up. EEG; LP with infection panel as indicated; paired serum–CSF cell-based neuronal Abs; pelvic imaging for teratoma; continuous monitoring for seizures/autonomic/hypoventilation risk.[5][6]

Treatment. First-line immunotherapy (steroids ± IVIG ± PLEX); second-line rituximab/cyclophosphamide if needed; resect teratoma if present. Early care improves outcomes (Titulaer).[3][5]

Psychiatry role. Benzodiazepines for catatonia/agitation; cautious psychotropic bridge; capacity/legal pathway for investigation; family explanation; do not own solo immunosuppression without neurology.[4][5]

Answer the team. "Normal MRI does not exclude anti-NMDAR encephalitis. LP is high-yield and indicated. This may be a treatable autoimmune encephalitis — antipsychotics alone are insufficient."[6][1]