Antineuronal antibody testing in patients with first episode psychosis

Up to 80 percent of patients with anti-NMDA receptor encephalitis (ANMDARE) are first seen by psychiatrists, as a result of the psychiatric symptoms seen in the early stages of the illness. Presentation with symptoms and signs including hallucinations, paranoia and delusions may be misdiagnosed as schizophrenia, schizo-affective or bipolar disorder, contributing to delays in testing for antineuronal antibodies.Solutions are needed to improve recognition of patients with eminently treatable forms of first episode psychoses, including ANMDARE.

Dr. James G. Scott, an Australian psychiatrist and his colleagues have set out to do just that. In their recently published study considering the prevalence of antineuronal antibodies in the serum of 113 patientsadmitted for first episode of psychosis (FEP), they report detection of clinically-relevant antibodies in six patients—including 4 patients with NMDAR autoantibodies.  We invite you to read this exciting study in its entirety at the following link:

https://www.cambridge.org/core/journals/bjpsych-open/article/prevalence-and-treatment-outcomes-of-antineuronal-antibodypositive-patients-admitted-with-first-episode-of-psychosis/762DB1140ECE807C43D0456C66EFCA5F

The study “suggests that a small but significant proportion of people unwell enough to require admission to hospital for their FEP have an illness arising from an autoimmune etiology and respond to immunotherapy. The study supports recent recommendations for routine antineuronal antibody testing as screening for autoimmune encephalitis in patients admitted with FEP.”According to Dr. James, “…autoimmune psychosis is a very important area of psychiatry and … there will be many things that can be done to help people as we learn more about how the immune system can affect the brain.”

We look forward to hearing more from Dr. James and his colleagues as they expand their research.