Autoimmune Psychosis

Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin.

A group of renowned international physicians, led by Dr. Tom Pollak and senior authors Prof. Souhel Najjar, Prof. Karl Bechter and Prof. Angela Vincent, worked together to create a consensus on diagnosis and treatment of autoimmune psychosis for use in psychiatric practice.

Patients are often first hospitalized in psychiatric departments before being transferred to a neurology ward, prompting the question of whether a subset of patients may go misdiagnosed with a primary psychiatric disease. Recently, a high prevalence of CSF abnormalities including the detection of anti-neuronal autoantibodies (mostly NMDAR receptor antibodies) has been observed in 54.4% of psychotic patients, highlighting their potential role in psychiatry and underlining the need for increased clinical and scientific awareness of these treatable conditions.

The authors feel that patients with apparent isolated psychotic presentations (meaning with minimal neurological features) and that have tested positive for neuronal autoantibodies and who have responded to immunotherapy are different from typical autoimmune encephalitis patients, and propose to establish a new category named autoimmune psychosis.

With this position paper, the authors aim to develop guidelines for identifying psychoses of possible, probable, and definite autoimmune origin for use in the psychiatric practice. This consensus will help psychiatrists to better distinguish between a classic psychosis and one of autoimmune origin. It also serves as a reminder to undertake appropriate neurological workup, as early diagnosis with prompt treatment significantly improves outcomes.

We want to thank the authors for creating these important guidelines. You can access the article here.