British psychiatrists propose a change in practice

Due to the nature of early symptoms in AE, studies have shown that patients often present first to psychiatrists or mental health facilities. Screening for the potential of autoimmune encephalitis may or may not be done, depending on awareness of the treating physicians and availability of testing. Drs. Pollack and Lennox of the UK have just published a paper suggesting “It is time that all patients with acute-onset psychosis are screened for autoimmune encephalitis, that lumbar puncture becomes a routine psychiatric investigation and that immunotherapy is available in indicated cases. We call for a culture change in the management of psychosis by psychiatry.”

They cited a recently published study by Scott and colleagues conducted in Australia, in which a small but significant percentage of patients admitted to psychiatric wards tested positive for antineuronal antibodies in blood samples (5.3%). These patients went on to be further evaluated in a prompt manner with lumbar puncture and other studies, revealing an autoimmune neurological illness that resulted in an excellent response in 4/5 patients who received immunotherapy. This was despite normal MRIs and EEGs in all of these patients.

However, Pollack and Lennox stated that practice has largely not changed in psychiatric settings as it has in the neurological world, despite many publications in the literature about autoimmune encephalitis. They admit there are major challenges to overcome, including infrastructure since MRI, EEG and lumbar puncture are not usually available in psychiatric settings. Also, complexities in testing and diagnostic criteria are acknowledged. Nonetheless, they note that screening for AE in acute first episode psychosis “is of clear value and may, after appropriate further investigation, result in treatment that is potentially life-saving or at the very least disease-modifying.”

The entire paper by Pollack and Lennox can be read here.