The psychopathology of NMDAR-antibody encephalitis in adults

A group of researchers from the Autoimmune Neurology Group at the University of Oxford led by Dr. Sarosh Irani,  recently published an article in the Lancet Psychiatry, noting that a focus on the psychopathology is likely the most effective way to promote prompt recognition of NMDAR-antibody encephalitis.

NMDAR-antibody encephalitis is an autoantibody-mediated disease that typically presents with psychiatric symptoms before progressing to neurological symptoms. Early diagnosis with early and prompt treatment greatly improves outcomes. As most patients with NMDAR-antibody encephalitis present to psychiatrists first, the psychopathology of NMDAR-antibody encephalitis needs to be clearly described in order to come to an accurate clinical identification and prompt treatment.

The study reviewed 464 individual adult patients diagnosed with NMDAR-antibody encephalitis. Key findings of the study:

  • 79% of the patients were female;
  • Rapid onset of psychiatric symptoms (days or weeks instead of months or years in primary psychiatric disorders);
  • 30% of the cases was associated with ovarian teratoma, 2% with previous herpes simplex virus encephalitis and 5% with pregnancy;
  • The five categories into which the 464 patients were grouped are behavior, psychosis, mood, catatonia and sleep disturbance. In 334 (74%) of 451 patients, these five features overlapped, 26% exhibited only a single feature;
  • The distinctive aspect of NMDAR-antibody encephalitis psychopathology is complexity; core aspects of mood and psychotic disorders consistently coexist within individual patients.
  • A more nuanced, multifaceted architecture of NMDAR-antibody encephalitis psychopathology could help psychiatrists to develop a clinical index of suspicion for patients with possible NMDAR-antibody encephalitis, whose care will benefit from CSF analysis;
  • Early involvement by psychiatrists alongside neurology colleagues is crucial.

The full paper is available online and can be viewed here. Many thanks to Dr. Sarosh Irani and  The Autoimmune Neurology Group who conducted this study.