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.