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Autoimmune encephalitis: a potentially treatable cause of mental disorder

  • Hugh Rickards, Saiju Jacob, Belinda Lennox and Tim Nicholson
Summary

Autoimmune encephalitides can present with altered mental states, particularly psychosis and delirium. Psychiatrists need to be particularly vigilant in cases of first-episode psychosis and to look out for other, sometimes subtle, features of encephalitis. Encephalitis related to N-methyl-d-aspartate (NMDA) receptor autoantibodies is the most common autoimmune cause of isolated psychosis, the second being related to voltage-gated potassium channel (VGKC)-complex antibodies. Psychiatrists should note ‘red flag’ signs of seizures, autonomic instability, movement disorders and sensitivity to antipsychotic medication (including neuroleptic malignant syndrome). They should also be aware that, in some cases, encephalitis is a non-metastatic manifestation of malignancy. Treatment primarily involves suppression of immunity and is often successful if delivered early. There is accumulating evidence that isolated psychiatric syndromes can be caused by autoimmunity and this could potentially signal a significant change in the approach to disorders such as schizophrenia. Psychiatrists and neurologists need to work together to diagnose, manage and understand this group of conditions.

LEARNING OBJECTIVES

  1. Consider ‘red flags' for the diagnosis of autoimmune encephalitis presenting to general psychiatric practice.
  2. Understand the investigations required to diagnose autoimmune encephalitis.
  3. Become familiar with the basics of treatment of autoimmune encephalitis.

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Copyright
Corresponding author
Dr Hugh Rickards, Department of Neuropsychiatry, The Barberry, National Centre for Mental Health, 25 Vincent Drive, Edgbaston, Birmingham B15 2FG, UK. Email: hugh.rickards@bsmhft.nhs.uk
Footnotes
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Declaration of Interest

B.L. and S.J. work in departments whose laboratories perform assays mentioned in this article, but they have no financial interests in these assays.

Footnotes
References
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Autoimmune encephalitis: a potentially treatable cause of mental disorder

  • Hugh Rickards, Saiju Jacob, Belinda Lennox and Tim Nicholson
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