Below is some guidance for the use of clinicians interested in antibody testing and interpretation of a positive result
At the time of writing we do not know the relevance of a positive antibody test result in a psychiatric setting. Clinical screening of all patients presenting to psychiatrists may pick up irrelevant autoantibodies, and clinicians are encouraged to screen patients through the PPiP and other research studies.
In a research setting we are trying to screen all cases of psychosis with symptom onset within the last 2 years and develop a randomised controlled trial to evaluate immunotherapy (low dose steroids and intravenous immunoglobulin (IVIG) versus placebo or rater-only-blinded steroids and plasmaexchange (PLEX) versus treatment as usual) on top of treatment as usual (usually 2nd generation antipsychotic medication). This approach will tell us whether immunotherapy is effective and safe in this patient group.
If positive autoantibodies are identified currently outside of the research studies then referral to a neurologist with a special interest in neuroimmunology is advised. The neurologist will make a clinical judgement on the probability of an underlying or evolving autoimmune encephalitis, including often with the use of MRI brain imaging, EEG and spinal fluid examination. At present we advise empirical immunotherapy for atypical cases with prominent cognitive dysfunction, seizures, movement disorder, refractory symptoms to conventional antipsychotic therapy and/or with supportive evidence of an autoimmune process including normal or abnormal MRI, inflammatory spinal fluid and/or slow EEG (see publications), but a careful clinical assessment with psychiatry, psychology and neurology involvement is advised for each patient, and other treatable causes (tumours, infection, metabolic causes) should be excluded.
If you have a query or would like some advice about how to treat a patient who is positive for these antibodies please get in touch using the form below and a relevant member of the group will respond.