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000282905 1001_ $$aAl-Diwani, Adam$$b0
000282905 245__ $$aThe distinctive psychopathology of NMDAR-antibody encephalitis compared with primary psychoses: an international, multicentre, retrospective phenotypic analysis.
000282905 260__ $$aPhiladelphia, Pa.$$bElsevier$$c2026
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000282905 520__ $$aN-methyl-D-aspartate receptor (NMDAR)-antibody encephalitis is a life-threatening neuropsychiatric disorder requiring prompt immunotherapy. The earliest features are mental-state changes, often mistaken for primary psychosis. Improved clinical differentiation could assist rational diagnostic investigation and expedite immunotherapy. Inspired by patients' and relatives' lived experience, we aimed to explore the psychiatric phenotype of NMDAR-antibody encephalitis and the features common to and distinct from real-world episodes of psychosis.In this international, multicentre, retrospective phenotypic analysis we collected data on episodes of NMDAR-antibody encephalitis from specialised neurology services in Europe (UK, Germany, and Sweden) and the USA. For comparison, we collected similar data from de-identified accepted referrals to a UK early intervention in psychosis service, including consecutively presenting cases (unselected psychosis) and a group defined by having been assessed and admitted to hospital under the Mental Health Act (selected psychosis). Additionally, we included episodes of postpartum psychosis from a mother and baby unit in the Netherlands. In our mental-state inventory we included core features from ICD-11, the Bush-Francis catatonia score, and the Neuropsychiatric Inventory encompassing anxiety, depression, mania, schizophrenia, catatonia, and also more granular transdiagnostic behavioural features including those common to neuropsychiatric and neurobehavioural syndromes, such as delirium and dementia. Ethnicity data were not available. We compared and visualised the neuropsychiatric phenotype of these cohorts.We collected data from 100 episodes of NMDAR-antibody encephalitis from 96 patients between 2010 and 2022 (median age 22 years, female:male ratio 3·80), 135 episodes of psychosis from 135 patients between 2018 and 2019 (median age 27 years, female:male ratio 0·75), and ten episodes of postpartum psychosis from ten patients between 2005 and 2012 (median age 30 years, all female sex). Psychopathology in NMDAR-antibody encephalitis was abundant (92 [92%] of 100 episodes) and ultra-rapid in onset (median 1 day [95% CI 1-1; IQR 1-7]) versus unselected primary psychoses (median 180 days [120-210; 91-365]; p<0·0001). 21 (36%) of 58 mental-state features, including catatonic and visual hallucinations, were over-represented in NMDAR-antibody encephalitis and 12 (21%) were under-represented, including features typical of affective (eg, elated mood, flight of ideas, grandiose delusions) and non-affective psychoses (eg, thought broadcasting, thought withdrawal, paranoid delusions; false discovery rate threshold <0·05). Typically, in NMDAR-antibody encephalitis, the complexity sequentially evolved from mood to psychotic to catatonic predominance within 2 weeks.NMDAR-antibody encephalitis has a rapid-onset, complex, and dynamic neuropsychiatric phenotype, sufficiently distinctive to drive a clinical approach to differentiation.UK NIHR, Wellcome, and UK Medical Research Council (MRC)/UK Research and Innovation.
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000282905 650_2 $$2MeSH$$aHumans
000282905 650_2 $$2MeSH$$aPsychotic Disorders: diagnosis
000282905 650_2 $$2MeSH$$aPsychotic Disorders: psychology
000282905 650_2 $$2MeSH$$aAnti-N-Methyl-D-Aspartate Receptor Encephalitis: psychology
000282905 650_2 $$2MeSH$$aAnti-N-Methyl-D-Aspartate Receptor Encephalitis: diagnosis
000282905 650_2 $$2MeSH$$aFemale
000282905 650_2 $$2MeSH$$aRetrospective Studies
000282905 650_2 $$2MeSH$$aMale
000282905 650_2 $$2MeSH$$aAdult
000282905 650_2 $$2MeSH$$aPhenotype
000282905 650_2 $$2MeSH$$aYoung Adult
000282905 650_2 $$2MeSH$$aMiddle Aged
000282905 650_2 $$2MeSH$$aEurope
000282905 650_2 $$2MeSH$$aAdolescent
000282905 7001_ $$aTheorell, Jakob$$b1
000282905 7001_ $$aZghoul, Tarek$$b2
000282905 7001_ $$aVoruganti, Aniruddha$$b3
000282905 7001_ $$aTownsend, Leigh$$b4
000282905 7001_ $$aDe Giorgi, Riccardo$$b5
000282905 7001_ $$aGriffin, Benjamin$$b6
000282905 7001_ $$aBajorek, Tomasz$$b7
000282905 7001_ $$aOkai, David$$b8
000282905 7001_ $$aLennox, Belinda$$b9
000282905 7001_ $$aLeite, M Isabel$$b10
000282905 7001_ $$aKim, Carla Y$$b11
000282905 7001_ $$aCoughlin, Arielle$$b12
000282905 7001_ $$aMartin, Kelsey$$b13
000282905 7001_ $$aGlassberg, Brittany$$b14
000282905 7001_ $$aLachner, Christian$$b15
000282905 7001_ $$aWesterbeek, Nicola$$b16
000282905 7001_ $$aBergink, Veerle$$b17
000282905 7001_ $$aThakur, Kiran T$$b18
000282905 7001_ $$aYeshokumar, Anusha K$$b19
000282905 7001_ $$0P:(DE-2719)2810931$$aPrüss, Harald$$b20$$udzne
000282905 7001_ $$aDay, Gregory S$$b21
000282905 7001_ $$aFinke, Carsten$$b22
000282905 7001_ $$aHandel, Adam E$$b23
000282905 7001_ $$aManohar, Sanjay G$$b24
000282905 7001_ $$aJoyce, Dan W$$b25
000282905 7001_ $$aIrani, Sarosh R$$b26
000282905 773__ $$0PERI:(DE-600)2771442-1$$a10.1016/S2215-0366(25)00305-0$$gVol. 13, no. 1, p. 47 - 61$$n1$$p47 - 61$$tThe lancet / Psychiatry$$v13$$x2215-0366$$y2026
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