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@ARTICLE{AlDiwani:282905,
      author       = {Al-Diwani, Adam and Theorell, Jakob and Zghoul, Tarek and
                      Voruganti, Aniruddha and Townsend, Leigh and De Giorgi,
                      Riccardo and Griffin, Benjamin and Bajorek, Tomasz and Okai,
                      David and Lennox, Belinda and Leite, M Isabel and Kim, Carla
                      Y and Coughlin, Arielle and Martin, Kelsey and Glassberg,
                      Brittany and Lachner, Christian and Westerbeek, Nicola and
                      Bergink, Veerle and Thakur, Kiran T and Yeshokumar, Anusha K
                      and Prüss, Harald and Day, Gregory S and Finke, Carsten and
                      Handel, Adam E and Manohar, Sanjay G and Joyce, Dan W and
                      Irani, Sarosh R},
      title        = {{T}he distinctive psychopathology of {NMDAR}-antibody
                      encephalitis compared with primary psychoses: an
                      international, multicentre, retrospective phenotypic
                      analysis.},
      journal      = {The lancet / Psychiatry},
      volume       = {13},
      number       = {1},
      issn         = {2215-0366},
      address      = {Philadelphia, Pa.},
      publisher    = {Elsevier},
      reportid     = {DZNE-2025-01366},
      pages        = {47 - 61},
      year         = {2026},
      abstract     = {N-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.},
      keywords     = {Humans / Psychotic Disorders: diagnosis / Psychotic
                      Disorders: psychology / Anti-N-Methyl-D-Aspartate Receptor
                      Encephalitis: psychology / Anti-N-Methyl-D-Aspartate
                      Receptor Encephalitis: diagnosis / Female / Retrospective
                      Studies / Male / Adult / Phenotype / Young Adult / Middle
                      Aged / Europe / Adolescent},
      cin          = {AG Prüß},
      ddc          = {610},
      cid          = {I:(DE-2719)1810003},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41386901},
      doi          = {10.1016/S2215-0366(25)00305-0},
      url          = {https://pub.dzne.de/record/282905},
}