Neural Antibodies in First-episode Psychosis Patients with Warning Signs for Autoimmune Encephalitis
Denis Pavăl1,2, Nicoleta Gherghel-Pavăl2, Octavia Oana Căpățînă1,2, Adina Stan3, Lajos Raduly4, Liviuța Budișan4, Ioana Valentina Micluția1
1Department of Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2Romanian Association for Autoimmune Encephalitis, Cluj-Napoca, Romania
3Department of Neurology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
4Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Correspondence to: Denis Pavăl
Department of Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, 43 Victor Babeș, Cluj-Napoca 400012, Romania
E-mail: paval.denis@yahoo.com
ORCID: https://orcid.org/0000-0003-0532-586X
Received: January 2, 2024; Revised: February 28, 2024; Accepted: March 20, 2024; Published online: May 9, 2024.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: Autoimmune encephalitis (AE) remains an essential differential diagnosis in patients with first-episode psychosis (FEP). In this study, we aimed to assess to prevalence of AE in a cohort of FEP patients.
Methods: We used a phenotype-driven algorithm to detect AE in patients with FEP. Initially, we screened patients for warning signs with a low or high pre-test probability for AE, defined as “yellow” and “red flags”, respectively. In the next step, patients with red flags underwent cerebrospinal fluid analysis (including neural antibodies), while patients with yellow flags underwent tests for serum neural antibodies, electroencephalography, and brain magnetic resonance imaging.
Results: We screened 78 patients with FEP and found that eight (10.3%) had at least one warning sign for AE: four (5.13%) patients had at least one red flag, while four (5.13%) had only yellow flags. Among these, two patients (2.56%) had anti-N-methyl-D-aspartate receptor encephalitis, while the remaining six (7.69%) received a primary psychiatric disorder diagnosis.
Conclusion: Our study highlights the importance of considering AE in the differential diagnosis of FEP.
Keywords: Autoimmune encephalitis; Autoimmune psychosis; First-episode psychosis; Neural antibodies; Warning signs; Algorithms


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