scholarly journals Time for a change of practice: the real-world value of testing for neuronal autoantibodies in acute first-episode psychosis

BJPsych Open ◽  
2018 ◽  
Vol 4 (4) ◽  
pp. 262-264 ◽  
Author(s):  
Thomas A. Pollak ◽  
Belinda R. Lennox
Keyword(s):  
Lumbar Puncture ◽  
Real World ◽  
Culture Change ◽  
Autoimmune Encephalitis ◽  
First Episode Psychosis ◽  
Acute Onset ◽  
First Episode ◽  
The Real ◽  
Episode Psychosis ◽  
Neuronal Autoantibodies

SummaryIt is time that all patients with acute-onset psychosis are screened for autoimmune encephalitis, that lumbar puncture becomes a routine psychiatric investigation and that immunotherapy is available in indicated cases. We call for a culture change in the management of psychosis by psychiatry.Declaration of interestNone.

scholarly journals A comparison of neurocognition and functioning in first episode psychosis populations: do research samples reflect the real world?

2018 ◽  
Vol 54 (3) ◽  
pp. 291-301 ◽  
Author(s):  
Emily Kline ◽  
Victoria Hendel ◽  
Michelle Friedman-Yakoobian ◽  
Raquelle I. Mesholam-Gately ◽  
Ann Findeisen ◽  
...  
Keyword(s):  
Real World ◽  
First Episode Psychosis ◽  
First Episode ◽  
The Real ◽  
Episode Psychosis

scholarly journals Screening for pathogenic neuronal autoantibodies in serum and CSF of patients with first-episode psychosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jakob Theorell ◽  
Melanie Ramberger ◽  
Ruby Harrison ◽  
Victor Mgbachi ◽  
Leslie Jacobson ◽  
...  
Keyword(s):  
Glycine Receptor ◽  
Autoimmune Encephalitis ◽  
First Episode Psychosis ◽  
First Episode ◽  
Control Group ◽  
Accurate Identification ◽  
Multiple Parameters ◽  
Episode Psychosis ◽  
Neuronal Autoantibodies ◽  
Neurological Features

AbstractPatients with autoimmune encephalitides, especially those with antibodies to the N-methyl-d-aspartate receptor (NMDAR), often present with prominent psychosis and respond well to immunotherapies. Although most patients progress to develop various neurological symptoms, it has been hypothesised that a subgroup of patients with first-episode psychosis (FEP) suffer from a forme fruste of autoimmune encephalitis. Without accurate identification, this immunotherapy-responsive subgroup may be denied disease-modifying treatments. Thirty studies addressing aspects of this hypothesis were identified in a systematic review. Amongst other shortcomings, 15/30 reported no control group and only 6/30 determined cerebrospinal fluid (CSF) autoantibodies. To ourselves address these—and other—limitations, we investigated a prospectively ascertained clinically well-characterised cohort of 71 FEP patients without traditional neurological features, and 48 healthy controls. Serum and CSF were tested for autoantibodies against seven neuronal surface autoantigens using live cell-based assays. These identified 3/71 (4%) patient sera with weak binding to either contactin-associated protein-like 2, the NMDAR or glycine receptor versus no binding from 48 control samples (p = 0.28, Fisher’s test). The three seropositive individuals showed no CSF autoantibodies and no differences from the autoantibody-negative patients in their clinical phenotypes, or across multiple parameters of peripheral and central inflammation. All individuals were negative for CSF NMDAR antibodies. In conclusion, formes frustes of autoimmune encephalitis are not prevalent among FEP patients admitted to psychiatric care. Our findings do not support screening for neuronal surface autoantibodies in unselected psychotic patients.

scholarly journals Acute and transient psychotic disorders: precursors, epidemiology, course and outcome

2004 ◽  
Vol 185 (6) ◽  
pp. 452-459 ◽  
Author(s):  
Swaran P. Singh ◽  
Tom Burns ◽  
Shazad Amin ◽  
Peter B. Jones ◽  
Glynn Harrison
Keyword(s):  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Acute Onset ◽  
Favourable Outcome ◽  
First Episode ◽  
Affective Psychosis ◽  
Episode Psychosis ◽  
Icd 10 ◽  
Premorbid Functioning ◽  
Better Than

BackgroundICD–10 has introduced the diagnostic group acute and transient psychotic disorders (ATPDs; F23). Aims To validate the nosological distinctiveness of ICD–10 ATPDs by following up an inception cohort with first-episode psychosis. Method All patients with first-episode psychosis identified in Nottingham between 1992 and 1994 and diagnosed using ICD–10 criteria were reassessed 3 years later. ATPD outcomes were compared with schizophrenia and affective psychosis. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable 3-year outcome in first-episode psychosis. Results Of 168 cases of first-episode psychosis, 32 (19%) received an intake diagnosis of ATPD. The diagnosis of ATPD was stable in women over 3 years, but not in men. Outcomes in ATPD were better than in schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and premorbid functioning rather than acute onset and early remission. Conclusions The ICD–10 criteria for ATPDs identify a diagnostically unstable group of disorders. Acute onset and early remission do not independently predict favourable outcome over 3 years in first-episode psychosis.

First-episode psychosis: What does it mean?

2016 ◽  
Vol 33 (S1) ◽  
pp. s258-s258
Author(s):  
S. Marques ◽  
F. Godinho ◽  
A.L. Melo ◽  
D. Barrocas
Keyword(s):  
Real World ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Real World Setting ◽  
Episode Psychosis ◽  
Competing Interest ◽  
Disorganized Speech ◽  
Psychotic Features

IntroductionFirst-Episode Psychosis (FEP) is a variable condition, characterized by the emergence of new psychotic features for a period of at least 1 week. The majority of existing studies about FEP only address schizophrenia spectrum psychosis (SSP), which may limit the capacity to fully characterize this entity.Objectives/AimsReport the clinical and socio-demographic characteristics of patients with FEP in real-world setting, and compare the differences among SSP and affective FEP.MethodsRetrospective analysis of clinical files of patients admitted to our hospital unit with FEP diagnosis from January/2012 to April/2015. Clinician-rated dimensions of psychosis symptom severity scales (DSM-5) were applied.ResultsAnnual incidence of FEP was 11,3/100,000. From a total of 755 patients, 57 (7,5%) corresponded to FEP; 38 (66,7%) were diagnosed with SSP, 11 (19,3%) affective psychosis, 3 (5,2%) toxic psychosis and 5 (8,8%) organic psychosis. Most were female (61,4%), with a mean age of 49 years. The majority were unemployed (66,7%), lived with family (57,9%), and presented with moderate-severe delusions (80,1%), but without hallucinations (57,8%), disorganized speech (59,6%) or negative symptoms (85,9%). Affective FEP patients were older (61 vs 45 years), presented with less severe psychotic symptoms (7,2 vs 8,3 points), but with higher hospital admission (26,1 vs 21,1 days).ConclusionsRegardless the growing interest concerning FEP, its conceptualization and characterization remains controversial. Our results differ from pre-existing literature data, especially concerning gender and age. By including all the possible etiologies of FEP, we aimed to obtain a more realistic characterization of this entity in a real-world setting.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Prevalence of autoimmune encephalitis in patients with a first episode psychosis

2020 ◽  
pp. 010-013
Author(s):  
Remon Monica Crosas ◽  
Ruiz Virginia Casado ◽  
Batiste Desire Muriana ◽  
Busca Nicolau Guanyabens ◽  
Serven Eloi Gine ◽  
...  
Keyword(s):  
Autoimmune Encephalitis ◽  
First Episode Psychosis ◽  
First Episode ◽  
Episode Psychosis

Influence of ethnicity on presentation and outcome of first episode psychosis

2007 ◽  
Vol 24 (3) ◽  
pp. 117-118
Author(s):  
Foluso Ademola ◽  
Kenneth Harte ◽  
Noel Kennedy
Keyword(s):  
Ethnic Minority ◽  
Minority Groups ◽  
Psychiatric Service ◽  
First Episode Psychosis ◽  
Acute Onset ◽  
First Episode ◽  
Homogeneous Population ◽  
Irish Context ◽  
Episode Psychosis ◽  
Assessment And Treatment

AbstractWe describe a young African male presenting to an Irish psychiatric service with first episode psychosis with an acute onset, no prodromal features and early and complete remission. Migrant and ethnic minority groups may differ in their clinical presentation, course and outcome of psychosis compared with the Caucasian population. This has implications for assessment and treatment of ethnic minority patients in an Irish context given the recent migration into a previously homogeneous population.

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