Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis

Abstract

Neuronal autoantibodies targeting cell surface antigens have been described in association with autoimmune encephalitides which frequently feature psychosis and other psychiatric disturbances alongside neurological signs and symptoms. Little has been written however about the long-term psychiatric status of individuals following recovery from the acute phase of autoimmune encephalitis, despite case series and anecdotal evidence suggesting this may be a cause of considerable disability. Here, we describe a man aged 58 years with no psychiatric history who developed a severe and acute psychotic disorder following resolution of a protracted course of limbic encephalitis associated with antibodies to leucine-rich glioma inactivated 1 protein. No indications of a gross ongoing inflammatory or encephalopathic process were present at presentation of his psychosis. Possible aetiologies of his acute psychosis are discussed. This case highlights the importance of ongoing psychiatric follow-up of patients following an episode of autoimmune encephalitis.

Autoantibody-associated psychiatric syndromes in children: link to adult psychiatry

“…There are autoimmune encephalopathies characterized by their chronic relapse-remitting character, such as GAD65 autoimmune encephalitis (Hansen et al 2018 ), which probably disturbs brain function and structure repeatedly and may lead to permanent deficits resulting in the manifestation of psychiatric disease. Furthermore, a recent report suggested that a patient who recovered from LGI1- encephalitis developed a new onset psychotic disorder after surviving a one-year course of LGI1-antibody-positive encephalitis (Pollak and Moran 2017 ). This is a paradigmatic example of how a subsiding or chronic, recurrent autoimmune encephalitis with circulating serum or cerebrospinal fluid autoantibodies may influence psychiatric disorders.…”

Brucella-Induced Acute Psychosis: A Novel Cause of Acute Psychosis

“…In other infection-induced psychoses, the production of autoantibodies has been noted [ 19 ]. However, this appears to be a less likely cause of psychosis in this patient, given the short timescale in which his symptoms resided once Brucella had been eradicated.…”

Leucine-rich Glioma Inactivated 1 (LGI-1) Limbic Encephalitis Presenting with Psychotic Symptoms without Seizures: A Case Report with Five-year Follow-up and Review of Literature

“…12 Additionally, primary HCWs-based models are effective, feasible, and scalable for integrative care, including screening, monitoring, and referral care. These models effectively improve the screening of perinatal women for depression using the Patient Health Questionnaire (PHQ-2 or PHQ-9) in tertiary care settings 13 and can be included as community-based assessments (e.g., Community Based Assessment Checklist in India) and part of national programs. 14 However, there are various challenges for the implementation of these interventions/models in resource-limited settings, including limited training resources, overburdened primary HCWs with multiple responsibilities under different programs, and difficulty maintaining records and arranging follow-ups.…”