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Cohn SL, Mohan A, Lappin JM, Curtis J, Scott JG. Anti- N-Methyl-d-Aspartate Receptor Antibody Testing in First-Episode Psychosis: Universal or Targeted Testing. J Neuropsychiatry Clin Neurosci 2023; 35:98-101. [PMID: 36128677 DOI: 10.1176/appi.neuropsych.21080214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an immune-mediated disorder that typically presents with rapid development of neuropsychiatric symptoms. As a potentially reversible cause of psychosis, there have been calls internationally for routine serological screening for anti-NMDAR antibodies in patients presenting with first-episode psychosis (FEP). Increased serological testing has, however, exposed several limitations of universal screening and rekindled debate as to which patients should be tested. Screening criteria have been proposed for high-risk clinical features in FEP in which antineuronal antibody testing is indicated. The authors present a clinical vignette and a service audit as well as discuss the limitations of universal screening advocating instead for targeted testing for antineuronal antibodies in patients diagnosed as having FEP.
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Affiliation(s)
- Sarah L Cohn
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
| | - Adith Mohan
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
| | - Julia M Lappin
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
| | - Jackie Curtis
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
| | - James G Scott
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia (Cohn, Mohan); University of New South Wales, Sydney (Cohn, Mohan, Lappin, Curtis); South Eastern Sydney Local Health District, Sydney (Cohn, Mohan, Lappin, Curtis); Mindgardens Neuroscience Network, Sydney (Curtis); Child and Youth Research Group, QIMR Berghofer Medical Research Institute, and Early Psychosis Service, Metro North Mental Health Service, Herston, Australia (Scott); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia (Scott)
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