Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCP, FEAN, Queen’s Hospital, Romford, UK, discusses why all patients with new-onset psychosis should be investigated for and, unless another cause is found, should be treated with corticosteroids for potential autoimmune encephalitis. Patients should be offered corticosteroid treatment after excluding other reasons responsible for the psychosis, such as drugs, alcohol consumption, and other primary psychological disorders. This assumption is based on two facts: the first one being that before autoimmune encephalitis antibody testing was implemented in the clinical process, diagnosis took too long. Secondly, there is a small group of young patients with psychosis who do not respond to antipsychotics and can suffer neuroleptic death – autoimmune encephalitis could be the reason behind it. Additionally, symptoms of autoimmune encephalitis can be mistaken as functional problems of psychosis; for example, facial brachial dystonic seizures, which occur with anti-LGI1 antibody-related encephalitis, are often misdiagnosed. Overall, providing steroid treatments may reduce deaths. Dr Chaudhuri understands this is controversial and encourages debate, and states that psychosis itself may even be an autoimmune disease, especially in patients with a family history of autoimmune disease. This interview was conducted during the 2022 World Congress on Controversies in Neurology (CONy) meeting.
