Identifying the prevalence of antibodies to neuronal membrane targets in first episode psychosis

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In the last ten years there have been breakthroughs in the discovery of new treatment responsive causes of limbic encephalitis. This is a rare, life threatening brain disorder. These new causes have been antibodies against targets on the surface of brain cells. In the descriptions of these new disorders patients often present with promninent psychiatric symptoms, with symptoms of psychosis such as hallucinations and delusions and disordered thinking and impaired memory. However they also develop difficulties with fits, loss of unconsciousness, blood pressure control or electrolyte disturbance which means that they end up under the management of neurologists or intensive care specialists rather than psychiatrists. We were interested whether a proportion of patients with purely psychiatric symptoms of the disorder would also have these antibodies. We therefore tested 47 patients with a first episode of psychosis, without other features of limbic encephalitis and found that 3 of them did have these antibodies. We have since identified, without systematic screening a further 9 patients, and have treated 4 of these by treating their immune system rather than traditional psychiatric medication. This gives further support to the theory that the antibodies are causing the psychosis in these patients. We now wish to establish just how common this disorder is. We want to screen a larger number of patients for all known antibodies that can cause limbic encephalitis. This will help us to estimate how significant a disorder this is, and help with planning clinical services.