Anti-NMDAR encephalitis was initially described as a severe neuropsychiatric syndrome, commencing with a prodrome of headache, fever, vomiting, diarrhoea and upper respiratory tract symptoms. Commonly, within three weeks, neuropsychiatric symptoms emerge with anxiety, insomnia, hallucinations, delusions, agitation, mania and catatonia but social withdrawal and stereotypical behaviours may also be evident. During this phase, approximately 80% of patients present for psychiatric care.

Diagnosis is made by testing for NMDAR antibodies in plasma and cerebrospinal fluid (CSF). The presence of NMDAR antibodies in this clinical situation necessitates specialist medical care.

Although early detection and initiation of immune therapy is important to improve long-term outcomes, presentation to mental health services potentially delays diagnosis and appropriate treatment because there is a lack of consensus as to the role of testing for anti-neuronal antibodies (ANAb) in patients with psychosis and the management in those who test positive.

This study aims to screen 1200 patients across SE QLD and interstate mental health services. It is estimated 40 patients who are positive for the antibody will be invited to participate in the main study.

This study seeks to validate clinical criteria for testing patients with psychosis for anti-neuronal antibody (ANAB) and to compare clinical outcomes of patients who are positive for ANAB who receive immunotherapy early in their illness with those who receive late or no immunotherapy.

It will also examine and compare the sensitivity and specificity of three types of assays (fixed cell assays, immunohistochemistry and live cell assays) for detection of ANAb’s in patients with psychosis compared to the gold standard.

This research is headed by Professor James Scott and funded through NHMRC. The Clinical Support Unit at QCMHR headed by Andrea Baker will coordinate the clinical trial.

This study is ongoing and looking for volunteers!   If you would like to participate in this study, please email Andrea Baker on andrea_baker@qcmhr.uq.edu.au.

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