High Risk of Auto immune associated Psychosis (H-RAP) Study

Psychosis is a heterogeneous syndrome with a life time prevalence of 3% and a highly variable prognosis where treatment refractory and relapsing courses with persistent disability are all too common. There are a growing number of case reports of patients with psychosis who have antibodies to neuronal cell surface receptors (NSAbs). We recently reported that 5 of 113 patients admitted to hospital with a diagnosis of psychosis had neuronal cell surface antibodies (NSAbs) with evidence of inflammatory activity in the central nervous system. Treatment with immunotherapy resulted in excellent clinical outcomes with remission of psychosis. We also also reported a case series of patients who had been diagnosed with anti-N-Methyl-D-Aspartate Receptor encephalitis and received immunotherapy. Three of these patients were misdiagnosed with treatment refractory psychosis (2 patients for 6 years and 1 for 15 years). For these patients who had been diagnosed with psychosis, appropriate investigations for NSAbs, diagnosis and management has transformed their lives.

The H-RAP study aims to provide clinical guidance as to which patients with psychosis should be tested for NSAbs by prospectively validating proposed high risk clinical criteria for psychosis associated with NSAbs in a large patient population (n=1200). Further, the study will compare the most appropriate method for detecting NSAbs (fixed cell vs live cell assay) in people living with psychosis. Finally the study will compare the functional outcomes of patients with psychosis who are positive for NSAbs and receive immunotherapy early after onset of illness with those who receive later or no immunotherapy. The H-RAP study will provide critical information to enable the most efficient use of health resources whilst ensuring patients with psychosis associated with NSAbs presenting to mental health services are detected early so as to prevent delays in diagnosis and treatment.

The core aim of this project is to improve evidence-based outcomes for adolescents with severe, persistent, and complex mental illness through the creation of a sustainable and meaningful evaluation framework.

Chief Investigator
Professor James Scott

Project Team
A/Prof Judith Greer
Dr Stefan Blum
Dr Belinda Lennox
Dr Brian O’Donoghue
Dr Dan Siskind
Dr Shuichi Suetani

Funded by
NHMRC