Evidence map›Paper›PMID 41386901›Full record

ArticleThe lancet. Psychiatry2026

The distinctive psychopathology of NMDAR-antibody encephalitis compared with primary psychoses: an international, multicentre, retrospective phenotypic analysis.

Adam Al-Diwani, Jakob Theorell, Tarek Zghoul, Aniruddha Voruganti, Leigh Townsend, Riccardo De Giorgi, Benjamin Griffin, Tomasz Bajorek, David Okai, Belinda Lennox and 17 more

Abstract readMulticenter StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. Psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Adam Al-DiwaniUniversity Department of Psychiatry, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre, Oxford Health NHS Foundation Trust, Oxford, UK.
Jakob TheorellCenter for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Tarek ZghoulUniversity Department of Psychiatry, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre, Oxford Health NHS Foundation Trust, Oxford, UK.
Aniruddha VorugantiNational Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre, Oxford Health NHS Foundation Trust, Oxford, UK.
Leigh TownsendOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.
Riccardo De GiorgiUniversity Department of Psychiatry, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre, Oxford Health NHS Foundation Trust, Oxford, UK.
Benjamin GriffinUniversity Department of Psychiatry, University of Oxford, Oxford, UK; Brighton & Sussex Medical School, Falmer, UK; Sussex Partnership NHS Foundation Trust, Brighton, UK.
Tomasz BajorekOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Psychological Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
David OkaiOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Psychological Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Neuropsychiatry, South London and Maudsley NHS Foundation Trust, London, UK.
Belinda LennoxUniversity Department of Psychiatry, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre, Oxford Health NHS Foundation Trust, Oxford, UK.
M Isabel LeiteOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Carla Y KimDepartment of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
Arielle CoughlinDepartment of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Kelsey MartinDepartment of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Brittany GlassbergDepartment of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Christian LachnerDepartment of Neurology, Mayo Clinic, Jacksonville, FL, USA.
Nicola WesterbeekDepartment of Psychiatry, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands.
Veerle BerginkDepartment of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands.
Kiran T ThakurDepartment of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
Anusha K YeshokumarDepartment of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Harald PrüssDepartment of Neurology and Experimental Neurology, Charité, Universitätsmedisin Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany.
Gregory S DayDepartment of Neurology, Mayo Clinic, Jacksonville, FL, USA.
Carsten FinkeDepartment of Neurology and Experimental Neurology, Charité, Universitätsmedisin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
Adam E HandelNational Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre, Oxford Health NHS Foundation Trust, Oxford, UK; Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Sanjay G ManoharDepartment of Experimental Psychology, University of Oxford, Oxford, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Dan W JoyceDepartment of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mental health Research for Innovation Centre (M-RIC), University of Liverpool, and Mersey Care NHS Foundation Trust, Liverpool, UK.
Sarosh R IraniOxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA. Electronic address: irani.sarosh@mayo.edu.

Funding

Bio-RaPID: Biomarkers and Rates of Progression In Dementia.R01AG089380 · MAYO CLINIC JACKSONVILLE · 2025 to 2025
$2.3M
NIA NIH HHS K23 AG064029NIA NIH HHS R01 AG089380
6 · The paper itself

Abstract

backgroundN-methyl-D-aspartate receptor (NMDAR)-antibody encephalitis is a life-threatening neuropsychiatric disorder requiring prompt immunotherapy. The earliest features are mental-state changes, often mistaken for primary psychosis. Improved clinical differentiation could assist rational diagnostic investigation and expedite immunotherapy. Inspired by patients' and relatives' lived experience, we aimed to explore the psychiatric phenotype of NMDAR-antibody encephalitis and the features common to and distinct from real-world episodes of psychosis.

methodsIn this international, multicentre, retrospective phenotypic analysis we collected data on episodes of NMDAR-antibody encephalitis from specialised neurology services in Europe (UK, Germany, and Sweden) and the USA. For comparison, we collected similar data from de-identified accepted referrals to a UK early intervention in psychosis service, including consecutively presenting cases (unselected psychosis) and a group defined by having been assessed and admitted to hospital under the Mental Health Act (selected psychosis). Additionally, we included episodes of postpartum psychosis from a mother and baby unit in the Netherlands. In our mental-state inventory we included core features from ICD-11, the Bush-Francis catatonia score, and the Neuropsychiatric Inventory encompassing anxiety, depression, mania, schizophrenia, catatonia, and also more granular transdiagnostic behavioural features including those common to neuropsychiatric and neurobehavioural syndromes, such as delirium and dementia. Ethnicity data were not available. We compared and visualised the neuropsychiatric phenotype of these cohorts.

findingsWe collected data from 100 episodes of NMDAR-antibody encephalitis from 96 patients between 2010 and 2022 (median age 22 years, female:male ratio 3·80), 135 episodes of psychosis from 135 patients between 2018 and 2019 (median age 27 years, female:male ratio 0·75), and ten episodes of postpartum psychosis from ten patients between 2005 and 2012 (median age 30 years, all female sex). Psychopathology in NMDAR-antibody encephalitis was abundant (92 [92%] of 100 episodes) and ultra-rapid in onset (median 1 day [95% CI 1-1; IQR 1-7]) versus unselected primary psychoses (median 180 days [120-210; 91-365]; p<0·0001). 21 (36%) of 58 mental-state features, including catatonic and visual hallucinations, were over-represented in NMDAR-antibody encephalitis and 12 (21%) were under-represented, including features typical of affective (eg, elated mood, flight of ideas, grandiose delusions) and non-affective psychoses (eg, thought broadcasting, thought withdrawal, paranoid delusions; false discovery rate threshold <0·05). Typically, in NMDAR-antibody encephalitis, the complexity sequentially evolved from mood to psychotic to catatonic predominance within 2 weeks.

interpretationNMDAR-antibody encephalitis has a rapid-onset, complex, and dynamic neuropsychiatric phenotype, sufficiently distinctive to drive a clinical approach to differentiation.

fundingUK NIHR, Wellcome, and UK Medical Research Council (MRC)/UK Research and Innovation.

Indexed as

Anti-N-Methyl-D-Aspartate Receptor EncephalitisPsychotic DisordersAdolescentAdultEuropeFemaleHumansMaleMiddle AgedPhenotypeRetrospective StudiesYoung Adult

Identifiers

PMID41386901
PMCPMC13003407

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.