Measuring long-term psychiatric outcomes in post-acute autoimmune encephalitis

Area of Science:

• Neurology
• Psychiatry
• Immunology

Background:

• Autoimmune encephalitis (AE) can lead to long-term psychiatric complications.
• Comprehensive psychiatric evaluation is crucial for patients with post-acute AE.
• Assessing psychiatric outcomes in AE requires validated measurement tools.

Purpose of the Study:

• To compare the diagnostic performance of self-report psychiatric symptom measures against a structured clinical interview in post-acute AE patients.
• To identify optimal cutoff scores for self-report measures to improve accuracy in detecting psychiatric diagnoses in AE.

Main Methods:

• Compared sensitivity and specificity of Patient Health Questionnaire (PHQ-9), Profiles of Mood States-2 (POMS-2), and Generalized Anxiety Disorder 7-item (GAD7) against the Mini Neuropsychiatric Inventory (MINI).
• Utilized the Youden Index Method to determine new, optimized cutoff scores for self-report measures.
• Included 35 patients with post-acute AE, assessed a median of 3 years post-symptomatic onset.

Main Results:

• 71% of AE patients met criteria for a psychiatric diagnosis via the MINI.
• Standard cutoffs for PHQ-9, POMS-2, and GAD7 showed limited sensitivity (23-50%) and high specificity (80-91%) compared to the MINI.
• Optimized cutoffs (PHQ-9 ≥5, POMS-2 ≥50, GAD7 ≥3) improved accuracy but reduced specificity.

Conclusions:

• Self-report measures may lead to underrecognition of psychiatric sequelae in post-acute AE.
• Clinician-administered structured interviews are recommended for accurate psychiatric assessment in AE.
• The POMS-2, with adjusted cutoffs, may offer better validity for psychiatric symptom assessment in AE patients.