Subjective psychiatric symptoms in post-acute autoimmune encephalitis: findings from the Australian autoimmune...

This study examined self-reported psychopathology in patients with autoimmune encephalitis (AE), and explored their relationship with clinical outcomes as measured by the modified Rankin Scale (mRS) and Clinical Assessment Scale in Autoimmune Encephalitis (CASE) scores.

Eighty-seven AE patients (49.43% female, mean age = 54.47 years, SD = 17.84) from the Australian Autoimmune Encephalitis Consortium completed the SPECTRA-Indices of Psychopathology, time-matched with CASE and mRS scores within six months of the assessments.

On average, assessments occurred 12 months post-onset. Median CASE and mRS scores were 2, with 84.13% of patients scoring mRS ≤ 2. Mean SPECTRA scores were significantly elevated across multiple domains, indicating greater psychopathology, particularly in depression, post-traumatic stress, suicidal ideation, and cognitive functioning. Patients with seronegative AE exhibited more severe psychopathology compared to those with anti-N-methyl-D-aspartate receptor (NMDAR) and anti-leucine-rich glioma-inactivated 1 (LGI1) subtypes. Psychiatric diagnoses prior to AE onset were associated with worse outcomes, compared to those with no pre-existing psychiatric conditions and those diagnosed post-onset. The mRS and CASE scores each explained only a small amount of variance (7-26%) across SPECTRA domains, and adding the other score to the model provided only little improvement.

AE patients exhibit significant psychopathology across multiple domains, with significant internalising symptoms-including depression, post-traumatic stress, and suicidal ideation-as well as cognitive concerns, highlighting the considerable psychiatric burden in this population. Our findings highlight the need for systematic, timely assessments of psychological symptoms in AE, and the use of sensitive, comprehensive instruments to capture the full spectrum of their psychopathology.