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Autoimmune encephalitis often presents with psychiatric or cognitive symptoms, delaying diagnosis.

Many patients first present to psychiatry or other services because symptoms mimic common conditions.

Awareness must be balanced with careful testing to avoid harmful over-diagnosis and mistreatment.

Dr. Tom Pollak, Ph.D., MRCPsych, Reader in Immunopsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Scientific Advisory Panel Member, Encephalitis International.

Felicity Amberson-Jones, MSc, Research Assistant, Institute of Psychiatry, Psychology and Neuroscience, King's College London.

Autoimmune encephalitis doesn’t always announce itself—and when it doesn’t, patients pay the price. Autoimmune encephalitis is an immune-mediated inflammation of the brain. It tends to present in a number of recognisable patterns, but these patterns themselves can be quite varied and, problematically for doctors, these patterns are frequently more commonly seen in branches of medicine other than neurology. That means diagnosis can be tricky, and that in turn means that there can sometimes be a considerable delay between the time that the symptoms first come on and the time that the diagnosis is correctly made. This, of course, can result in delays in receiving the appropriate treatment, and as in many neurological diseases, the quicker that a patient gets the treatment they need, the better their outcomes will be on the other side.In autoimmune encephalitis, the immune system starts reacting to proteins involved in brain function. People can become acutely confused or frightened. They can develop seizures, abnormal movements, sleep disruption, changes in speech, or memory problems. In some cases, psychiatric symptoms dominate early: paranoia, hallucinations, bizarre beliefs, agitation, catatonia, behavioural change. Families often describe an abrupt shift in personality and reality-testing that........

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