Below is some guidance for the use of clinicians interested in antibody testing and interpretation of a positive result

Advice for Clinicians

 

The findings from previous studies suggest that approximately 5-10% of patients presenting to NHS Early Intervention in Psychosis services are positive for autoantibodies against neuronal targets   (Lennox et al, 2016, Zandi et al, 2011). Clinical screening of as many patients as possible with acute psychosis symptoms presenting to psychiatrists would help to build a more accurate estimate. Patients can be tested either through participating in the PPiP2 study or clinically. We encourage clinicians to screen patients through PPiP2 and other research studies. Mental health NHS trusts participating in PPiP2 are listed here .

 

To request a blood test clinically, please visit this page. We recommend requesting for  NMDAR, LGI1 and GABA-A using live cell-based assays. In PPiP2 we are screening inpatients and outpatients with first episode of psychosis or relapse with psychosis symptom onset of the current episode within the last 2 years.

 

If positive autoantibodies are identified clinically or through PPiP2 then referral to a neurologist with a special interest in neuroimmunology is advised. We are conducting a double-blinded randomised controlled trial (SINAPPS2) which aims to test the efficacy and safety of IVIG and Rituximab treatment versus placebo of patients with antibody-associated psychosis. During the trial, study participants will continue with standard psychiatric care including antipsychotic medication as prescribed by their psychiatrist.

 

The SINAPPS2 trial neurologists are based in hospitals across England and clinicians are encouraged to consider referring adult patients with acute psychosis and anti-neuronal antibodies to hospitals listed below. The neurologist will make a clinical judgement on the probability of an underlying or evolving autoimmune encephalitis, often with the use of MRI brain imaging, EEG and spinal fluid examination. At present we advise immunotherapy for atypical cases with prominent cognitive dysfunction, seizures, movement disorder, refractory symptoms to conventional antipsychotic therapy and/or with supportive evidence of an autoimmune process including normal or abnormal MRI, inflammatory spinal fluid and/or slow EEG (see publications). A careful  clinical assessment with psychiatry, psychology and neurology involvement is advised for each patient, and other treatable causes (tumours, infection, metabolic causes) should be excluded.

 

There are currently five active SINAPPS2 sites located in different NHS acute hospitals across England.

Below there is the list of the sites recruiting for SINAPPS2. Clikc on the name of the hospital to be put in contact with the local SINAPPS2 staff:

 

Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust

 

John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust  

 

National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust

 

Royal Devon and Exeter Hospital, Royal Devon and Exeter NHS Foundation Trust

 

King’s College Hospital, King’s College Hospital NHS Foundation Trust