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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).

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Advice for clinicians

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 applying live-based assay or clinically (fixed assays). We encourage clinicians to screen patients through PPiP2 as live-based assays is more sensitive test (Cullen et al, 2021) and it is only available in PPiP2 study. Please email oxfordhealth.ppip@nhs.net to test patients with psychosis through PPiP2 study. To request a blood test (fixed assays) clinically, please visit this page. We recommend requesting tests for NMDAR, LGI1 and GABA-A.

In PPiP2 we are screening inpatients and outpatients with first episode of psychosis or relapse with at least one psychosis symptom and onset of the current episode within the last 2 years.

If anti-neuronal membrane 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 placebo-controlled trial (SINAPPS2 trial) 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 nine active SINAPPS2 sites located in NHS acute hospitals across England.

 

Antibody testing through PPiP2 study - JOIN HUNDREDS OF OTHER CLINICIANS IN THE UK AND START TESTING PATIENTS WITH PSYCHOSIS

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