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Encephalitis and schizophrenia: a matter of words

Published online by Cambridge University Press:  02 January 2018

Kieran O'Loughlin
Affiliation:
Louth Mental Health Service, Ardee, Co. Louth, Ireland. Email: kieran.oloughlin@ucd.ie
Paul Ruge
Affiliation:
Louth Mental Health Service, Ardee, Co. Louth
MacDara McCauley
Affiliation:
Louth Mental Health Service, Ardee, Co. Louth, Ireland
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2012 

The two recent articles Reference Lennox, Coles and Vincent1,Reference Barry, Hardiman, Healy, Keogan, Moroney and Molnar2 on the psychiatric manifestations of antibody-mediated encephalitis are important reminders that a well-informed differential diagnosis has far reaching implications for providing optimal patient care. It is indeed instructive to note that a marked recovery is possible with immunosuppressant therapy. Additionally, the need for close liaison with plasma exchange facilities, gynaecologists, neurologists and immunologists represents a novel departure for many practitioners, we presume. We did, however, have some concerns with the title of the Lennox et al editorial. Reference Lennox, Coles and Vincent1 Describing the encephalitis as a treatable cause of schizophrenia jarred a little. First, we were concerned that the editorial title could give the impression that other causes of schizophrenia are not treatable. This brings to mind another excellent editorial, by Williams et al. Reference Williams, Newton, Roberts, Finlayson and Brabbins3 They proposed that we should use the term ‘neuroleptic resistance’ as opposed to treatment resistance when discussing clozapine therapy to avoid therapeutic nihilism. Second, is what is being described schizophrenia or a schizophrenia-like illness? The ICD-10 4 states that ‘schizophrenia should not be diagnosed in the presence of overt brain disease.’ As neuroimaging progresses, this stipulation might no longer be tenable. Is it preferable to refer to this type of presentation as a psychosis? However, these are minor quibbles and we will certainly view initial psychotic presentations differently as a consequence of these two important contributions to the psychiatric literature.

References

1 Lennox, BR, Coles, AJ, Vincent, A. Antibody-mediated encephalitis: a treatable cause of schizophrenia. Br J Psychiatry 2012; 200: 92–4.Google Scholar
2 Barry, H, Hardiman, O, Healy, DG, Keogan, M, Moroney, J, Molnar, PP, et al. Anti-NMDA receptor encephalitis: an important differential diagnosis in psychosis. Br J Psychiatry 2011; 199: 508–9.CrossRefGoogle ScholarPubMed
3 Williams, L, Newton, G, Roberts, K, Finlayson, S, Brabbins, C. Clozapine-resistant schizophrenia: a positive approach. Br J Psychiatry 2002; 181: 184–7.CrossRefGoogle ScholarPubMed
4 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.Google Scholar
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