Autoimmune Encephalitis, Autoimmune Encephalopathy and Mild Encephalitis-new challenges for psychiatry

Prof. Karl Bechter


Since the discovery of a variety of CNS autoantibodies, which continues to be emerging, an increasing subgroup of patients with unexplained neurological psychiatric syndromes is attributed to CNS autoimmunity. It is also established now that a number of environmental factors including diet are important risk factors for severe mental illness of various types, including depression bipolar disorder and schizophrenia spectrum. The onset of disease seems related, at least in an emerging subgroup, to mild neuroinflammation as proposed in the mild encephalitis hypothesis (Bechter 2001). Part of these cases with exclusive psychiatric syndromes or with neuropsychiatric syndromes are now diagnosed as autoimmune encephalitis with CNS autoantibodies or all mild encephalitis or immune encephalopathy with or without CNS autoantibodies. Treatment with cortisone, immuneglobulines, plasmapheresis or various immune modulating therapies are used with considerable therapeutic success.

Diagnostic methods including neuroimaging, CSF analysis, autoantibody and other parameters determination are important clinical means to identify this new diagnostic subgroup in psychiatric samples.