Autoimmune Encephalitis in First Episode Psychoses: All Smoke and No Fire?

The discovery of patients with prominent psychosis and subacute decline in neurologic function associated with immunoglobulin G (IgG) autoantibodies against CNS NMDA receptors (NMDAR) established anti-NMDAR encephalitis as a novel cause of new-onset psychoses.1 Although patients may be severely affected at presentation (earning the moniker “brain on fire”), remarkable improvement is noted after early induction of appropriate immunotherapies.2 The importance of early treatment has highlighted the need to improve recognition of patients early in the disease course when psychiatric symptoms predominate and most patients are likely to meet criteria for first episode psychoses (FEP).