Encephalitis and schizophrenia: a matter of words

The two recent articles ^1,2 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. ¹ 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. ³ 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.