A Retrospective Case Series of Possible Autoimmune Encephalitis Primarily Presenting with Psychiatric Symptoms at a Tertiary Health Center in Gujarat, India

A Retrospective Case Series of Possible Autoimmune Encephalitis Primarily Presenting with Psychiatric Symptoms at a Tertiary Health Center in Gujarat, India

Background: Autoimmune encephalitis (AE) often presents with psychiatric symptoms and is frequently misdiagnosed as a primary psychiatric disorder, delaying effective treatment. Early recognition is crucial for improving outcomes. Methods: In this retrospective series of 29 patients, we analyzed clinical features including investigations (magnetic resonance imaging, Electroencephalogram (EEG), cerebrospinal fluid, and serum autoantibodies as available), responses to immunotherapy including pulse steroids, intravenous immunoglobulin (IVIG), and maintenance immunosuppressants. Results: Common features included depression (27.6%), psychosis (27.6%), catatonia (20.7%), seizures (24.1%), and cognitive decline (89.7%). Standard psychiatric treatment showed no response in 79.3% of cases. Following immunotherapy, 93.1% showed marked clinical improvement within 7–30 days; relapses occurred mainly after treatment discontinuation. Conclusion: Early immunotherapy, including in seronegative or atypical cases, was associated with substantial clinical improvement. These findings support considering AE in patients with atypical or treatment-resistant psychiatric presentations.