Although Autoimmune Encephalitis (AE) is a neurological disorder, we all know that there is a large mental health aspect to the illness. From mild psychosis to patients who end up in the Psychiatric system instead of the medical system. We all have our stories to tell, some suffer from mental health issues more than others depending on the type of autoimmune encephalitis one has and the level of severity.  With adults, psychosis is a prominent symptom at the beginning of the disease and with children seizures play a dominant role in symptom onset.  Recent research has uncovered that genetics plays a role in LGI1 limbic encephalitis.  The type of antibody you have has distinct symptoms and syndromes that occur.  

All I know for sure is that most of us as caregivers or warriors have dealt with some form of mental health issue. According to the National Institute for Mental Health (NIMH) Fact sheet on First Episode Psychosis (FEP), the word Psychosis is used to describe conditions that affect the mind, where there has been some loss of contact with reality. Psychosis can be a symptom of a mental illness or a physical condition. There lies a major problem for us neurologically challenged warriors as so many uneducated doctors make the mistake of assuming the former and not considering the later. Psychosis can include visual, auditory and tactile hallucinations. Also smell and taste can be involved. I often felt like I had a mask or web on my face, when I wasn’t hearing voices or seeing the color peach in blobs everywhere I looked. FEP can also include paranoia and delusions. Delusions are when you believe in something that is not real even when presented with the facts. Disordered thoughts and speech can also be included in the term psychosis. My tip for surviving FEP is to make sure that your loved ones and those around you understand that you are not dangerous and how they are expected to respond.

Tips for loved ones based on my nursing training and personal experience.

 • Don’t overreact. The victim of Psychosis can pick up on your emotions, if you panic so will they. Don’t take anything said in this state personally.

• Listen non-judgmentally, the feelings are real. Ask “What can I do to help” or “Can you tell me more”. DO NOT dispute your loved ones ‘reality’. This is all ‘real’ to them. You can say that you do not hear or see what the person is experiencing.

• Speak slowly and simply, ask one question at a time. DO NOT treat them as if they are not in the room if speaking to someone else. The person in psychosis can hear you through their delusion and this behavior may lead to paranoia.

• Don’t threaten, especially if dealing with a child, although adults should not be treated this way either. The behavior is not intentional or bad. Stay at eye level don’t hover over the person in psychosis as this may present you as a threat.

• Stay positive and reinforce that they are receiving help. Keep yourself positive and comforting. Above all believe your loved one. What they are experiencing is real to them and no amount of denial on your part will change that and only serve to alienate you to them.

The other major mental health issue for AE warriors is depression. Depression occurs as a part of AE. The autoimmune attack on the brain causes the chemical imbalance that results in AE. You are not just depressed because you have a rare chronic disorder. Why is this distinction important? Because the cure for the depression is curing or controlling the AE. Antidepressant medications can help short term while the autoimmune system is being controlled but should not be necessary long term. Although some people do experience primary depression after the AE is controlled because they have a chronic illness.  Be aware that some of the medication taken for secondary effects of AE can cause the chemical imbalance. However, it is an important distinction in the acute phase of the disorder.  that are prescribed for psychosis should be avoided with autoimmune encephalitis, especially in the cases on anti-NMDAr encephalitis.

The NIMH recognizes several types of depression but the most common type that presents with AE is Psychotic Depression, mixing some form of psychosis with depressed mood. Most often the delusions take the form of depressive subjects. Such as poverty, illness or guilt especially over illness. We have had a few members with autoimmune encephalitis who have committed suicide, so if you feel like harming yourself talk to someone immediately.  If you are a care giver,  watch your warrior closely for signs that depression may include thoughts of self-harm. The usual treatment for AE induced FEP and depression is IV steroids which are then tapered after a steroid sparing agent has been brought to full dose and effectively supporting the patient by suppressing the immune system.  Short term anti-depressants and anti-psychotics may be used to alleviate symptoms until immunosuppression has been achieved.

However, the NIMH does offer some tips that may help with depression during treatment.

• Try to be active and exercise as this increases blood flow to the brain.

• Set realistic goals for yourself.

• Try to spend time with other people and confide in a trusted friend or relative.

• Try not to isolate yourself and let others help you.

• Expect your mood to improve gradually not immediately. Report feelings of self-harm to someone immediately.

• Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better.

• Discuss decisions with others who know you well and have a more objective view of your situation.

• Continue to educate yourself about depression. (I would add also about AE.)

To sum up, while these mental health issues are an aspect of AE and not separate from the disorder and while short term medications may relieve symptoms while waiting for the immune system to become suppressed, the only real fix is to fix the AE.