Voltage-gated potassium channel blanket testing in first-episode psychosis: Diagnostic nihilism?

Author:

Chan Fiona1,O’Gorman Cullen123,Swayne Andrew23,Gillis David45,Blum Stefan123,Warren Nicola36ORCID

Affiliation:

1. Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia

2. Mater Centre for Neurosciences, Mater Hospital Brisbane, Brisbane, QLD, Australia

3. School of Medicine, The University of Queensland, Brisbane, QLD, Australia

4. Queensland Pathology, Brisbane, QLD, Australia

5. Immunology Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia

6. Metro South Addiction and Mental Health, Princess Alexandra Hospital, Brisbane, QLD, Australia

Abstract

Objective: Voltage-gated potassium channel antibodies are implicated in limbic encephalitis and currently included in first-episode psychosis organic screening guidelines. Individuals with high-positive voltage-gated potassium channel titres most commonly present with neurological symptoms as well as sleep, cognitive, behaviour, psychosis and mood disturbance. The significance of low-positive voltage-gated potassium channel antibody titres in psychiatric patients is unclear and has not been previously examined. We aim to describe a statewide cohort of psychiatric patients with low- and high-positive voltage-gated potassium channel titres and explore if this finding influenced clinical management and patient outcomes. Methods: A retrospective review of all voltage-gated potassium channel antibodies testing performed in public psychiatric services in Queensland, Australia, with comparison of the clinical presentation and long-term outcomes of low- and high-positive voltage-gated potassium channel titre cases. Specific antigen targets (leucine-rich glioma-inactivated protein 1 and contactin-associated protein 2 antibodies) were also assessed. Results: The overall prevalence of voltage-gated potassium channel antibody positivity in Queensland, public, psychiatric service testing was 0.3% (14/4098), with 12 cases of low-positive voltage-gated potassium channel titre, 2 cases of high-positive (leucine-rich glioma-inactivated protein 1 antibody positive) cases and a voltage-gated potassium channel negative contactin-associated protein 2 antibody positive case. No low-positive case developed neurological abnormalities or had abnormal paraclinical investigations. In comparison, both high-positive voltage-gated potassium channel/leucine-rich glioma-inactivated protein 1 cases and the contactin-associated protein 2 antibody positive case rapidly developed neurological symptoms, had abnormal paraclinical testing and improved only with immunotherapy. There was no later development of encephalitic symptoms in the low-positive cases over an average of 1067 days follow-up. Conclusion: Voltage-gated potassium channel antibody–associated limbic encephalitis was rare, and always associated with high antibody titres. Low-positive titres were not associated with the development of encephalitis over a long period of follow-up. The value of universal voltage-gated potassium channel antibody screening is unclear, and further prospective studies in first-episode psychosis populations are required.

Publisher

SAGE Publications

Subject

Psychiatry and Mental health,General Medicine

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