Bean Paris, Heck Ashley, Habis Ralph, Sowmitran Swathi, Cartaina Zoe, Gupta Rajesh, Probasco John, Hasbun Rodrigo, Venkatesan Arun
Department of Medicine, Section of Infectious Disease, McGovern Medical School, UTHealth Science Center, Houston, Texas, USA.
Department of Neurology, Johns Hopkins Encephalitis Center, Johns Hopkin School of Medicine, Baltimore, Maryland, USA.
Ann Clin Transl Neurol. 2025 Feb;12(2):405-414. doi: 10.1002/acn3.52260. Epub 2025 Jan 7.
Encephalitis is a serious and potentially life-threatening condition of infectious or autoimmune cause. We aim to characterize the frequency and clinical spectrum of presenting psychiatric symptoms in encephalitis in order to inform earlier recognition and initiation of treatment.
This was a retrospective study of adult patients who met the 2013 International Encephalitis Consortium (IEC) and/or 2016 Graus criteria between February 2005 and February 2023. The study included two hospital systems in Houston, Texas, and Baltimore, Maryland and included a total of 642 patients. Psychiatric manifestations were grouped into five high-level categories: behavior, psychosis, mood, sleep disturbances, and catatonia.
In our cohort of 642 patients, 318 (49.6%) had psychiatric symptoms at the time of initial presentation, including 78.2% with autoimmune etiologies and 35.2% with viral etiologies (P < 0.001). Those with psychiatric symptoms were younger (median age 47.5 vs. 51.5; P < 0.001), and more likely to have a history of documented psychiatric disorders, as well as longer lengths of hospital stay, and poorer discharge outcomes. Of patients initially admitted to a psychiatric service (n = 28), most had autoimmune causes, although 3 out of 28 (10.7%) had herpes viral infections; admission to a psychiatric service was associated with substantially longer interval to initiation of antivirals and immunotherapy. Autoimmune and infectious etiologies differed in the spectrum and frequency of psychiatric manifestations.
Psychiatric symptoms are common across etiologies of encephalitis and are associated with longer lengths of hospital stay and worse clinical outcomes. Specific patterns and dimensionality of psychiatric symptoms distinguish autoimmune from infectious causes.
脑炎是一种由感染或自身免疫性病因引起的严重且可能危及生命的疾病。我们旨在描述脑炎患者出现精神症状的频率和临床谱，以便更早地识别并开始治疗。
这是一项对2005年2月至2023年2月期间符合2013年国际脑炎联盟（IEC）和/或2016年Graus标准的成年患者进行的回顾性研究。该研究纳入了得克萨斯州休斯顿和马里兰州巴尔的摩的两个医院系统，共642例患者。精神症状被分为五个高级类别：行为、精神病性症状、情绪、睡眠障碍和紧张症。
在我们的642例患者队列中，318例（49.6%）在初次就诊时出现精神症状，其中自身免疫性病因的患者占78.2%，病毒性病因的患者占35.2%（P<0.001）。有精神症状的患者更年轻（中位年龄47.5岁对51.5岁；P<0.001），更有可能有精神疾病记录史，住院时间更长，出院结局更差。最初入住精神科的患者（n = 28）中，大多数有自身免疫性病因，尽管28例中有3例（10.7%）有疱疹病毒感染；入住精神科与开始抗病毒和免疫治疗的间隔时间显著更长有关。自身免疫性和感染性病因在精神症状的谱和频率方面有所不同。
精神症状在脑炎的各种病因中都很常见，并且与更长的住院时间和更差的临床结局相关。精神症状的特定模式和维度可区分自身免疫性病因和感染性病因。
