Diagnosing Autoimmune Psychosis

Katlyn Nemani, MD, explores how autoimmune and inflammatory brain disorders can present as first-episode psychosis—and why some patients diagnosed with schizophrenia may actually have a treatable immune-mediated illness. She explains the clinical features that should prompt suspicion for autoimmune psychosis, including subacute onset, subtle neurologic signs, and poor response to antipsychotics, even when standard imaging and antibody tests are unrevealing.

Dr. Nemani also discusses the limits of current biomarkers, how to think clinically when diagnostic certainty is incomplete, and why early immunotherapy can dramatically alter outcomes. The conversation closes with a forward-looking discussion of emerging research suggesting that a meaningful subset of schizophrenia-like illness may ultimately be reclassified as autoimmune in origin.

Katlyn Nemani, MD, is a Research Assistant Professor in the Departments of Psychiatry and Neurology at NYU Grossman School of Medicine and a graduate of NYU’s combined Neurology-Psychiatry residency program.

▶️ Watch Insights on Psychiatry on YouTube

00:00 When Psychosis May Be an Autoimmune Disease
01:18 Early Psychiatric Symptoms of Autoimmune Encephalitis
02:47 Why Subtle Neurologic Clues Matter
04:00 A Case of Rapidly Reversible Psychosis
06:37 The Limits of Antibody Testing
07:51 Why Early Treatment Changes Outcomes
08:18 Rethinking the Heterogeneity of Schizophrenia
09:31 How Common Is Autoimmune Contribution to Psychosis?
10:48 Network-Level Brain Effects and Open Research Questions

This episode is intended for psychiatrists, neurologists, and other clinicians interested in psychosis, neuroinflammation, and complex diagnostic presentations at the psychiatry–neurology interface.

This discussion is for educational purposes and does not substitute for individual clinical judgment or patient care.

Senior Producer: Jon Earle