Largest-ever review calls for integrated mental health care after encephalitis

A major paper identifying mental health consequences of encephalitis has been published by researchers including members of Encephalitis International’s Scientific Advisory Panel (see below for further information), and its CEO Dr Ava Easton MBE.

Background

While advances in diagnosing and managing encephalitis in the clinic have reduced mortality in the last few decades, major consequences for the quality of life persist long after the acute illness itself.

Medical record data have indicated significantly increased risk of psychiatric disorders following encephalitis, including bipolar and psychotic disorders. Yet despite these findings, scientists’ understanding of the long-term mental health outcomes following encephalitis has been relatively limited.

The research

The study, led by a team of scientists and clinicians at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, University of Oxford, and University of Liverpool, involved analysing data from over 100 studies involving more than 4,700 encephalitis survivors worldwide. Using advanced statistical techniques, they calculated the average rates of different symptoms and explored how these varied by cause, age, and other factors. The most comprehensive analysis of its kind, both infectious causes (such as herpes simplex virus and Japanese encephalitis) and autoimmune causes of encephalitis were included. Some of the key findings were:

• Around 27 per cent of survivors experienced depression.
• Both infectious and autoimmune forms of encephalitis showed similar rates of psychiatric problems.
• Changes in mood, however, were more frequent after infectious encephalitis.
• Heterogeneity was substantial, reflecting aetiologic, methodological, and demographic diversity in the included studies.
• The substantial heterogeneity highlights the need for consistent diagnostic criteria and the development of a standardised mental health outcome set to improve both care and research.
• Psychiatric sequelae following encephalitis occur at rates comparable to neurological complications.

The study was funded by the National Institute for Health and Care Research and has been published in the journal Brain Communications.

Dr Cameron Watson, the study’s lead author and MRC Clinical Research Teaching Fellow at the IoPPN, said:

“Encephalitis doesn’t end when patients leave hospital. Many people experience difficulties with their mental health, including depression and anxiety as well as changes to their personality. The true scale of these problems, however, hasn’t been clear so we wanted to bring together all available evidence to understand just how common these psychiatric conditions are among survivors of encephalitis.”

The researchers

Some of the authors of the work are members of Encephalitis International’s Scientific Advisory Panel, which provides expert professional guidance to inform Encephalitis International’s research strategy, information resources, and support services. In addition to Encephalitis International’s CEO Dr Ava Easton MBE, the members of the scientific panel who were involved in this work are:

• Professor Benedict Michael, Chair of the Scientific Advisory Panel – Professor of Neuroscience, MRC Clinician Scientist and Honorary Consultant Neurologist Clinical Infection, Microbiology & Immunology.
• Dr Thomas Pollak, NIHR Clinical Lecturer at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London and a specialty trainee general adult psychiatrist at South London and Maudsley NHS Foundation Trust.

The full list of authors of the paper were:

Cameron J. Watson, Jack B. Fanshawe, Danish Hafeez, Katharine Lynch-Kelly, James Marsh, Yasmin Abdat, Hamish Hamilton, Dory A. Ghanem, Wafaa Mowlabaccus, Brendan F. Sargent, Hamilton Morrin, Ella Burchill, Cerian Jackson, Stephen McKeever, Belinda R. Lennox, Adam E. Handel, Benedict D. Michael, Ava Easton, Matthew Butler, and Thomas A. Pollak.

Conclusion

The authors call for prospective, long-term studies that track mental health outcomes using consistent, validated tools. They also urge the integration of neuropsychiatric expertise into standard care and the inclusion of patients with lived experience in research design.

Together, these steps could ensure that recovery from encephalitis is measured not only by physical survival, but by mental and emotional wellbeing.

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To read the full paper, click here.

To read our factsheet on mental health and encephalitis, click here.

To view our animation on mental health and encephalitis on YouTube click here.