Study suggests psychiatric symptoms follow encephalitis

Survivors of encephalitis — an inflammation of the brain that can lead to permanent brain injury — are at a high risk of suicide and self-harm, according to new research. ¹

Doctors in Australia are urged to be encephalitis aware as the nation remains on high alert and at heightened risk of the neurological condition from ongoing heavy rainfall and flooding.

Two new papers, ‘Mental health outcomes of encephalitis, an international web-based study’ released by Encephalitis Society and Kings College London and ‘Suicidal thoughts and behaviours in Anti-NMDAR Encephalitis: Psychopathological features and clinical outcomes’ published in the Journal of Neuropsychiatry and Clinical Neurosciences, show almost 5% of encephalitis survivors surveyed (4.4%), have attempted to take their life, and almost 40% (37.5%) have had suicidal thoughts.¹ In those with autoimmune encephalitis, 12.5% of patients had suicidal behaviours during early stages of the illness with nearly half (5.83%) carrying out a suicide attempt.²

According to Dr Ava Easton, Chief Executive of the international charity, the Encephalitis Society, and one of the study authors, addressing the mental health impact is vital for ensuring encephalitis death rates and burden of disability are decreased.

“Our study found that psychiatric symptoms following encephalitis are common and highlight a need for increased provision of proactive psychiatric care for these patients and represent a call to action for increased research and mental health outcomes of encephalitis so that this patient group can be better supported,” Easton said.

The new research focused on all types of encephalitis including encephalitis following infection from common everyday viruses such as the COVID-19 virus, flu, measles, herpes simplex (cold sore virus), bacterial infection and autoimmune diseases. Many Australian encephalitis survivors continue to suffer from various types of encephalitis; however, flood-related Japanese encephalitis virus (JEV) and Murray Valley encephalitis (MVE) cases have recently been on the rise with JEV declared as a Communicable Disease Incident of National Significance since March 2022.³

As at 5 January 2023, there have been 45 human cases of JEV notified in Australia (from 1 January 2021), with 35 laboratory confirmed cases across New South Wales (14), Northern Territory (2), Queensland (2), South Australia (6) and Victoria (11), with seven deaths nationally.³

The Australian Capital Territory and Western Australia have not reported any JEV cases to date; however, continue to monitor the situation closely.^4,5 The risk of JEV in Tasmania is currently assessed as very low.⁶

The Kings College study involved 445 respondents from 31 countries and also highlighted that 53.3% of survivors reported poor access to mental health care, 47.2% reported initial misdiagnosis of psychiatric or physical illness (18.2 and 66.0% respectively) and 78.5% reported an ongoing hypersensitivity that further impacted their mental health following encephalitis.

“There is clearly a need for increased provision of mental health care for encephalitis survivors, and as we mark World Encephalitis Day today [22 February 2023], it’s important to not only bring encephalitis but also its associated mental health impact into discussion,” Easton said.

“Mental health issues, self-injurious thoughts and suicidal behaviours following encephalitis may occur for a number of reasons, including the direct biological effects on the brain during the early stages of encephalitis, the physical or psychological consequences of resulting disability, impaired self-image, limited social life, reduced financial security, dependency on others, pain, substance use or as an adverse effect of treatment.

Around 500,000 people globally are affected by encephalitis annually, equating to one person every minute. The illness leads to cognitive, physical or emotional difficulties including impaired memory, language problems, changes in decision-making, planning and organisation, personality changes, anxiety, depression, mood swings, fatigue, weakness and epilepsy among others.

Encephalitis can be life-threatening, killing up to 30% of those affected (mortality varies depending on cause). Globally, encephalitis is a leading brain health concern, with a higher incidence than multiple sclerosis, motor neurone disease, bacterial meningitis and cerebral palsy in many countries.

While the severity and symptoms of encephalitis can vary, they include flu-like illness, headache, drowsiness, uncharacteristic behaviour, inability to speak or control movement and seizures.

In order to shine a light on encephalitis, famous landmarks and buildings around the world will light up in red for World Encephalitis Day.

^{[1] Abdat Y et al. Mental health outcomes of encephalitis, an international web-based study. (This article is a preprint and has not yet been certified by peer review. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.).}

^{[2] Tellez-Martinez et al. Suicidal thoughts and behaviours in anti-NMDAR encephalitis: psychopathological features and clinical outcomes. Journal of Neuropsychiatry and Clinical Neurosciences. Feb 2023. Available Feb 22, 2023 at https://neuro.psychiatryonline.org/.}

^{[3] Australian Government Department of Health and Aged Care. Japanese Encephalitis Virus. 2023. Available at https://www.health.gov.au/health-alerts/japanese-encephalitis-virus-jev/japanese-encephalitis-virus-jev.}

^{[4] ACT Government. Japanese Encephalitis Virus. Available at https://www.health.act.gov.au/jev.}

^{[5] Government of Western Australia Department of Health. Japanese encephalitis: information for local government and industry. Available at https://ww2.health.wa.gov.au/Articles/J_M/Mosquitoes/Japanese-encephalitis.}

^{[6] Tasmanian Government. Japanese Encephalitis Virus. Available at https://www.health.tas.gov.au/publications/japanese-encephalitis-virus.}

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