Brain relevant antibodies, such as anti-NMDAR antibodies, have been associated with autoimmune encephalitis, which can present with psychiatric symptoms, including psychosis. However, clinical presentations vary greatly, and none are pathognomonic of an autoimmune encephalitis. Further, autoimmune disorders, and indeed infections and other conditions, can present with psychiatric features. Reciprocally, antipsychotics themselves have effects on the immune system. Rates of true autoimmune encephalitides are relatively low in people with long-standing psychotic illnesses, but they do exist. Dr Tom Pollak will present his latest research in this field along with guidance on decision making in clinical practice.
The assessment and management of psychotic disorders in later life is complicated by co-morbid conditions, drug interactions and age-related changes in speed of metabolism. In her talk, entitled, Managing complex psychosis across the age range - can we individualise treatment? Professor Suzanne Reeves will present the existing evidence on this complexity. She will also present her research on the relative importance of the effects of age, sex, smoking status and ethnicity on clozapine pharmacokinetics, and how to use this knowledge to improve the safety of clozapine prescribing.
In his talk, Point of care blood testing for clozapine FBC and levels, Professor James MacCabe will summarise the latest evidence on point of care testing options for haematological monitoring and dose finding, and present recent evidence on the relevance of haematological tests in prevention of adverse outcomes on clozapine. For a third of people with schizophrenia, clozapine is the treatment of choice, but some groups experiences challenges in access, monitoring and /or dose refinement.
Learning objectives
In this session you will:
- Gain understanding of the pharmacokinetics of prescribing for psychosis in later life
- Learn of the various ways in which immunological changes can affect mental state, and understand how to apply this knowledge in practice
- Gain understanding of the relationship between psychotic illnesses and obsessional compulsive symptoms, and in particular the complex interaction with clozapine.
Speakers
Chair: Professor Fiona Gaughran, National Psychosis Unit, South London and Maudsley Trust, London, Institute of Psychiatry, Psychology and Neuroscience, London
Professor Suzanne Reeves, University College London, London
Dr Thomas Pollak, Institute of Psychiatry, Psychology and Neuroscience, London, South London and Maudsley Foundation Trust, London
Professor James MacCabe, National Psychosis Unit, South London and Maudsley Trust, London, Institute of Psychiatry, Psychology and, Neuroscience, London
Availability
This webinar is part of the Congress webinar 2025 package. If you attended all four days of Congress, you will have access to these as part of your Congress package. Otherwise the Congress webinar 2025 package can be purchased below.
