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BackgroundAntineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.AimsTo examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.MethodIndividuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.ResultsOf 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.ConclusionsA small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.Declaration of interestNone.

'Paediatric bipolar disorder' rates are lower than claimed -a reexamination of the epidemiological surveys used by a meta-analysis 2011, 72, 1250) claimed that the prevalence of PBD was similar to adults at 1.8% with no difference between the United States and other countries. This conclusion has been highly cited. Methods: The heterogeneous nature of the original 12 epidemiological surveys warrants a qualitative analysis, rather than statistical meta-analysis as performed by Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250. Thus, the meta-analysis and each of the 12 studies (six from the United States; six from other countries) were reexamined. Results: Most of the 12 surveys predated the emergence of the PBD hypothesis. The 12 surveys were mainly of adolescents and at times young adults with few prepubertal children. Prevalence rates in the 12 studies suggest a lower rate of bipolar disorder, especially in non-US samples. For example, the Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250 meta-analysis chose a rate of 2.8% by summation of adolescent and parent responses in a Dutch survey, however the rate fell to 0% if requiring concordance of adolescent and parent responses. Indeed, it could be argued that four of the non-US studies show 0% rates of PBD. Conclusions: Rates of PBD were generally substantially lower than 1.8%, particularly in non-US surveys, and if both parent and adolescent reports were required to meet the diagnostic threshold they fell to close to zero. The reanalysis suggests that bipolar disorder is rare before the expected age of onset in later adolescence. Key Practitioner Message• A highly cited meta-analysis of the epidemiological studies covering 'ages 7 to 21-years-old' concluded that PBD was equally prevalent in the United States and elsewhere at 1.8%, suggesting PBD may be underdiagnosed and undermedicated outside the United States.• Our reexamination of the original 12 community epidemiological surveys reveals few studies included children, heterogeneous methodology unsuited to statistical meta-analysis, and lower rates of bipolar disorder especially outside the United States.