Anti-LGI-1 limbic encephalitis, the second most common autoimmune encephalitis, typically presents with psychotic symptoms. However, systematic characterization of psychotic features in this disease remains scarce, with insufficient granularity in existing symptom descriptions. This systematic review aims to characterize the psychotic manifestations in anti-LGI-1 encephalitis through a comprehensive analysis of published cases and institutional data.

Following PRISMA guidelines, we systematically searched PubMed, Embase, and Web of Science for case reports of anti-LGI-1 encephalitis, specifically focusing on cases with confirmed diagnoses and psychotic symptoms. Additionally, clinical data from patients diagnosed with anti-LGI-1 encephalitis and admitted to Shanxi Medical University First Hospital between January 2018 and June 2024 who also exhibited psychotic symptoms were collected. The data were then classified and statistically analyzed to assess patient characteristics.

31articles and 24 clinical cases were found, leading to 74 cases that met the inclusion criteria. Among these, 59.46 % of patients showed initial psychotic symptoms during their illness. Common positive symptoms included hallucinations, delusions, and delirium presenting with disorganized speech, while negative symptoms often involved apathy/indifference, depression, and catatonia-related physical issues. Sleep disturbances were also common.

When a patient presents with an unexplained alteration in mental status, the potential diagnosis of anti-LGI-1 encephalitis must be considered. This consideration facilitates timely and accurate diagnosis for patients suffering from anti-LGI-1 encephalitis, ultimately enhancing their prognosis.