Electroconvulsive therapy in a patient with positive anti-NMDA receptor antibodies presenting with isolated psychiatric symptoms: A case report

IntroductionAnti-NMDA-receptor encephalitis is subacute disorder that has been recently described in young women and girls who often present neuropsychiatric symptoms as first clinical features; thus, it is common that they receive an initial assessment, diagnose or even treatment by a specialist in Psychiatry.ObjectivesPresenting a case of Anti-NMDA-receptor encephalitis that was observed at our hospital and the steps taken from its initial assessment by Psychiatry to the final diagnose and treatment by Neurology, our objective is to describe this disorder in order to make it known to the specialists in Psychiatry.MethodsThe case is that of a 14 year old girl who presents altered behavior, bizarre delusions and auditory hallucinations with subacute onset. In psychiatric assessment it is noted that the patient presents fever, slight and language impairment: Medical and Neurological assessment are requested. The steps followed to rule out other disorders are presented. SPECT and the detection of specific anti-NMDA-receptor antibodies in serum were necessary for an accurate diagnose.ResultsThe detection of specific antibodies is necessary for the diagnose of Anti-NMDA-receptor encephalitis. NMDA receptors are ligand-gated cation channels with crucial roles in synaptic transmission and plasticity. Their alteration could be a pathogenic mechanism in disorders such as epilepsy, dementia and schizophrenia.ConclusionsAnti-NMDA-receptor encephalitis is a recently described clinical entity that should be taken in consideration to rule out other causes of subacute onset psychiatric symptoms in young women and girls. Its well-defined set of clinical characteristics should become familiar to the specialists in Psychiatry.

Download Full-text

Management And Psychiatric Manifestations Of Anti-NMDA Receptor Encephalitis, A Case Report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1946 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S525-S526

Author(s):

R. Gallego ◽

A. Flores

Keyword(s):

Case Report ◽

Nmda Receptor ◽

Psychiatric Symptoms ◽

Multidisciplinary Treatment ◽

Autoimmune Disorder ◽

Clonic Seizure ◽

Nmda Receptor Encephalitis ◽

Abnormal Movements ◽

Nmdar Encephalitis ◽

Psychiatric Manifestations

IntroductionAnti-NMDA receptor (NMDAR) encephalitis, formally recognized in 2007 by Dalmau et al, is an autoimmune disorder with a complex presentation that includes psychiatric symptoms, memory deficits, and autonomic instability. The exact incidence is unknown but age, gender, and ethnicity may all play a role. Presence of antibodies against the GluN1 subunit of the NMDAR in the CSF and serum confirm the diagnosis of NMDAR encephalitis.Case reportWe report the case of a previously healthy, 19-year-old woman, 6 weeks pregnant. She had a generalized tonic-clonic seizure followed by psychiatric symptoms, including insomnia, emotional lability, delusions, and disorganized behavior. During the course of the disease, she demonstrated speech impairments and catatonic features associated with abnormal movements.She was provided lorazepam 1 mg twice a day to treat her catatonic symptoms, her insomnia and her speech improved. Olanzapine was introduced, reaching a dose of 20 mg/day for managing psychosis and agitation.DiscussionNMDA-R encephalitis is a novel disorder with prominent psychiatric manifestations that is widely underdiagnosed. Neuroleptics may be helpful for managing psychosis and agitation, but may exacerbate movement abnormalities. Benzodiazepines are helpful for agitation, insomnia and catatonia associated with this condition.ConclusionEarlier recognition of this illness is crucial as prompt diagnosis and multidisciplinary treatment, can potentially improve prognosis. There is an increasing need for psychiatrists to become aware of the disorder and consider it in their differential diagnosis, specially in patients with new onset psychosis, history of encephalitis or subtle neurological symptoms. Careful selection of psychopharmacological interventions may reduce suffering.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Poster 348: Recovery from Malignant Catatonia with Electroconvulsive Therapy in a Child with Anti-NMDA Receptor Encephalitis: A Case Report

PM&R ◽

10.1016/j.pmrj.2018.08.017 ◽

2018 ◽

Vol 10 ◽

pp. S115-S115

Author(s):

Roger R. Wang ◽

Cheryl Benjamin

Keyword(s):

Case Report ◽

Nmda Receptor ◽

Electroconvulsive Therapy ◽

Nmda Receptor Encephalitis ◽

Malignant Catatonia

Download Full-text

Atypical Association of Autoimmune Limbic Encephalitis with Anti-NMDA Receptor Antibodies in a Young Male Patient: Clinical, Imaging, and Neuropsychological Characteristics

Case Reports in Neurology ◽

10.1159/000518195 ◽

2021 ◽

pp. 541-548

Author(s):

José Alberto Choreño-Parra ◽

Tania de la Rosa-Arredondo ◽

André Garibay-Gracián ◽

Ingrid Montes de Oca-Vargas ◽

Deyanira Capi-Casillas ◽

...

Keyword(s):

Nmda Receptor ◽

Limbic Encephalitis ◽

Psychiatric Symptoms ◽

Brain Mri ◽

Clinical Manifestations ◽

Memory Loss ◽

Autoimmune Encephalitis ◽

Young Male ◽

Autoimmune Limbic Encephalitis ◽

Receptor Antibodies

The spectrum of autoimmune encephalitis (AE) encompasses several entities characterized by a variable frequency of psychiatric symptoms, cognitive dysfunction, focal deficits, and seizures. Although patients with AE can be categorized in specific syndromes, overlapping manifestations are also common. Furthermore, atypical correlations between clinical phenotypes and autoantibody profiles could occur in rare cases. Here, we report the rare case of a young adult man attending due to new-onset seizures and a history of memory loss, autonomic disturbances, headache, behavioral changes, and visual and olfactory hallucinations. The patient was subjected to a complete diagnostic approach that included a comprehensive laboratory workup, neuropsychological testing, electroencephalogram, cerebrospinal fluid (CSF) analysis, brain MRI, and positron emission tomography/computed tomography scan that revealed a functional and structural compromise of the bilateral medial temporal lobes. Together with the clinical manifestations of the patient, these findings were compatible with the diagnosis of autoimmune limbic encephalitis (ALE). Strikingly, further analysis of the CSF showed autoantibodies against the N-methyl-D-aspartate (NMDA) receptor. We found very few cases of the co-occurrence of anti-NMDA receptor antibodies and nonparaneoplastic ALE in the literature, especially in male patients. Our report exemplifies the complicated differential diagnosis of ALE and adds clinical information of the association with anti-NMDA receptor antibodies.

Download Full-text

The effectiveness of electroconvulsive therapy for psychiatric symptoms and cognitive fluctuations similar to dementia with Lewy bodies: a case report

Psychogeriatrics ◽

10.1111/psyg.12465 ◽

2019 ◽

Vol 20 (2) ◽

pp. 229-231

Author(s):

Muneto Izuhara ◽

Sadayuki Hashioka ◽

Takeki Sato ◽

Hikaru Nishikoori ◽

Masahiro Koike ◽

...

Keyword(s):

Case Report ◽

Electroconvulsive Therapy ◽

Dementia With Lewy Bodies ◽

Psychiatric Symptoms ◽

Lewy Bodies ◽

Cognitive Fluctuations

Download Full-text

Anti-NMDA Receptor Encephalitis in a Patient with Previous Psychosis and Neurological Abnormalities: A Diagnostic Challenge

Case Reports in Psychiatry ◽

10.1155/2015/253891 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

R. David Heekin ◽

Maria C. Catalano ◽

Alfred T. Frontera ◽

Glenn Catalano

Keyword(s):

Nmda Receptor ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Memory Loss ◽

Autoimmune Disorder ◽

Diagnostic Challenge ◽

Manic Symptoms ◽

Nmda Receptor Encephalitis ◽

Autonomic Instability ◽

Receptor Antibodies

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune disorder characterized by IgG autoantibodies directed against the NR1 subunit of the NMDA glutamate receptor. Psychiatric symptoms are common and include psychosis, mania, depressed mood, aggression, and speech abnormalities. Neurological symptoms such as seizures, decreased responsiveness, dyskinesias, and other movement abnormalities and/or autonomic instability are frequently seen as well. We present the case of a woman who was followed up at our facility for over 14 years for the treatment of multiple neuropsychiatric symptoms. Initially, she presented with paresthesias, memory loss, and manic symptoms. Nine years later, she presented to our facility again, this time with left sided numbness, left eyelid droop, and word finding difficulties. Finally, five years later, she presented with manic symptoms, hallucinations, and memory impairment. During her hospitalization, she subsequently developed catatonic symptoms and seizures. During her stay, it was discovered that she was positive for anti-NMDA receptor antibodies and her symptoms responded well to appropriate therapy. This case demonstrates that it may be useful for clinicians to consider screening for anti-NMDA receptor antibodies in long-term patients with neuropsychiatric symptoms that have not adequately responded to therapy.

Download Full-text

15 - LATE-ONSET PSYCHOSIS WITH PERSISTENT POSITIVE ANTI-NMDA RECEPTOR ANTIBODIES: A CASE REPORT

10.26226/morressier.5d1a038457558b317a140de8 ◽

2019 ◽

Author(s):

Margarida Araújo ◽

Ana Samouco ◽

Filipa Caetano ◽

Andreia Norton ◽

Ana Paula Correia

Keyword(s):

Case Report ◽

Nmda Receptor ◽

Late Onset ◽

Receptor Antibodies

Download Full-text

Prevalence of anti-N-methyl-d-aspartate (NMDA) receptor antibodies in patients with schizophrenia and related psychoses: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s003329171300295x ◽

2013 ◽

Vol 44 (12) ◽

pp. 2475-2487 ◽

Cited By ~ 82

Author(s):

T. A. Pollak ◽

R. McCormack ◽

M. Peakman ◽

T. R. Nicholson ◽

A. S. David

Keyword(s):

Nmda Receptor ◽

Psychiatric Symptoms ◽

Meta Analysis ◽

Clinical Signs ◽

Psychotic Symptoms ◽

First Episode ◽

Antipsychotic Treatment ◽

Significant Heterogeneity ◽

Receptor Antibody ◽

Receptor Antibodies

BackgroundAnti-N-methyl-d-aspartate (NMDA) receptor encephalitis is an autoimmune condition caused by immunoglobulin (Ig)G antibodies directed against the NR1 subunit of the NMDA glutamate receptor. Approximately 65% of cases present with psychiatric symptoms, particularly psychosis. It remains to be established whether anti-NMDA receptor antibodies can cause a ‘purely’ psychotic illness without overt neurological symptoms.MethodWe conducted a systematic literature search to establish what proportion of patients with schizophrenia and related psychoses have antibodies directed against the NMDA receptor. Studies were included if (a) subjects had a diagnosis of schizophrenia, schizophrenia spectrum disorder or first-episode psychosis (FEP) using standard criteria, (b) serum was analysed for the presence of anti-NMDA receptor antibodies; and (c) the purpose of the study was to look for the presence of anti-NMDA receptor antibodies in patients with a primary psychiatric diagnosis without clinical signs of encephalitis.ResultsSeven studies were included, comprising 1441 patients, of whom 115 [7.98%, 95% confidence interval (CI) 6.69–9.50] were anti-NMDA receptor antibody positive. Of these, 21 (1.46%, 95% CI 0.94–2.23) patients were positive for antibodies of the IgG subclass. Prevalence rates were greater in cases than controls only for IgG antibodies; other subclasses are of less certain aetiological relevance. There was significant heterogeneity in terms of patient characteristics and the antibody assay used.ConclusionsA minority of patients with psychosis are anti-NMDA receptor antibody positive. It remains to be established whether this subset of patients differs from antibody-negative patients in terms of underlying pathology and response to antipsychotic treatment, and whether immunomodulatory treatments are effective in alleviating psychotic symptoms in this group.

Download Full-text