scholarly journals Psychiatric Symptoms of Patients With Anti-NMDA Receptor Encephalitis

2020 ◽  
Vol 10 ◽  
Author(s):  
Wei Wang ◽  
Le Zhang ◽  
Xiao-Sa Chi ◽  
Li He ◽  
Dong Zhou ◽  
...  
Keyword(s):  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Nmda Receptor Encephalitis

Frequency and temporal sequence of clinical features in adults with anti-NMDA receptor encephalitis presenting with psychiatric symptoms

2018 ◽  
Vol 49 (16) ◽  
pp. 2709-2716 ◽  
Author(s):  
Ronald J. Gurrera
Keyword(s):  
Nmda Receptor ◽  
Clinical Features ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Signs And Symptoms ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Unexplained Fever ◽  
Study Inclusion

AbstractBackgroundAnti-NMDA receptor (NMDAr) encephalitis is the most common autoimmune encephalitis in adults. It mimics psychiatric disorders so often that most patients are initially referred to a psychiatrist, and many are misdiagnosed. Without prompt and effective treatment, patients are likely to suffer a protracted course with significant residual disability, or death. This study focuses on the frequency and chronology of salient clinical features in adults with anti-NMDAr encephalitis who are likely to be first evaluated by a psychiatrist because their presentation suggests a primary psychiatric disorder.MethodsA systematic search of PubMed and EMBASE databases identified published reports of anti-NMDAr encephalitis associated with prominent behavioral or psychiatric symptoms. After eliminating redundancies, the frequencies and relative timing of clinical features were tabulated. Signs and symptoms were assigned temporal ranks based on the timing of their first appearance relative to the first appearance of other signs and symptoms in each patient; median ranks were used to compare temporal sequencing of both individual features and major symptom domains.ResultsTwo hundred thirty unique cases (185 female) met study inclusion criteria. The most common features were seizures (60.4%), disorientation/confusion (42.6%), orofacial dyskinesias (39.1%), and mutism/staring (37.4%). Seizures, fever, and cognitive dysfunction were often the earliest features to emerge, but psychiatric features predominated and sequencing varied greatly between individuals.ConclusionsClinicians should consider anti-NMDAr encephalitis when new psychiatric symptoms are accompanied by a recent viral prodrome, seizures or unexplained fever, or when the quality of the psychiatric symptoms is unusual (e.g. non-verbal auditory hallucinations).

scholarly journals Anti-NMDAR Encephalitis: Higher Suspicious Needed for Earlier Diagnosis (Case Report, Literature Review and Diagnostic Criteria)

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Chanaka Amugoda ◽  
Noushin Chini Foroush ◽  
Hamed Akhlaghi
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Health Assessment ◽  
Young Patients ◽  
Psychotic Episode ◽  
Acute Psychosis ◽  
Nmda Receptor Encephalitis ◽  
Immune Mediated

Background. Auto-immune mediated anti-NMDA receptor encephalitis is a very common delayed diagnosed encephalitis which predominately affecting young population. Objectives. This encephalitis is relatively unknown amongst emergency physicians and a majority of patients are admitted to psychiatric wards before their diagnosis is confirmed and appropriate treatments are commenced. We reported a case of a 22-year-old female presented to our emergency department with acute psychiatric symptoms. She was initially diagnosed with first presentation of acute psychosis and was hospitalised under mental health act. further assessment in the emergency department identified possible an organic cause for her acute psychosis and she was later admitted under medical team after her mental health assessment order was revoke. Several days later, her CSF result was positive with anti-NMDA receptor anti-bodies. Appropriate treatments were instituted leading to her full recovery. Conclusion. This case was the first confirmed anti-NMDA receptor encephalitis in our emergency department. It highlights the importance of thorough assessment of psychiatric presentations to emergency departments and consideration of auto-immune medicated encephalitis as one of the differential diagnosis in young patients presenting with first acute psychotic episode.

scholarly journals A 24-Year-Old Female With Anti-NMDA Receptor Encephalitis: A Case Report.

2020 ◽  
Author(s):  
Antoine Steeman ◽  
Ionut-Adrian Andriescu ◽  
Guy Mazairac
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Delayed Diagnosis ◽  
Young Patients ◽  
Tumour Resection ◽  
Female Ratio ◽  
Nmda Receptor Encephalitis ◽  
Initial Symptoms

Abstract Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a form of autoimmune encephalitis with paraneoplastic and nonparaneoplastic origin. Patients with this disease usually arrive at the intensive care unit without any diagnosis or with complications as a result of a delayed diagnosis. This disease is not well known and is underdiagnosed. Due to the variability of the initial symptoms and the lack of knowledge regarding these symptoms, anti-NMDA receptor encephalitis is not only underdiagnosed but also can be misdiagnosed as viral encephalitis or other pathologies. Anti-NMDA receptor encephalitis preferentially affects children (from 8 months) and young adults, and it has a male/female ratio of 1/4. In case of clinical suspicion, electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) are useful. The diagnosis is confirmed by the detection of IgG antibodies directed against NMDA receptors in serum and CSF. Treatment for this disease includes immunosuppression and tumour resection when indicated.Case presentation: We report the case of a 24-year-old female admitted to the emergency room following the onset of acute confusion. Due to the rapid deterioration of consciousness and swallowing disorders, the patient was transferred to the intensive care unit. On day 23 after presentation, MRI suggested autoimmune limbic encephalitis. Serologic and CSF results were positive for anti-NMDA antibodies. After IV methylprednisolone therapy and plasmapheresis and a second line therapy with corticosteroid therapy and mycophenolic acid, the patient’s clinical condition gradually improved.Conclusions: Anti-NMDA receptor encephalitis typically occurs in young patients with no history of acute psychiatric symptoms. The possibility of this pathology should be taken into account before diagnosing a patient with a psychiatric illness.

Anti-NMDA-receptor encephalitis: aethology of psychiatric symptoms in young women

2011 ◽  
Vol 26 (S2) ◽  
pp. 876-876
Author(s):  
E. Marin Diaz-Guardamino ◽  
L. Larrañaga Rementeria ◽  
I. Hervella Garces ◽  
T. Aldasoro Carcedo ◽  
J. Fernandez Bilbao ◽  
...  
Keyword(s):  
Nmda Receptor ◽  
Young Women ◽  
Language Impairment ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Initial Assessment ◽  
Nmda Receptor Encephalitis ◽  
Women And Girls ◽  
Receptor Antibodies ◽  
Rule Out

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.

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

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.

scholarly journals Anti-NMDA receptor encephalitis: an important differential diagnosis in psychosis

2011 ◽  
Vol 199 (6) ◽  
pp. 508-509 ◽  
Author(s):  
Helen Barry ◽  
Orla Hardiman ◽  
Daniel G. Healy ◽  
Mary Keogan ◽  
Joan Moroney ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Nmda Receptor ◽  
Initial Phase ◽  
Psychiatric Symptoms ◽  
Previous History ◽  
Brain Biopsy ◽  
The Other ◽  
Nmda Receptor Encephalitis ◽  
Important Differential Diagnosis ◽  
History Of

SummaryWe present four cases of confirmed anti-NMDA receptor encephalitis; three presented initially with serious psychiatric symptoms and the other developed significant psychiatric symptoms during the initial phase of illness. Brain biopsy findings of one patient are also described. Psychiatrists should consider anti-NMDA receptor encephalitis in patients presenting with psychosis and additional features of dyskinesias, seizures and catatonia, particularly where there is no previous history of psychiatric disorder.

P06.4 Isolated psychiatric symptoms in anti-NMDA receptor encephalitis

2011 ◽  
Vol 15 ◽  
pp. S55
Author(s):  
S. Lebon ◽  
C. Mayor-Dubois ◽  
I. Popea ◽  
C. Poloni ◽  
N. Selvadoray ◽  
...  
Keyword(s):  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Nmda Receptor Encephalitis

scholarly journals Anti-NMDA receptor encephalitis: An emerging differential diagnosis in the psychiatric community

2016 ◽  
Vol 6 (6) ◽  
pp. 297-303
Author(s):  
Taylor A. Nichols
Keyword(s):  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Tumor Resection ◽  
Significant Proportion ◽  
Clinical Manifestations ◽  
Disease Awareness ◽  
Nmda Receptor Encephalitis ◽  
Health Community ◽  
Autonomic Instability ◽  
New Diagnosis

Abstract Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a new diagnosis, as recent as 2007, that develops as a result of autoantibodies to the NMDA receptor. The clinical manifestations of the disorder include complex psychiatric symptoms, seizures, movement disorders, cognitive dysfunction, and autonomic instability. Tumor resection, if present, and immunotherapy are the mainstays of therapy. Treatment should be initiated early and aggressively as it has been associated with better patient outcomes. A significant proportion of patients with anti-NMDA receptor encephalitis initially seek the help of a psychiatrist, highlighting the importance of its recognition within the mental health community. In an effort to promote disease awareness, this article will review a patient case and the pathophysiology, clinical presentation, diagnosis, and management of anti-NMDA receptor encephalitis.

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