scholarly journals Case Report: Severe Adolescent Major Depressive Syndrome Turns Out to Be an Unusual Case of Anti-NMDA Receptor Encephalitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Alexander Moldavski ◽  
Holger Wenz ◽  
Bettina E. Lange ◽  
Cathrin Rohleder ◽  
F. Markus Leweke
Keyword(s):  
Cognitive Deficits ◽  
Psychiatric Symptoms ◽  
Previous History ◽  
Rapid Onset ◽  
Depressive Syndrome ◽  
Psychotic Symptoms ◽  
Major Depressive ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Initial Symptoms

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory condition mediated by autoantibodies against the GluN1 subunit of the receptor. Clinically, it is characterized by a complex neuropsychiatric presentation with rapidly progressive psychiatric symptoms, cognitive deficits, seizures, and abnormal movements. Isolated psychiatric manifestations of anti-NMDAR encephalitis are rare and usually dominated by psychotic symptoms. We present a case of an 18-year-old female high school student—without a previous history of psychiatric disorders—with a rapid onset severe depressive syndrome. Surprisingly, we found pleocytosis and anti-NMDAR autoantibodies in the cerebrospinal fluid (CSF), despite an otherwise unremarkable diagnostic workup, including blood test, clinical examination, and cranial magnetic resonance imaging (MRI). After intravenous immunoglobulins treatment, a complete remission of the initial symptoms was observed. In a follow-up 5 years later, the young woman did not experience any relapse or sequelae. Anti-NMDAR encephalitis can present in rare cases as an organic disorder with major depressive symptoms without distinct concomitant psychotic or neurological symptoms. A clinical presentation such as a rapid onset of symptoms, distinct disturbance in the thought process, restlessness, and cognitive deficits should prompt screening for NMDAR- and other neural autoantibodies to rule out this rare but debilitating pathology.

Les manifestations psychiatriques dans la démence: perspective phénoménologique

1993 ◽  
Vol 38 (10) ◽  
pp. 671-677 ◽  
Author(s):  
Isabelle Paquette
Keyword(s):  
Major Depression ◽  
Cognitive Deficits ◽  
Clinical Characteristics ◽  
Depressive Symptomatology ◽  
Psychiatric Symptoms ◽  
Memory Loss ◽  
Psychotic Symptoms ◽  
Neuropsychological Evaluations ◽  
Operational Criteria ◽  
Psychiatric Manifestations

The study of psychiatric manifestations in dementia has long been overshadowed by the more classical manifestations of the disease, such as memory loss and other cognitive deficits. In recent years, however, psychiatric symptoms as part of the demential process have attracted interest and research has become more specific. Clinicians are faced with diagnostic, treatment and management difficulties related to affective or psychotic symptoms, which account for much distress and morbidity. Several studies indicate that the prevalence of psychiatric manifestations in clinical populations of patients suffering from dementia is high: 15% to 30% for hallucinations, 15% to 30% for delusions, ten percent to 20% for major depression and 40% to 50% for depressed mood. These figures tend to confirm the hypothesis that psychiatric features in dementia are neither infrequent nor atypical. Thus, researchers have sought to link psychotic or depressive symptomatology with several clinical characteristics of dementia, namely stage, severity, prognosis or cognitive dysfunction. Some recent studies involving extensive neuropsychological evaluations indicate that subgroups of patients can be defined according to psychiatric criteria, as well as cognitive or neurological criteria. Unfortunately, results are inconsistent. Some of the contradictions in the literature are related to poorly defined terms and symptoms, a lack of reliable operational criteria, absence of validation of instruments and scales and heterogeneity of the populations studied. Ambiguous syndromes, such as pseudodementia, while illustrative of certain clinical situations, have not been helpful in categorizing demented patients. The author suggests that research focused on specific and clearly defined psychiatric symptoms in dementia will better serve our comprehension of mixed syndromes.

Encephalopathy Resembling Creutzfeldt–Jakob Disease Following Oral, Prescribed Doses of Bismuth Nitrate

1991 ◽  
Vol 158 (2) ◽  
pp. 278-280 ◽  
Author(s):  
Michael J. Von Bose ◽  
Michael Zaudig
Keyword(s):  
Psychiatric Symptoms ◽  
Dose Range ◽  
Depressive Syndrome ◽  
Bismuth Nitrate ◽  
Panic Attacks ◽  
Recommended Dose ◽  
Close Attention ◽  
Major Depressive ◽  
Jakob Disease ◽  
Myoclonic Encephalopathy

A patient given bismuth nitrate in the recommended dose range over 16 months developed panic attacks and a major depressive syndrome and, after 15 months, a myoclonic encephalopathy resembling Creutzfeldt–Jakob disease. He recovered four months after bismuth had been discontinued. Bismuth preparations are becoming popular in the treatment of gastritis; close attention to neurological and psychiatric symptoms seems mandatory.

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- NMDAR Autoimmune Encephalitis Presenting as Acute Psychosis: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 59-61
Author(s):  
Bibek Rajbhandari ◽  
Minani Gurung
Keyword(s):  
Behavioral Change ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Autoimmune Disorder ◽  
Clinical Findings ◽  
Acute Psychosis ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Long Time ◽  
Autonomic Instability

Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with prominent psychiatric symptoms. Patients usually present with acute behavioral change, psychosis, catatonic symptoms, memory deficits, seizures, dyskinesias, and autonomic instability. We present a case of a 13-year old who presented with noticeably chirpiness, excessive talking with unknown people and wandering around the neighborhood without purpose.The main symptoms of the patient and the important clinical findings were irrelevant talking which later developed into slurring of speech, abnormal movements and memory loss.This case is an example of how easily we are misled towards diagnosis based on the present symptoms. The patient suffered the unnecessary stigma of a psychiatric illness, which might stay imprinted on her for a long time. In this report we call for attention to the inclusion of anti-NMDAR encephalitis in the differential diagnosis of acute psychosis. It adds on to show that NMDAR might present in the most unexpected and unpredictable ways, sometimes misleading the patient away from medical help.Prompt diagnosis is critical as early immunotherapy and tumor removal could dramatically affect outcomes.

scholarly journals Differences in Demographic and Clinical Characteristics of Patients With Depressive vs. Manic First Episode of Bipolar Disorder

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhonggang Wang ◽  
Yuying Cao ◽  
Yaya Zhu ◽  
Kunkun Li ◽  
Xianfei Jiang ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Characteristics ◽  
Psychiatric Symptoms ◽  
Education Level ◽  
Chinese Patients ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Clinical Variables ◽  
Depression Group ◽  
Initial Symptoms

Background: Bipolar disorder is a serious mental disease marked by episodes of depression, mania, hypomania, or mixed states. Patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to compare demographic and clinical variables based on a patient's first episode of bipolar disorder, including risk of recurrence over a 2-year period.Methods: A large cohort (N = 742) of patients with bipolar disorder in China was analyzed. Patients were divided into two groups according to their first episode of bipolar disorder, either depression or mania. Patients in mixed state first episode were classified based on predominant symptoms. Three hundred eighteen patients of the cohort had a first episode of mania and 424 patients had initial symptoms of depression. Demographic and clinical data were collected. All patients were followed up for 24 months. Data on compliance with follow-up appointments and recurrence of symptoms after 6, 12, 18, and 24 months were collected. Clinical characteristics (course of disease, age of onset, psychiatric family history, etc.) were compared between the mania group and depression groups.Results: More patients with bipolar disorder had a first episode of depression than mania (57.14 vs. 42.86%). Compared with the depression group, the mania group had later age of diagnosis of bipolar disorder [(38.64 ± 13.50) vs. (36.34 ± 14.94), P = 0.028], lower education level [(9.37 ± 4.34) vs. (10.17 ± 4.81), P = 0.017] and longer latency between an initial episode of psychiatric symptoms and formal bipolar diagnosis [(10.80 ± 10.76) vs. (8.85 ± 9.90), P = 0.012]. More patients in the mania group were male and without psychotic symptoms (all P < 0.05). In comparison with the mania group, more patients in the depression group were female, with higher frequency of a reported precipitating event before first mood episode (all P < 0.05). Compared with the depression group, the mania group had more recurrences of illness at the end of 12 months (Z =-2.156, P = 0.031), 18 months (Z =-2.192, P = 0.028), and 24 months (Z = −2.364, P = 0.018).Conclusions: In our study, there are a number of differences in demographic and clinical characteristics of patients with different onset syndromes of bipolar disorder. These differences include gender, education level, diagnosis age, the rate of recurrences, and others. These data of a cohort of Chinese patients add to the growing international literature on the relationship between index episode of bipolar disorder and clinical variables and outcomes. These results and further study may allow clinicians to offer patients and families more reliable prognostic information at the onset of disease.

scholarly journals M99. INVESTIGATING THE BEST PREDICTIVE CLINICAL FEATURES OF ANTI-N-METHYL-D-ASPARTATE RECEPTOR (NMDAR) ENCEPHALITIS IN THE 2010 AUSTRALIAN NATIONAL SURVEY OF HIGH IMPACT PSYCHOSIS (SHIP) COHORT

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S172-S173
Author(s):  
Susan Rossell ◽  
Denny Meyer ◽  
Cyndi Shannon Weickert ◽  
Andrea Phillipou ◽  
Cherrie Galletly ◽  
...  
Keyword(s):  
Machine Learning ◽  
Medical History ◽  
Clinical Features ◽  
Clinical Data ◽  
Psychiatric Symptoms ◽  
Learning Algorithm ◽  
Psychotic Symptoms ◽  
Gradient Boosting ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

Abstract Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, a recently reported autoimmune disorder, can be mistakenly diagnosed as a psychotic disorder, especially schizophrenia, as patients can present with prominent psychotic symptoms, in particular persecutory ideation, hallucinations and disturbed speech. In this study we used machine learning of the clinical data in a large cohort of persons with a positive psychosis history to ascertain whether we could predict NMDAR-positive cases, and which variables most accurately distinguished between NMDAR-positive and -negative cases. Methods SHIP collected nationally representative data from 1825 individuals with a psychotic illness. Plasma samples were available for n=472. To investigate the prevalence of NMDAR autoantibodies a recombinant indirect immunofluorescence test was performed (EuroImmun AG, Lübeck, Germany), with NMDAR transfected human embryonic kidney (HEK) 293 cells quantified using NIS Elements software. NMDAR-positive cases were estimated. Gradient boosting machine learning (the data were randomly split: 60% for initial ascertainment and 40% for validation) was subsequently performed using the clinical data available: 120 variables in total across various domains of sociodemographic, medical history, psychiatric diagnosis and current psychiatric symptoms. Only the variables found to have significant (or near significant) association with being NMDAR-positive were used to develop rules for identifying cases. Results There were 38 NMDAR-positive cases. They were more likely to be associated with a schizophrenia /schizoaffective and a depressive psychosis diagnosis, and less likely to be associated with a bipolar diagnosis, than antibody-negative cases. They were also more likely to be associated with a single episode with good recovery, and with anxiety symptoms and dizziness in the prior 12 months (which included light headedness, feeling faint and unsteady). For the present state symptoms, restricted affect was more likely to be present whereas poverty of speech was rare. Initial insomnia and a medical history that included epilepsy were not present for any of the NMDAR-positive cases. The machine learning algorithm was able to successfully classify 94% of cases to the correct antibody group. Discussion In this significant Australian epidemiological cohort, we have identified key clinical features associated with anti-NMDAR encephalitis, including diagnosis, and symptoms and clinical course. The novel and insightful analyses afforded by using machine learning should be replicated in other samples to confirm the important clinical findings reported in the current work.

The Effect of Clozapine on Cognition and Psychiatric Symptoms in Patients with Schizophrenia

1993 ◽  
Vol 162 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Terry E. Goldberg ◽  
Richard D. Greenberg ◽  
Suzanne J. Griffin ◽  
James M. Gold ◽  
Joel E. Kleinman ◽  
...  
Keyword(s):  
Problem Solving ◽  
Cognitive Deficits ◽  
Psychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Cognitive Disability ◽  
Memory Functions ◽  
Not Otherwise Specified ◽  
Level Problem ◽  
Attention Memory ◽  
Rate Limiting

Psychiatric symptoms and cognition were assessed in 13 patients with schizophrenia, one patient with schizoaffective disorder, and one patient with psychosis not otherwise specified while they received a conventional neuroleptic and again after an average of 15 months on clozapine. Despite improvements in psychiatric symptoms, attention, memory, and higher-level problem-solving were essentially unchanged. This suggests that certain cognitive deficits are relatively independent of psychotic symptoms in schizophrenia, and are probably central and enduring features of the disorder. Cognitive disability appeared to have been rate-limiting in the sample's rehabilitation, as patients' social and vocational adjustment remained marginal during the study. We also observed that treatment with clozapine was associated with a decline in some memory functions; the potent anticholinergic properties of the drug may have been responsible for this.

Psychiatric Symptoms As Onset of Anti-Nmdar Encephalitis

2016 ◽  
Vol 33 (S1) ◽  
pp. S525-S525
Author(s):  
M.C. Cancino Botello ◽  
A. Cercos López ◽  
V. Chavarria Romero ◽  
G. Sugranyes Ernest
Keyword(s):  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Autoimmune Disorder ◽  
Psychotic Symptoms ◽  
Nmdar Encephalitis ◽  
Clinical Presentations ◽  
Children And Young Adults ◽  
Competing Interest ◽  
Specific Symptoms

IntroductionEvery more often, there is evidence that shows a relationship between psychiatric symptoms and autoimmune disorders. Such is the case of anti-NMDAR encephalitis, in which it has been recently described the development of psychotic symptoms. Anti-NMDAR encephalitis is an autoimmune disorder that involves IgG autoantibodies against the NMDA receptor subunit GluN1. This last fact could support the relationship with the glutamatergic model of schizophrenia.ObjectiveTo conduct a current review to deepen the detection and management of anti-NMDAR encephalitis, due to the frequent existence of psychiatric symptoms at onset, which have contributed to the difficulty of diagnose.MethodSystematic review of the literature in English (PubMed), with the following keywords: “Autoimmune encephalitis”, “psychosis”, and “NMDA receptor”.ResultsAutoimmune encephalitis appears more frequently in children and young adults and it is characterized by a prodromal period, in which there usually are non-specific symptoms of headaches or fever. Next, it could progress to cognitive deficits, seizures, catatonic symptoms and psychosis. However, sometimes in the rarest clinical presentations, there is nothing but psychiatric symptoms at the onset of encephalitis, which leads to misdiagnose and lack of proper treatment. This fact has stimulated the curiosity of the psychiatry scientific community, since the anti-NMDAR encephalitis may mimic the glutamatergic model of schizophrenia.ConclusionsTo make an accurate and detailed diagnostic formulation in people with psychiatric symptoms as onset of any disorder is essential to determine whether it is a primary psychiatric disorder or symptoms associated to another disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals REMISSION OF TREATMENT RESISTANT SCHIZOPHRENIA FOLLOWING RESECTION OF OVARIAN TERATOMA: A CASE OF ANTI-NMDAR ENCEPHALITIS

2019 ◽  
Author(s):  
Su Tein Sim
Keyword(s):  
Psychiatric Symptoms ◽  
Poor Response ◽  
Neurological Deficits ◽  
Response To Treatment ◽  
Ovarian Teratoma ◽  
Treatment Resistant ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Brain Circuitry ◽  
High Index Of Suspicion

Objective: Ovarian teratoma has been frequently associated with Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis in recent years since its discovery by Dalmao in the year 2007. Most patients with anti-NMDAR encephalitis develop a multistage illness that progresses from psychosis, memory deficits, seizures, and language disintegration into a state of unresponsiveness with catatonic features often associated with abnormal movements, and autonomic and breathing instability. Milder or incomplete forms of the disorder in which patients develop predominant or apparently isolated psychiatric symptoms are uncommon. The overlap of symptomatology between anti-NMDAR encephalitis and schizophrenia often result in misdiagnosis. This case represents a forme fruste of ovarian teratoma related anti-NMDAR encephalitis which only presents with psychiatric and cognitive symptoms without obvious neurological deficits. Method: We report a case of a 37-year-old lady diagnosed with Treatment-Resistant Schizophrenia (TRS) who had a poor response to treatment despite multiple trials of antipsychotics and electroconvulsive therapy. Results: Our patient achieved remission following the excision of the ovarian teratoma and had been maintaining well with minimal psychotropic intervention. Conclusion: This case suggests that clinicians should always have a high index of suspicion for anti-NMDAR encephalitis in young women presenting with new-onset psychiatric symptoms and/or treatment-resistant psychosis. More research is needed to shed light on the exact role of NMDAR within the brain circuitry and the effects of its modulation in both Schizophrenia and anti-NMDAR encephalitis.

scholarly journals Effect of Lacticaseibacillus paracasei Strain Shirota on Improvement in Depressive Symptoms, and Its Association with Abundance of Actinobacteria in Gut Microbiota

2021 ◽  
Vol 9 (5) ◽  
pp. 1026
Author(s):  
Machiko Otaka ◽  
Hiroko Kikuchi-Hayakawa ◽  
Jun Ogura ◽  
Hiroshi Ishikawa ◽  
Yukihito Yomogida ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Gut Microbiota ◽  
Intestinal Permeability ◽  
Rating Scale ◽  
Psychiatric Symptoms ◽  
Daily Intake ◽  
Probiotic Strain ◽  
Major Depressive ◽  
Colony Forming Units ◽  
And Biological Markers

We previously reported lower counts of lactobacilli and Bifidobacterium in the gut microbiota of patients with major depressive disorder (MDD), compared with healthy controls. This prompted us to investigate the possible efficacy of a probiotic strain, Lacticaseibacillus paracasei strain Shirota (LcS; basonym, Lactobacillus casei strain Shirota; daily intake of 8.0 × 1010 colony-forming units), in alleviating depressive symptoms. A single-arm trial was conducted on 18 eligible patients with MDD or bipolar disorder (BD) (14 females and 4 males; 15 MDD and 3 BD), assessing changes in psychiatric symptoms, the gut microbiota, and biological markers for intestinal permeability and inflammation, over a 12-week intervention period. Depression severity, evaluated by the Hamilton Depression Rating Scale, was significantly alleviated after LcS treatment. The intervention-associated reduction of depressive symptoms was associated with the gut microbiota, and more pronounced when Bifidobacterium and the Atopobium clusters of the Actinobacteria phylum were maintained at higher counts. No significant changes were observed in the intestinal permeability or inflammation markers. Although it was difficult to estimate the extent of the effect of LcS treatment alone, the results indicated that it was beneficial to alleviate depressive symptoms, partly through its association with abundance of Actinobacteria in the gut microbiota.

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