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

Abstract

We 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.

Predicting Risk and the Emergence of Schizophrenia

“…There are also behavioral changes, autonomic dysfunction, and impaired consciousness. 91 The combination of psychotic symptoms with catatonia and orofacial dyskinesias, which are indicators of dopaminergic involvement, are all consistent with the effects of the NMDA receptor antagonist, phencyclidine, which replicates many aspects of the presentation of schizophrenia. 92 It is also implicated in phencyclidine induced psychosis.…”

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A New Challenging Entity for Consultation-Liaison Psychiatrist

“…Tricyclics, selective serotonin reuptake inhibitors, antidepressants, and neuroleptics may induce autonomic dysregulation as well as hyperreflexia, myoclonus, restless leg syndrome, rigidity, behavioural disorders and delirium. Without treatment, the clinical picture can evolve into malignant hyperthermia, muscular rigidity, dyskinesia progressing to unstable blood pressure and autonomic dysregulation [4,14]. In our case, a detailed history provided by her family and treating physician allowed the exclusion of antipsychotic and/or antidepressant use before symptom onset.…”

“…In our patient, the rapid progression of mental fatigue and concentration difficulties to psychotic symptoms and auditory and olfactory hallucinations together with neurological impairment (delirium, abnormal movements, speech deterioration) were highly suggestive of an organic cause, rather than a primary psychiatric disorder. Important differential diagnoses apart from encephalitis, included serotonin and neuroleptic malignant syndromes given that neurological symptoms (hyperreflexia, myoclonus, restless syndrome, rigidity, behavioural disorders) and delirium can be present in both [4,14]. Tricyclics, selective serotonin reuptake inhibitors, antidepressants, and neuroleptics may induce autonomic dysregulation as well as hyperreflexia, myoclonus, restless leg syndrome, rigidity, behavioural disorders and delirium.…”

La interfaz entre neurología y psiquiatría: el caso de la esclerosis múltiple [translation of “The interface between neurology and psychiatry: the case of multiple sclerosis” by Rodolfo Zaratiegui]

“…Más recientemente, los medios de comunicación han mostrado un interés creciente en pacientes con diagnóstico de enfermedad psiquiátrica en los que subsecuentemente se encontró encefalitis producida por anticuerpos, y esto ha llegado a sugerir que una proporción de tales pacientes pudieran tener una etiopatogénesis mediada por anticuerpos (Barry 2011, Lennox 2012. El optimismo en nuestras capacidades científicas, junto con la tendencia de reclasificar las enfermedades mentales como neurológicas a medida de los avances de los conocimientos biológicos, ha provocado preocupación por la supervivencia de la Psiquiatría como especialidad por derecho propio (Oyebode 2011), y puede marcar también el comienzo de una era en la que tanto el cerebro como la mente (aun la Psiquiatría y la Neurología) sean considerados esenciales en el entendimiento de cada uno.…”