Anti-NMDA Receptor Encephalitis in Psychiatry

Abstract

Anti-NMDA receptor encephalitis is an autoimmune disorder in which antibodies attack NMDA (N-methyl-D-aspartate)-type glutamate receptors at central neuronal synapses. Symptoms include a highly characteristic set of neurologic deficits, but also prominent psychiatric manifestations that often bring mental health professionals into the course of care. Distinct phases of illness have become increasingly appreciated, and include a range of psychotic symptoms early in the course of the disease followed by more severe fluctuations in consciousness with neurologic involvement, and ultimately protracted cognitive and behavioral deficits. Young women are most commonly impacted and an ovarian teratoma is sometimes associated with the syndrome. Patients respond well to immunotherapy, but psychiatric symptoms can be challenging to manage. We provide an up to date review of this disorder and highlight the role of psychiatry in diagnosis, symptomatology, and treatment.

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

“…more frequent psychiatric episodes in younger adults and teenagers, more frequent seizures or dyskinesias in young children), development of a full blown syndrome, or clinical course and relapses can vary among patients [8][9][10][11]. Furthermore, a recent study highlighted the possibility of isolated psychiatric presentation (without neurological symptoms) [12], and Soe et al recently described the first case of β-Thalassemia trait association with anti-NMDAR encephalitis in a 10-year-old girl [13]. Our case illustrates that even extremely severely affected patients may show impressive recovery but require long-term psychiatric care.…”

A case report: anti-NMDA receptor encephalitis

“…Anti-NMDAR encephalitis is a relatively rare diagnosis with just a few hundred cases reported in the literature but its true prevalence, especially in individuals with purely psychiatric manifestations, is yet to be determined as a large majority present to a psychiatrist first [1]. …”

Anti-NMDA-reseptorencefalitt

“…Et flertall av pasientene rapporterer først om prodromale plager som hodepine, lavgradig feber, kvalme, oppkast, diaré eller plager forenlig med en øvre luftveisinfeksjon (1,11,24). Innen et par uker oppstår nye symptomer, og hyppigst er de nevropsykiatriske i form av visuelle eller auditive hallusinasjoner, vrangforestillinger, angst, mani, personlighetsforandringer, katatoni, forvirring og hukommelsestap samt epileptiske anfall og utfall i en rekke kognitive funksjoner, deriblant språk (24,25). Denne fasen varer i ca.…”