Anti-NMDA receptor encephalitis with the initial presentation of psychotic mania

Kuo, Yen Lin; Tsai, Hsing Fang; Lai, Ming Chi; Lin, Chien Ho; Yang, Yen Kuang

doi:10.1016/j.jocn.2011.10.006

Cited by 31 publications

(15 citation statements)

References 12 publications

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“…Some previous publications have reported a similar phenomenon in a few case reports, 15–18 but the extremely high rate in our cohort is unprecedented. In several medical records, psychiatrists had diagnosed NMS or malignant catatonia, which are extremely rare conditions that are reported in fewer than 0.1% of patients hospitalized in psychiatric institutions.…”

Section: Discussionsupporting

confidence: 81%

Neuroleptic intolerance in patients with anti-NMDAR encephalitis

Lejuste

Thomas

Picard

et al. 2016

Neurol Neuroimmunol Neuroinflamm

142

124

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Objective:To precisely describe the initial psychiatric presentation of patients with anti-NMDA receptor (NMDAR) antibodies encephalitis (anti-NMDAR encephalitis) to identify potential clues enhancing its early diagnosis.Methods:We retrospectively studied the French Reference Centre medical records of every adult patient with anti-NMDAR encephalitis to specify the patients' initial psychiatric symptoms leading to hospitalization in a psychiatric department and the reasons underlying the diagnosis of anti-NMDAR encephalitis.Results:The medical records of 111 adult patients were reviewed. Psychiatric features were the initial presentation in 65 patients (59%). Among them, several psychiatric manifestations were observed, including visual and auditory hallucinations (n = 26, 40%), depression (n = 15, 23%), mania (n = 5, 8%), acute schizoaffective episode (n = 15, 23%), and eating disorder or addiction (n = 4; 6%). Forty-five patients (40% of total cohort) were first hospitalized in a psychiatric institution (91% women), with a median duration of stay of 9 days (range 0.25–239 days). Among them, 24 patients (53%) had associated discreet neurologic signs at the first evaluation, while 17 additional patients (38%) developed neurologic signs within a few days. Twenty-one patients (47%) were transferred to a medical unit for a suspicion of antipsychotic intolerance characterized by high temperature, muscle rigidity, mutism or coma, and biological results suggesting rhabdomyolysis.Conclusions:Several psychiatric presentations were observed in patients with anti-NMDAR encephalitis, although none was specific; however, patients, mostly women, also had discreet neurologic signs that should be carefully assessed as well as signs of antipsychotic intolerance that should raise suspicion for anti-NMDAR encephalitis.

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Section: Discussionsupporting

confidence: 81%

Neuroleptic intolerance in patients with anti-NMDAR encephalitis

Lejuste

Thomas

Picard

et al. 2016

Neurol Neuroimmunol Neuroinflamm

142

124

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“…This cohort often present with an abrupt or acute onset of psychosis or behavioural change accompanied by memory impairment, mutism or insomnia which may serve as early clues of the underlying diagnosis 2 36 39 40. These initial symptoms are consistent with the known distribution and hypofunction of NR1/NR2 NMDAR in the basal forebrain, limbic system and hypothalamus 24.…”

Section: Discussionmentioning

confidence: 88%

Autoimmune limbic encephalitis presenting as relapsing psychosis

Hopkins¹,

Moodley

Chan

2013

BMJ Case Reports

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A 34-year-old woman with a history of relapsing psychosis presented with a 15-month history of impassivity and social withdrawal associated with cognitive impairment. The subsequent recurrence of psychomotor agitation, auditory hallucinations and delusional thinking resulted in an emergency admission under psychiatric services. Initial investigations, including MRI of the brain and cerebrospinal fluid studies were unremarkable and she was treated for a primary psychiatric disorder. The diagnosis of autoimmune limbic encephalitis was established after further investigations revealed the presence of antibodies to the NR1 subunit of theN-Methyl-d-aspartate receptor (NMDAR). Immunotherapy resulted in rapid resolution of psychosis and marked improvement in cognitive and social function. This case underlines the importance of considering anti-NMDAR encephalitis within the differential diagnosis of psychosis associated with cognitive impairment even in those with an apparent previous psychiatric history and response to antipsychotics.

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“…44,95 Early identification and intervention can shorten the duration of intensive care admission and ventilation, improve the outcome, and protect against relapse. 85,96,97 Anti-NMDAr encephalitis epidemiology…”

Section: Encephalitismentioning

confidence: 99%

Catatonia secondary to anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis: a review

Macedo

Marques

2019

CNS Spectr.

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Anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis is a relatively recent autoimmune entity, as it was first described in 2007. Given that it is a condition with neuropsychiatric symptoms, its initial symptom is frequently psychiatric in nature. Hence, psychiatrists are often the first physicians to assess these patients and, as so, must recognize this type of encephalitis as a possible cause. Catatonia may be inaugural or develop throughout the course of the disease. Management of patients with anti-NMDAr encephalitis is based on etiologic treatment with immunotherapy and removal of the associated tumor, if any. However, these catatonic patients may have variable responses to etiologic treatment, sometimes with refractory catatonic symptoms, which attests to the necessary urgency to know how to manage these patients. In the clinical setting, physicians appear to be using guidelines originally created to the management of catatonia due to primary psychiatric conditions. In this literature review, catatonia was historically contextualized and anti-NMDAr encephalitis overall described. Finally, catatonia secondary to this type of encephalitis was discussed.

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Anti-NMDA receptor encephalitis with the initial presentation of psychotic mania

Cited by 31 publications

References 12 publications

Neuroleptic intolerance in patients with anti-NMDAR encephalitis

Neuroleptic intolerance in patients with anti-NMDAR encephalitis

Autoimmune limbic encephalitis presenting as relapsing psychosis

Catatonia secondary to anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis: a review

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