Autoimmune encephalitis in psychiatric institutions: current perspectives

Abstract

Autoimmune encephalitis is a rare and newly described group of diseases involving autoantibodies directed against synaptic and neuronal cell surface antigens. It comprises a wide range of neuropsychiatric symptoms. Sensitive and specific diagnostic tests such as cell-based assay are primordial for the detection of neuronal cell surface antibodies in patients’ cerebrospinal fluid or serum and determine the treatment and follow-up of the patients. As neurological symptoms are fairly well described in the literature, this review focuses on the nature of psychiatric symptoms occurring at the onset or during the course of the diseases. In order to help the diagnosis, the main neurological symptoms of the most representative synaptic and neuronal cell surface autoantibodies were detailed. Finally, the exploration of these autoantibodies for almost a decade allowed us to present an overview of autoimmune encephalitis incidence in psychiatric disease and the general guidelines for the management of psychiatric manifestations. For the majority of autoimmune encephalitis, the prognosis depends on the rapidity of the detection, identification, and the management of the disease. Because the presence of pronounced psychiatric symptoms drives patients to psychiatric institutions and can hinder the diagnosis, the aim of this work is to provide clues to help earlier detection by physicians and thus provide better medical care to patients.

Psychiatric Manifestation of Anti-NMDA Receptor Autoimmune Encephalitis

“…Findings from several studies have linked the presence of anti-NMDA receptor autoimmune encephalitis to the development of new-onset psychiatric symptoms [3]. As psychiatric symptoms may predominate at the onset or over the course of these diseases, the diagnosis is frequently delayed.…”

“…Psychiatric symptoms are the most frequent initial presenting symptoms, with 77% of patients soliciting the help of a psychiatrist first [2]. Most patients reported do not have any psychiatric history; therefore, a new-onset, first psychiatric episode should be considered as an argument to test the presence of anti-NMDA receptor antibodies in the patient's cerebrospinal fluid [3].…”

Rare causes of acute psychiatric manifestation in children: a case report of anti-NMDA receptor encephalitis

“…They advised to use atypical antipsychotics for sedation and sleep, while advised valproic acid for mood symptoms, sedation and to control seizure. There isn't significant change with Lithium and benzodiazepines unless there is catatonic symptoms [14]. In literature, many case reports about anti-NMDA encephalitis in adults can be found but very few cases have been reported in children as early recognition and diagnosis is often missed because of its presentation that mimics acute psychotic episode [15].…”

“…The estimated prevalence of psychosis is 17% in children aged between 9-12 years while it drops to 7% among 13 to 18 years old [2]. However, this is the age group that constitute the early onset psychosis that is defined by psychosis presented in age group (12)(13)(14)(15)(16)(17) years) while the very early onset psychosis is defined by psychosis onset before age of 12. Still, there is lack of evidence for the psychosis onset before the age of 18 years [3].…”

Antikörpervermittelte Enzephalitiden in der Psychiatrie

“…Der NMDA-Rezeptor, ein ionotroper Glutamatrezeptor, wird durch Bindung des Antikörpers internalisiert und abgebaut. Dies führt zur reduzierten Expression an der Zelloberfläche [15]. Die beobachtbaren Folgen ähneln denen einer Behandlung mit Inhibitoren der glutamatergen Transmission, wie beispielsweise Phencyclidin oder Ketamin [16].…”