Catatonic Syndrome in Anti-NMDA Receptor Encephalitis

Abstract

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a newly recognised autoimmune condition. With its typical clinical pattern, consistent association with the presence of auto antibodies and rapid improvement with immunotherapy, this condition is giving insights into the boundaries between psychiatry and other neurosciences, and is opening avenues for future research. In a young lady who presented with catatonia, we considered anti-NMDA receptor encephalitis, after ruling out other aetiologies. After a positive antibody test we treated her with immunotherapy. She showed gradual improvement in her psychotic and catatonic symptoms. Knowledge regarding the nature and function of NMDA receptors and pathophysiology of this particular encephalitis is important for psychiatric practice. The great opportunity for research in this area due to its association with psychotic disorders is evident but an appeal to temper the enthusiasm by considering the historical lessons learnt from Karl Jaspers’ critique of General Paresis of Insane, is in place. Catatonic syndrome has to be conceptualised broadly and should be recognised with a separate nosological position.

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

“…125 Voice et al 126 described the case of a 17-year-old with anti-NMDAr encephalitis with catatonic symptoms which resolved when all 3 first-line measures were combined after tumor resection (left ovarian teratoma), as was the case with the 19-year-old woman treated by Gulyayeva et al 71 (also an ovarian teratoma). Chatterjee et al 92 described a patient who improved, catatonic symptoms included, with methylprednisolone and plasmapheresis, as did the patient described by Mythri et al, 127 with immunotherapy only.…”

Effect of Clozapine on Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Psychiatric Symptoms: A Series of Three Cases

“…A study showed that among 111 anti-NMDAR encephalitis patients, 65 (58.6%) presented various psychiatric features, 43 (38.7%) were admitted initially to a psychiatric unit, and 2 (1.8%) were transferred from other inpatient units to a psychiatric unit before being finally correctly diagnosed (Lejuste et al, 2016). It was reported that catatonia was highly suggestive of NMDAR encephalitis, helping to diagnose anti-NMDAR encephalitis (Mythri and Mathew, 2016). The three patients in this study presented depression and aggressive behaviors, without catatonic syndrome.…”

The Clinical Challenge of Autoimmune Psychosis: Learning from Anti-NMDA Receptor Autoantibodies

“…Its exact physiopathology is still unknown but seems underpinned by a deregulation between glutamatergic and GABAergic signaling ( 59 ). Catatonia, schizophrenia, and NMDAR-Ab have been extensively associated in the literature, which might indicate catatonia as a sign of autoimmune psychosis ( 60 – 62 ).…”