Erstmanifestation eines organischen manisch-schizophreniformen Syndroms mit nachfolgender Katatonie bei NMDA-Rezeptor-Antikörper-positiver Encephalitis

Abstract

We report on a 39-year-old female patient who developed catatonia after there had been schizomanic symptoms in the six months before. At admission the patient exhibited catatonia, a tetraspastic syndrome and focal epileptic seizures. The cranial MRI revealed bilateral subcortical hyperintense lesions which took up contrast agent. Examination of the cerebrospinal fluid disclosed a lymphocytic pleocytosis and autochthone oligoclonal bands. In the serum autoantibodies against the NMDA-NR-1 receptor were reproducibly detected. A detailed search for a tumour was negative. In detail, we could exclude a neoplasm of the ovaries which is often present in the paraneoplastic type of anti-NMDA-receptor encephalitis. Therefore we assume an autoimmune, not paraneoplastic, encephalitis in our patient. The symptoms improved significantly after an immunosuppressive therapy - initially with glucocorticoids followed by rituximab - had been initiated. This case illustrates that an autoimmune encephalitis should be looked for when first psychotic symptoms occur.

Autoimmune encephalitis with psychiatric features in adults: historical evolution and prospective challenge

“…Schizophreniform psychosis is a frequent phenomenon and has been supported by a recent study of a 60-patient cohort of patients suffering first-episode psychosis and additional neurological features such as seizures or autonomic symptoms [27% of these patients had been diagnosed with NMDAR encephalitis] (Tang et al 2019). The complex psychiatric presentation of NMDAR encephalitis was enriched in subsequent years to incorporate bipolar mood dysfunction and mania (Choe et al 2013;Fousse et al 2013), anxiety (Maat et al 2013) and behavioral abnormalities including agitation (Maat et al 2013). Psychotic and depressive syndrome often coexist, as reported by a large-scale study of Al-Diwani et al (2019) including 505 patients reported with psychiatric symptomatology in NMDAR encephalitis.…”