Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Detailed Review of the Different Psychiatric Presentations and Red Flags to Look for in Suspected Cases

Abstract

Anti-N-methyl-D-aspartate receptor encephalitis is a rare autoimmune disorder that involves N-methyl-Daspartate (NMDA) receptors. It is the most common autoimmune encephalitis, and early detection and treatment are crucial for morbidity-free recovery. Distinguishing this disorder from a primary psychiatric illness is quite challenging as this disorder classically presents with psychiatric manifestations that often resemble schizophrenic psychosis. Therefore, this review intended to scope the psychiatric manifestations this disorder could present with and dissect how they differ from primary psychiatric disorders. A PubMed database search was done. The results yielded were analyzed; eventually, 50 papers were used to review the different signs and symptoms the disease can present with, including common and rare disease presentations. Diagnostic challenges and helpful clinical clues to recognize the disorder were reviewed as well.

Acute Psychosis Due to Anti-N-Methyl D-Aspartate Receptor Encephalitis Following COVID-19 Vaccination: A Case Report

“…There have been two recent studies on the psychiatric manifestations of anti-NMDAR encephalitis which report that severe agitation, speech disturbance, and catatonia amongst other psychiatric features, may signal the presence of organic pathology, particularly when dealing with a young female presenting at an atypical age for primary psychosis ( 16 ). The concomitant presence of seven features-agitation, aggression, hallucinations, delusions, mutism, irritability or mood instability, and depressed mood would not be typical of any single psychiatric diagnosis and point to organic brain pathology ( 17 ).…”

Mature ovarian teratoma-associated encephalitis

“…Anti-NMDA receptor encephalitis often (70%) begins with prodromal flu-like symptoms (fever, headache and fatigue) [2]. After this uncharacteristic clinical picture, psychological symptoms develop with a predominance of the following: agitation, hallucinations, changes in behavior and anxiety [14]. There is a significant overlap of neurological and psychiatric symptoms associated with autoimmune encephalitis.…”

Typical Metabolic Pattern of 18F-FDG PET in Anti-NMDAR Encephalitis in the Acute and Subacute Phases and its correlation with T2 FLAIR-MRI features

“…4 Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China. 5 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. 6 China National Clinical Center for Neurological Diseases, Beijing, 100070, China.…”

“…GluN1 is ubiquitously located in the brain but at a higher density in frontotemporal areas and the hippocampus. It can interestingly reversibly cause a selective titer-dependent decrease in glutamatergic synaptic function via antibody-mediated capping, cross-linking and internalization of NMDA receptors [4][5][6] . The synaptic function decreases without a substantial loss of synapses or other synapse proteins undergirding the reversible clinical process.…”