Anti-NMDA receptor encephalitis: An emerging differential diagnosis in the psychiatric community

Nichols, Taylor A.

doi:10.9740/mhc.2016.11.297

Cited by 7 publications

(8 citation statements)

References 35 publications

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“…Finally, spinal fluid was sent for further antibody analysis, which revealed a diagnosis of anti-NMDA receptor encephalitis. Therapy with intravenous immunoglobulin and rituximab yielded marked cognitive and behavioral improvement [2].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…The discovery of the correlation between autoimmune encephalitis and acute psychosis has uncovered a wide range of neurological diseases with a psychiatric disguise. 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].…”

Section: Introductionmentioning

confidence: 99%

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Psychiatric Manifestation of Anti-NMDA Receptor Autoimmune Encephalitis

Elamin¹,

Mir²,

Ali³

et al. 2018

Dubai Med J

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Several studies have linked the presence of anti-NMDA receptor autoimmune encephalitis to the development of new-onset psychiatric symptoms. As psychiatric symptoms may predominate at the onset or over the course of the disease, the diagnosis is frequently delayed. Patient prognosis depends on the speed of disease detection, identification, and management. The case presented in this report shows a patient with psychiatric manifestation discovered to have anti-NMDA receptor encephalitis. Late diagnosis of anti-NMDA receptor encephalitis caused her condition to deteriorate. Therefore, we underline the importance of consid ering anti-NMDA receptor encephalitis as part of the differential diagnosis in any case presenting with first-time emotional lability or any other psychiatric finding.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Psychiatric Manifestation of Anti-NMDA Receptor Autoimmune Encephalitis

Elamin¹,

Mir²,

Ali³

et al. 2018

Dubai Med J

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“…Lithium, Gabapentin and Valproic acid could help in mood symptoms [68,69]. In Anti-NMDAR encephalitis, glutamate activation of GABAergic neurons is decreased leading to reduced GABA activity causing significant glutamatergic hyperactivity and neuropsychiatric symptoms of anti-NMDA receptor encephalitis [70]. Gabapentin enhances the release of GABA [71] .…”

Section: Gabapentinmentioning

confidence: 99%

Psychotropics and Neuroprotection: Literature Review and Case Series Report

Meresh¹,

Daniels²,

Owens³

et al. 2019

obm neurobiol

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Agitation is a common manifestation of acute brain injury. When not addressed, agitation can lead to slower recovery rates, including delayed admission to acute rehabilitation programs. Antipsychotics are commonly used to control agitation in acute brain injury in the ICU. However, there is no current consensus on the most "efficacious and safest strategy" for use of antipsychotics in acute TBI. Haloperidol is arguably the commonly used antipsychotic for agitation in ICU setting at present. Interestingly, there are no studies to our knowledge that assess for haloperidol use in TBI patient's specifically. Further, there are some concerns with the use of Haloperidol given that it does not offer a neuroprotective effect and may have some adverse effects that are particularly harmful for this population. In this paper, we offer a review of alternate medications that may be more appropriate for the treatment of

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“…It is suggested to be the most common autoimmune cause of encephalitis after demyelinating encephalitis [2]. Although anti-NMDAR encephalitis can occur at any age and in both sexes, about 80% of cases are females, mostly 18 years and younger [3]. In many published cases, patients have underlying tumors, with ovarian teratomas being the most implicated [3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Although anti-NMDAR encephalitis can occur at any age and in both sexes, about 80% of cases are females, mostly 18 years and younger [3]. In many published cases, patients have underlying tumors, with ovarian teratomas being the most implicated [3][4]. Frequently, symptoms of anti-NMDAR encephalitis manifest with acute neuropsychiatric presentations such as mania, visual and auditory hallucinations, personality change, cognitive decline, catatonia, and newonset behavioral problems [3,[5][6].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Electroconvulsive Therapy on Catatonia in a Case of Anti-N-Methyl-D-Aspartate (anti-NMDA) Receptor Encephalitis

Olaleye

Oladunjoye

Otuada

et al. 2021

Cureus

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Catatonia is a symptom seen in a variety of neuropsychiatric conditions, including anti-N-Methyl Daspartate receptor (NMDAR) encephalitis. When associated with anti-NMDAR encephalitis, catatonia is resistant to standard therapy. However, electroconvulsive therapy (ECT) has shown promising success in management. This case report presents a 25-year-old African American female who presented to the emergency room with nervousness, sweating, insomnia, and visual and auditory hallucinations. She was treated symptomatically for anxiety but returned to the hospital after she continued to experience worsening symptoms. Her anxiety worsened, and she became more agitated, warranting an extensive workup, including magnetic resonance imaging (MRI) and electroencephalogram (EEG), which showed normal findings. She also had an anti-NMDA receptor antibodies titer done, which showed a positive titer result. She was treated with intravenous steroids, intravenous immunoglobulin G (IgG), plasma exchange, and rituximab, which did not improve her symptoms, and she was discharged home after a prolonged hospital stay. On follow-up visits, she reported worsening confusion, aggression, and suicidal behaviors. The patient was readmitted, during which she experienced catatonia and psychiatric symptoms, and her anti-NMDAR titer had increased to 1:1280. Further treatments with intravenous steroids, intravenous IgG, plasma exchange, and rituximab, including haloperidol and clonazepam, failed to improve her condition. However, her condition improved remarkably following treatment with 12 rounds of ECT. No randomized control trial has been done to demonstrate the effectiveness of ECT in the treatment of anti-NMDAR encephalitis despite various reports of the effectiveness of this treatment modality. This case report adds to the growing clinical evidence in support of the use of ECT in anti-NMDAR encephalitis patients with catatonia. ECT can be incorporated as standard protocol in the treatment of catatonia and associated psychiatric symptoms when managing a patient with anti-NMDAR encephalitis associated with catatonic features.

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Anti-NMDA receptor encephalitis: An emerging differential diagnosis in the psychiatric community

Cited by 7 publications

References 35 publications

Psychiatric Manifestation of Anti-NMDA Receptor Autoimmune Encephalitis

Psychiatric Manifestation of Anti-NMDA Receptor Autoimmune Encephalitis

Psychotropics and Neuroprotection: Literature Review and Case Series Report

The Effectiveness of Electroconvulsive Therapy on Catatonia in a Case of Anti-N-Methyl-D-Aspartate (anti-NMDA) Receptor Encephalitis

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