Capgras delusion in anti-NMDAR encephalitis: A case of autoimmune psychosis

Lozano-Cuervo, Rebeca; Espínola-Nadurille, Mariana; Restrepo-Martínez, Miguel; Kerik-Rotenberg, Nora E.; Pollak, Thomas A; Ramı́rez-Bermúdez, Jesús

doi:10.1016/j.ajp.2020.102208

Cited by 7 publications

(2 citation statements)

References 8 publications

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“…She reacted to the delusion by spitting out saliva which she believed to be grave dirt from her body. Whereas, earlier published case had reported an atypical presentation of anti-NMDAR encephalitis which include features of Cotard's syndrome together with Capgras delusion, Capgras delusion was comparatively absent in our patient ( 7 ).…”

Section: Discussioncontrasting

confidence: 73%

Case Report: Cotard's Syndrome in Anti-N-methyl D-aspartate (NMDA) Receptor (Anti-NMDAR) Encephalitis

et al. 2022

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Cotard's syndrome is uncommon psychopathology among patients with psychotic illnesses. Limited cases had been reported regarding the occurrence of this syndrome in anti-NMDAR encephalitis which itself is a relatively new disease that often presents with florid psychotic symptoms. This poses difficulties in differentiating it from a primary psychiatric illness. Late recognition of anti-NMDAR encephalitis can lead to death as it can progress to autonomic instability in its natural course of illness. We report a patient who first presented with psychotic symptoms with initial negative findings from baseline investigations. Further investigation revealed anti NMDAR antibodies in the cerebrospinal fluid. Prompt treatment was initiated and despite early poor response to the first-line treatment with the development of allergic reaction, our patient recovered completely after 1 month of hospitalization. This case report aims to highlight the importance of early detection of anti-NMDAR encephalitis and the possibility of uncommon psychopathology such as Cotard's syndrome occurring in this disease.

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Section: Discussioncontrasting

confidence: 73%

Case Report: Cotard's Syndrome in Anti-N-methyl D-aspartate (NMDA) Receptor (Anti-NMDAR) Encephalitis

et al. 2022

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“…Clinical features of autoimmune encephalitis include various neuropsychiatric symptoms, including altered consciousness, seizures, memory deficits, mood changes, delusions, hallucinations, and catatonia ( 1 , 2 ). Although the specific brain regions or neural circuits associated with these psychiatric symptoms remain unclear, abnormalities in the right hemisphere, insular cortex, prefrontal cortex, frontoparietal circuits, and midline structures have been implicated in certain types of delusions, particularly Cotard and Capgras delusions ( 3 , 4 ). Autoimmune encephalitis can be triggered by antibodies against neuronal cell-surface antigens, such as the N-methyl-D-aspartate (NMDA) receptor, leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (Caspr2), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor, gamma-aminobutyric acid-B (GABA-B) receptor, and dipeptidyl-peptidase-like protein 6 (DPPX), as well as antibodies against intracellular antigens, such as Hu, Ma2, and glutamic acid decarboxylase ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

Case report: A case of anti-recoverin antibody-positive encephalitis exhibiting Cotard and Capgras delusions that was successfully treated with electroconvulsive therapy

Akahane,

Takahashi,

Kobayashi

et al. 2024

Front. Psychiatry

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Recoverin is a neuron-specific calcium-binding protein that is mainly located in the retina and pineal gland. Few reports have described patients with anti-recoverin antibody-positive encephalitis, and no cases of psychosis associated with this encephalitis have been reported. We report a patient with anti-recoverin antibody-positive encephalitis with Cotard and Capgras delusions who was successfully treated with electroconvulsive therapy (ECT). The patient was a 25-year-old woman. She exhibited disorientation, executive function deficits, tremors in the upper limbs, generalized athetoid-like involuntary movements, hallucinations, incontinence, and fever, which led to her admission to our hospital. Upon admission, she complained of Cotard delusions. Various diagnostic tests, including cerebrospinal fluid analysis, antibody screening, and brain imaging, were unremarkable, except for positivity for serum anti-recoverin antibodies, non-specific general slowing on electroencephalography and decreased regional cerebral blood flow (rCBF) in the frontal and occipital lobes, and increased rCBF in the basal ganglia and pons on single-photon emission computed tomography. She was eventually diagnosed with encephalitis positive for anti-recoverin antibodies and treated with immunoglobulins and steroids. Her neurological symptoms improved temporarily, but three months later, psychiatric symptoms, i.e., suicidal thoughts and Cotard and Capgras delusions, were exaggerated. After ECT, her condition significantly improved. In conclusion, the present report suggests that pineal gland dysfunction due to anti-recoverin antibody or its cross-reactivity with neuron-specific calcium-binding proteins may contribute to the neuropsychiatric symptoms observed in anti-recoverin antibody-positive encephalitis and that ECT can be a viable treatment option if immunotherapy proves ineffective. Additionally, decreased rCBF in the prefrontal cortex may be associated with the clinical features of Capgras and Cotard delusions.

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