Rani A Sarkis1, M Justin Coffey1, Joseph J Cooper1, Islam Hassan1, Belinda Lennox1. 1. From the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Sarkis); the Menninger Clinic and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Tex. (Coffey); the Department of Psychiatry, University of Illinois at Chicago (Cooper); the British Columbia Neuropsychiatry Program and Vancouver General Hospital Epilepsy Program, University of British Columbia (Hassan); and the Department of Psychiatry, University of Oxford, Oxford, United Kingdom (Lennox).
Abstract
OBJECTIVE: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder characterized by prominent neuropsychiatric symptoms. Given the nature of its pathophysiology, psychiatrists tend to be one of the first clinicians encountering patients with the disease. METHODS: In the present review of patients described in the literature with psychiatric symptoms, the authors aimed to characterize the psychiatric symptoms of the disease and its management in adults and adolescents as well as children (≤12 years old). A total of 544 patients fulfilled the inclusion criteria. RESULTS: The authors found that 77% of patients with NMDAR encephalitis presented initially with psychiatric symptoms. These were mostly agitation (59%) and psychotic symptoms (in 54%, especially disorganized behavior and visual-auditory hallucinations), with agitation even more commonly being the presenting symptom in children (66%). Where psychotic symptoms were detailed, visual (64%) and auditory (59%) hallucinations were the most common, as well as persecutory delusions (73%). However, delusions were not clearly characterized in most cases. Catatonia was described in 42% of adult patients and 35% of children. Of the patients with documented exposure to antipsychotics, 33% were suspected to have an adverse drug reaction (notably, neuroleptic malignant syndrome in 22% of the cases). CONCLUSIONS: On the basis of these findings, it is important to consider anti-NMDAR encephalitis in the differential diagnosis of patients with an acute onset psychosis, especially in association with agitation, catatonia, or adverse response to antipsychotics. Furthermore, it is important to use antipsychotics with caution in patients with suspected or confirmed anti-NMDAR encephalitis.
OBJECTIVE: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder characterized by prominent neuropsychiatric symptoms. Given the nature of its pathophysiology, psychiatrists tend to be one of the first clinicians encountering patients with the disease. METHODS: In the present review of patients described in the literature with psychiatric symptoms, the authors aimed to characterize the psychiatric symptoms of the disease and its management in adults and adolescents as well as children (≤12 years old). A total of 544 patients fulfilled the inclusion criteria. RESULTS: The authors found that 77% of patients with NMDAR encephalitis presented initially with psychiatric symptoms. These were mostly agitation (59%) and psychotic symptoms (in 54%, especially disorganized behavior and visual-auditory hallucinations), with agitation even more commonly being the presenting symptom in children (66%). Where psychotic symptoms were detailed, visual (64%) and auditory (59%) hallucinations were the most common, as well as persecutory delusions (73%). However, delusions were not clearly characterized in most cases. Catatonia was described in 42% of adult patients and 35% of children. Of the patients with documented exposure to antipsychotics, 33% were suspected to have an adverse drug reaction (notably, neuroleptic malignant syndrome in 22% of the cases). CONCLUSIONS: On the basis of these findings, it is important to consider anti-NMDAR encephalitis in the differential diagnosis of patients with an acute onset psychosis, especially in association with agitation, catatonia, or adverse response to antipsychotics. Furthermore, it is important to use antipsychotics with caution in patients with suspected or confirmed anti-NMDAR encephalitis.
Entities:
Keywords:
CSF Brain Fluids and Their Disorders; Hallucinations; Neuroimmunology; Neuroleptics; Psychosis
Authors: Frank Leypoldt; Ludger Tebartz van Elst; Dominique Endres; Eva Lüngen; Alkomiet Hasan; Michael Kluge; Sabrina Fröhlich; Jan Lewerenz; Tom Bschor; Ida Sibylle Haußleiter; Georg Juckel; Florian Then Bergh; Barbara Ettrich; Lisa Kertzscher; Tatiana Oviedo-Salcedo; Robert Handreka; Martin Lauer; Klaas Winter; Norbert Zumdick; Anna Drews; Jost Obrocki; Yavor Yalachkov; Anna Bubl; Felix von Podewils; Udo Schneider; Kristina Szabo; Margarete Mattern; Alexandra Philipsen; Katharina Domschke; Klaus-Peter Wandinger; Alexandra Neyazi; Oliver Stich; Harald Prüss Journal: Mol Psychiatry Date: 2022-01-19 Impact factor: 13.437