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Acute psychosis due to non-paraneoplastic anti-NMDA-receptor encephalitis in a teenage girl: Case report.
Psych J. 2015 Dec; 4(4):226-30.PJ

Abstract

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a disease occurring when antibodies produced by the body's own immune system attack NMDA-type glutamate receptors in the brain. Most anti-NMDAR encephalitis cases are associated with paraneoplastic syndrome. We analyze the case of a 15-year-old girl who was hospitalized in a child psychiatry clinic in Riga, Latvia, with de novo acute polymorphic psychotic disorder gradually progressing to a catatonic state. The patient received antipsychotic and electroconvulsive therapy with no beneficial effect. The council of doctors discussed differential diagnoses of schizophrenia-induced catatonia and the autoimmune limbic encephalitis-induced catatonic condition. When the diagnosis of anti-NMDAR autoimmune encephalitis was finally confirmed by repeated immunological assays (specific immunoglobulin [Ig] G and IgM in her blood serum and cerebrospinal fluid), and a paraneoplastic process was ruled out, she was started on immunomodulating therapy (methylprednisolone, Ig, plasmapheresis, rituximab), which changed the course of her disease. On immunomodulating treatment, her physical and mental health have gradually improved to almost complete reconvalescence. Psychiatrists should consider anti-NMDAR encephalitis as a differential diagnosis in first-episode psychosis patients presenting with disorientation, disturbed consciousness, pronounced cognitive deficits, movement disorder, dysautonomia, or rapid deterioration, and test for specific IgG NR1 autoantibodies, even if there are no specific findings on routine neuroimaging, electroencephalography (EEG), or cerebrospinal fluid tests.

Authors+Show Affiliations

Riga Stradins University, Riga, Latvia.Child Psychiatry Clinic, Children's Clinical University Hospital, Riga, Latvia.Child Psychiatry Clinic, Children's Clinical University Hospital, Riga, Latvia.Department of Internal Diseases, Riga Stradins University, Riga, Latvia.Child Neurology and Neurosurgery Clinic, Children's Clinical University Hospital, Riga, Latvia.Child Neurology and Neurosurgery Clinic, Children's Clinical University Hospital, Riga, Latvia.Child Neurology and Neurosurgery Clinic, Children's Clinical University Hospital, Riga, Latvia.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26663628

Citation

Kramina, Sandra, et al. "Acute Psychosis Due to Non-paraneoplastic anti-NMDA-receptor Encephalitis in a Teenage Girl: Case Report." PsyCh Journal, vol. 4, no. 4, 2015, pp. 226-30.
Kramina S, Kevere L, Bezborodovs N, et al. Acute psychosis due to non-paraneoplastic anti-NMDA-receptor encephalitis in a teenage girl: Case report. Psych J. 2015;4(4):226-30.
Kramina, S., Kevere, L., Bezborodovs, N., Purvina, S., Rozentals, G., Strautmanis, J., & Viksna, Z. (2015). Acute psychosis due to non-paraneoplastic anti-NMDA-receptor encephalitis in a teenage girl: Case report. PsyCh Journal, 4(4), 226-30. https://doi.org/10.1002/pchj.121
Kramina S, et al. Acute Psychosis Due to Non-paraneoplastic anti-NMDA-receptor Encephalitis in a Teenage Girl: Case Report. Psych J. 2015;4(4):226-30. PubMed PMID: 26663628.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute psychosis due to non-paraneoplastic anti-NMDA-receptor encephalitis in a teenage girl: Case report. AU - Kramina,Sandra, AU - Kevere,Laura, AU - Bezborodovs,Nikita, AU - Purvina,Santa, AU - Rozentals,Guntis, AU - Strautmanis,Jurgis, AU - Viksna,Zane, PY - 2015/07/12/received PY - 2015/10/08/accepted PY - 2015/12/15/entrez PY - 2015/12/15/pubmed PY - 2016/9/1/medline KW - acute psychosis KW - anti-N-methyl-d-aspartate receptor (anti-NMDAR) KW - non-paraneoplastic encephalitis SP - 226 EP - 30 JF - PsyCh journal JO - Psych J VL - 4 IS - 4 N2 - Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a disease occurring when antibodies produced by the body's own immune system attack NMDA-type glutamate receptors in the brain. Most anti-NMDAR encephalitis cases are associated with paraneoplastic syndrome. We analyze the case of a 15-year-old girl who was hospitalized in a child psychiatry clinic in Riga, Latvia, with de novo acute polymorphic psychotic disorder gradually progressing to a catatonic state. The patient received antipsychotic and electroconvulsive therapy with no beneficial effect. The council of doctors discussed differential diagnoses of schizophrenia-induced catatonia and the autoimmune limbic encephalitis-induced catatonic condition. When the diagnosis of anti-NMDAR autoimmune encephalitis was finally confirmed by repeated immunological assays (specific immunoglobulin [Ig] G and IgM in her blood serum and cerebrospinal fluid), and a paraneoplastic process was ruled out, she was started on immunomodulating therapy (methylprednisolone, Ig, plasmapheresis, rituximab), which changed the course of her disease. On immunomodulating treatment, her physical and mental health have gradually improved to almost complete reconvalescence. Psychiatrists should consider anti-NMDAR encephalitis as a differential diagnosis in first-episode psychosis patients presenting with disorientation, disturbed consciousness, pronounced cognitive deficits, movement disorder, dysautonomia, or rapid deterioration, and test for specific IgG NR1 autoantibodies, even if there are no specific findings on routine neuroimaging, electroencephalography (EEG), or cerebrospinal fluid tests. SN - 2046-0260 UR - https://www.unboundmedicine.com/medline/citation/26663628/Acute_psychosis_due_to_non_paraneoplastic_anti_NMDA_receptor_encephalitis_in_a_teenage_girl:_Case_report_ L2 - https://doi.org/10.1002/pchj.121 DB - PRIME DP - Unbound Medicine ER -