Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a relatively newly identified autoimmune neuropsychiatric disorder that predominantly affects children and young adults. Although psychiatric symptoms are highly prevalent and frequently severe, it has mainly been reported in neurological, but not psychiatric, literature. Understanding this form of encephalitis, its quick diagnosis and which treatment to provide are of utmost importance for consultation-liaison (C-L) psychiatrists. The aim of this paper was to describe a case of anti-NMDAR encephalitis with severe psychiatric manifestations, who showed impressive recovery but required intensive involvement of the C-L psychiatry team. We emphasise the behavioural aspects, psychiatric symptoms and challenges faced by the CL consultant across the different phases of the treatment. We report the different treatment phases for a young woman with anti-NMDAR encephalitis who developed severe neuropsychiatric symptoms, with a focus on the role and challenges faced by the C-L psychiatrist. The literature is reviewed for each of these challenges. This case illustrated that even extremely severely affected patients may show impressive recovery, but require long lasting psychiatric care. C-L psychiatrists are faced with numerous challenges where only little literature is available. C-L psychiatrists play a pivotal role throughout the multidisciplinary care of patients with anti-NMDAR encephalitis and should be informed about this entity.
Highlights
Anti-N-methyl-D-aspartate receptor encephalitis is a subtype of a recently described autoimmune disorder of the brain
This study reports the case of a young woman presenting with antiNMDAR encephalitis, an autoimmune and paraneoplastic disorder that affects young adults and may be associated with tumours in up to 50% of cases [2]
A recent study highlighted the possibility of isolated psychiatric presentation [12], and Soe et al recently described the first case of β-Thalassemia trait association with anti-NMDAR encephalitis in a 10-year-old girl [13]
Summary
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a subtype of a recently described autoimmune disorder of the brain. It was first described in 2005 and subsequently has been characterized mainly in the neurological literature [1,2]. Up to 25% of patients may have a poor outcome, with persistent, severe neuropsychiatric deficits or even die [2,4] Understanding this entity, performing a quick diagnosis and deciding treatment are important for consultation-liaison (C-L) psychiatrists. Psychiatric symptoms are highly prevalent and frequently severe, it has mainly been reported in neurological, but not psychiatric, literature Understanding this form of encephalitis, its quick diagnosis and which treatment to provide are of utmost importance for consultation-liaison (C-L) psychiatrists. We emphasise the behavioural aspects, psychiatric symptoms and challenges faced by the CL consultant across the different phases of the treatment
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