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2015 ; 11
(ä): 1437-42
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Anti-N-methyl-d-aspartate receptor encephalitis in a patient with a 7-year
history of being diagnosed as schizophrenia: complexities in diagnosis and
treatment
#MMPMID26089673
Huang C
; Kang Y
; Zhang B
; Li B
; Qiu C
; Liu S
; Ren H
; Yang Y
; Liu X
; Li T
; Guo W
Neuropsychiatr Dis Treat
2015[]; 11
(ä): 1437-42
PMID26089673
show ga
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune
encephalitis associated with antibodies against the NR1 subunits of NMDARs.
Although new-onset acute prominent psychotic syndromes in patients with NMDAR
encephalitis have been well documented, there is a lack of case studies on
differential diagnosis and treatment of anti-NMDAR encephalitis after a long-term
diagnostic history of functional psychotic disorders. The present study reports
an unusual case of anti-NMDAR encephalitis. The patient had been diagnosed with
schizophrenia 7 years earlier, and was currently hospitalized for acute-onset
psychiatric symptoms. The diagnosis became unclear when the initial psychosis was
confounded with considerations of other neurotoxicities (such as neuroleptic
malignant syndrome). Finally, identification of specific immunoglobulin G NR1
autoantibodies in the cerebrospinal fluid and greater effectiveness of
immunotherapy over antipsychotics alone (which has been well documented in
anti-NMDAR encephalitis) indicated the diagnosis of anti-NMDAR encephalitis in
this case. Based on the available evidence, however, the relationship between the
newly diagnosed anti-NMDAR encephalitis and the seemingly clear, long-term
history of schizophrenia in the preceding 7 years is uncertain. This case report
illustrates that psychiatrists should consider anti-NMDAR encephalitis and order
tests for specific immunoglobulin G NR1 autoantibodies in patients presenting
with disorientation, disturbance of consciousness, cognitive deficit, dyskinesia,
autonomic disturbance, or rapid deterioration, even with a seemingly clear
history of a psychiatric disorder and no specific findings on routine
neuroimaging, electroencephalography, or cerebrospinal fluid tests in the early
stage of the illness.