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Anti-NMDA Receptor Encephalitis or Psychiatric disorder?

Published online by Cambridge University Press:  01 September 2022

B. Freitas*
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psiquiatria, Lisboa, Portugal
M.D.C. Vasconcelos
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psiquiatria, Lisboa, Portugal
F. Ramalheira
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psiquiatria, Lisboa, Portugal
D. Terêncio
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psiquiatria, Lisboa, Portugal
C. Moreira
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psiquiatria, Lisboa, Portugal
*
*Corresponding author.

Abstract

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Introduction

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis commonly begins with a prodromal phase characterized by flu-like symptoms, subsequently the patients experience a rapid deterioration with psychiatric symptoms that may include anxiety, irritability, insomnia, paranoia, aggression, auditory or visual hallucinations, sexual disinhibition, mania, cognitive disorder, and psychosis; seizures; motor and autonomic dysfunction. The triggers of the disorder comprise viral infections, tumors, and other unknown factors. Taking in count the prominence of psychiatric symptoms, it is relevant to rise the question whether patients with anti-NMDA receptor encephalitis are being misdiagnosed with psychiatric disorders.

Objectives

Non-systematic literature review of the relationship between anti-NMDA receptor encephalitis and psychiatric disorders.

Methods

From the review performed, 2 studies stand out: In one study, 459 serum samples for NMDA receptor antibodies were evaluated. The analysis compared samples from patients diagnosed with schizophrenia, major depressive disorder, and borderline personality disorder with nonpsychiatric controls. In another study, serum was obtained prospectively from a cohort (n = 46) of patients at first presentation of psychosis and NMDA receptor antibodies were measured.

Results

In the first study, the authors found that 9.9%, 2.8%, and 0% of patients with schizophrenia, major depressive disorder, and borderline personality disorder, respectively, were antibody positive. In the second study, it was found that 7% of the patients were serum NMDA receptor antibody positive.

Conclusions

It is unclear yet if patients with primary psychotic disorders have higher rates of pathogenic NMDA receptor antibodies. More evidence is needed to study this relationship.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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