Anti-NMDAR Encephalitis: What should you know as a Psychiatrist?
Anti-NMDA Receptor Encephalitis
This is an autoimmune disorder in which antibodies attack NMDA (N-methyl D aspartate) type glutamate receptors at central neuronal synapses.
Psychiatrists should have knowledge of this disorder and consider it in their differential diagnosis, as they are often the first to be consulted on these patients. Let’s begin by answering the following question first:
Let’s begin by answering this question first:
According to Josep Dalmau et al’s article published in Lancet Neurology (1), following criteria/acronym is helpful in identifying NMDA receptor autoimmunity:
SEARCH For NMDA Receptor Autoimmunity
- S: Sleep Dysfunction
- E: Excitement, Disinhibition or Manic Behavior alternating with Depressive behavior
- A: Agitation or Aggression
- R: Rapid Onset
- C: Children & Young Adults Dominance
- H: History of Psychiatric Disease: Absent
- F: Fluctuating Catatonia
- N: Negative & Positive Symptoms at Presentation
- M: Memory Deficit
- D: Decreased Verbal Output or Mutism
- A: Antipsychotic Intolerance
- R: Rule out NMS
- A: Antibodies & Other Additional Tests (EEG, MRI or CSF)
References:
- Dalmau J, Armangué T, Planagumà J, Radosevic M, Mannara F, Leypoldt F, Geis C, Lancaster E, Titulaer MJ, Rosenfeld MR, Graus F. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol. 2019 Nov;18(11):1045-1057. (PMID: 31326280)
- Can You Identify Autoimmune Psychosis? Psychiatric News. (Published Online:4 Jan 2021)
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Anti-NMDA Receptor Encephalitis: Diagnosis & Treatment
This chapter will be summarized in the following sections:
- Demographics.
- Clinical features (phases).
- Duration of illness.
- Diagnosis.
- Treatment.
- Prognosis.
- Additional Important Clinical Tips.
COFFEE CLUB DISCUSSION:
Watch the following video discussion by a neurologist Dr. Seyed Mirsattari on: Anti-NMDA: What should you know as a Psychiatrist?
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