Journalists write a lot more than psychiatrists, right? But how can you write meaningfully when your “brain is on fire”? A 24 year old New York Post reporter, Susannah Cahalan, had her “brain on fire” for nearly a month.
In her own words (1), she says, “I started [acting] very psychotic. I believed that I could age people with my mind. If I looked at them, wrinkles would form, and if I looked away, they would suddenly, magically get younger. And I believed that my father had murdered my stepmother. I believed all these incredibly paranoid — a huge, extreme example of persecution complex. And then as the days went on, I stopped being as psychotic, and I started entering into a catatonic stage, which was characterized by just complete lack of emotion, inability to relate, or to read, or hardly to be able to speak”
That description, her age as well as the combination of symptoms should tell us she is experiencing a typical psychotic episode. Right?
No! Susannah Cahalan’s psychotic break was anything but typical.
And it was not antipsychotics that got her out of this “month of madness”, as she puts it.
It turned out she had anti-NMDA encephalitis. While rare, it is important to know the ‘red flags’ for this condition, as it can be easily missed for schizophrenia or a mood disorder, but near-totally reversed with the right type of immunotherapy.
There are also many other conditions that can set your brain on psychotic fire, though pouring antipsychotics may not quench all the flames. We present a series of discussions on the topic of Atypical Psychosis in our PEF Coffee Club:
(1) When is First Episode Psychosis Atypical? (Read Coffee Club #1)
(2) Which Investigations are Needed for Late-Onset Psychosis? (Read Coffee Club #2)
(3) Performing Rapid Neurological Exam for Atypical Psychosis. (Read Coffee Club #3)
(4) Anti NMDA-R: What Should you Know as a Psychiatrist? (Read Coffee Club #4)
Have you ever come across anti-NMDA encephalitis? How long did it take before your patient was rightly diagnosed? Add your comments below!
Post Contribution by Dr. Lena Palaniyappan