Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2014-0036
Trends in Psychiatry and Psychotherapy
Case Report

Managing severe behavioral symptoms of a patient with anti-NMDAR encephalitis: case report and findings in current literature

Manejo de sintomas comportamentais severos em um paciente com encefalite-anti-NMDAR: relato de caso e literatura atual

Vanina Lima Monteiro; Felipe José Nascimento Barreto; Paulo Marcos Brasil Rocha; Paulo Henrique Teixeira do Prado; Frederico Duarte Garcia; Humberto Correa; Maila Castro Lourenço das Neves

http://dx.doi.org/10.1590/2237-6089-2014-0036 Trends Psychiatry Psychother, vol.37, n1, p.47-50, 2015
PDF
SciELO
Downloads: 0
Views: 384

Abstract

Objective: Psychiatric symptoms emerge in the early stages of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, and patients often seek treatment in psychiatric departments before visiting any other general medical services. Numerous articles about anti-NMDAR encephalitis have been published in the scientific community worldwide, but few emphasize the role of psychiatry in symptom management.Case description: We describe the case of a patient with anti- -NMDAR encephalitis seen in our service and discuss the management of behavioral symptoms based on current scientific literature. High doses of atypical antipsychotics and benzodiazepines were used to control agitation, and trazodone was administered to treat insomnia.Comments: Consultation-liaison psychiatry may help the healthcare team adjust the management of neuropsychiatric complications that might affect inpatients with anti-NMDAR encephalitis.

Keywords

Anti-NMDAR encephalitis, consultation-liaison psychiatry, behavioral symptoms

Resumo

Objetivo: Sintomas psiquiátricos surgem em estágios precoces da encefalite antirreceptor N-metil-D-aspartato (NMDAR), o que faz muitos pacientes procurarem tratamento em serviços de psiquiatria antes de se dirigirem a unidades de clínica geral. Embora muitos artigos sobre encefalite anti-NMDAR venham sendo publicados na comunidade científica internacional, poucos enfatizam o papel do psiquiatra no seu manejo sintomatológico.Descrição do caso: O presente artigo relata o caso de um paciente que desenvolveu encefalite anti-NMDAR em nosso serviço e discute manejo de alterações comportamentais com base na literatura científica atual. Altas doses de antipsicóticos atípicos e benzodiazepínicos foram usados para controle de agitação, e trazodona foi utilizada para tratar insônia.Comentários: A interconsulta psiquiátrica pode ajudar no ajuste de condutas de toda a equipe assistente para as complicações neuropsiquiátricas que possam surgir na evolução de pacientes internados por encefalite anti-NMDAR.

Palavras-chave

Encefalite anti-NMDAR, interconsulta psiquiátrica, sintomas comportamentais.

References

Wandinger KP, Saschenbrecker S, Stoecker W, Dalmau J. Anti-NMDA-receptor encephalitis: a severe, multistage, treatable disorder presenting with psychosis. J Neuroimmunol. 2011;231:86-91.

Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011;10:63-74.

Pollak TA, McCormack R, Peakman M, Nicholson TR, David AS. Prevalence of anti-N-methyl-d-aspartate (NMDA) antibodies in patients with schizophrenia and related psychoses: a systematic review and meta-analysis. Psychol Med. 2014;44:2475-87.

Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M. Anti- NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7:1091-8.

Maneta E, Garcia G. Psychiatric manifestations of anti-NMDA receptor encephalitis: neurobiological underpinnings and differential diagnostic implications. Psychosomatics. 2014;55:37-44.

Kayser MS, Titulaer MJ, Gresa-Arribas N, Dalmau J. Frequency and characteristics of isolated psychiatric episodes in anti-N-methyl-d-aspartate receptor encephalitis. JAMA Neurol. 2013;70:1133-9.

Dalmau J, Tüzün E, Wu HY, Masjuan J, Rossi JE, Voloschin A, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61:25-36.

Chapman MR, Vause HE. Anti-NMDA receptor encephalitis: diagnosis, psychiatric presentation, and treatment. Am J Psychiatry. 2011;168:245-51.

Mann A, Machado NM, Liu N, Mazin AH, Silver K, Afzal KI. A multidisciplinary approach to the treatment of anti-NMDA-receptor antibody encephalitis: a case and review of the literature. J Neuropsychiatry Clin Neurosci. 2012;24:247-54.

Barry H, Hardiman O, Healy DG, Keogan M, Moroney J, Molnar PP. Anti-NMDA receptor encephalitis: an important differential diagnosis in psychosis. Br J Psychiatry. 2011;199:508-9.

Kung DH, Qiu C, Kass JS. Psychiatric manifestations of anti-NMDA receptor encephalitis in a man without tumor. Psychosomatics. 2011;52:82-5.

Kuo YL, Tsai HF, Lai MC, Lin CH, Yang YK. Anti-NMDA receptor encephalitis with the initial presentation of psychotic mania. J Clin Neurosci. 2012;19:896-8.

Van de Riet EH, Esseveld MM, Cuypers L, Schieveld JN. Anti-NMDAR encephalitis: a new, severe and challenging enduring entity. Eur Child Adolesc Psychiatry. 2013;22:319-23.

Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU. Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2013;16:1205-18.

Jones KC, Benseler SM, Moharir M. Anti-NMDA receptor encephalitis. Neuroimag Clin N Am. 2013;23:309-20.

6169efaaa9539560f3317784 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections