Anti- N-Methyl-D-Aspartate Receptor Encephalitis: A Review of Psychiatric Phenotypes and Management Considerations: A Report of the American Neuropsychiatric Association Committee on Research

J Neuropsychiatry Clin Neurosci. Spring 2019;31(2):137-142. doi: 10.1176/appi.neuropsych.18010005. Epub 2018 Dec 18.

Abstract

Objective: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder characterized by prominent neuropsychiatric symptoms. Given the nature of its pathophysiology, psychiatrists tend to be one of the first clinicians encountering patients with the disease.

Methods: In the present review of patients described in the literature with psychiatric symptoms, the authors aimed to characterize the psychiatric symptoms of the disease and its management in adults and adolescents as well as children (≤12 years old). A total of 544 patients fulfilled the inclusion criteria.

Results: The authors found that 77% of patients with NMDAR encephalitis presented initially with psychiatric symptoms. These were mostly agitation (59%) and psychotic symptoms (in 54%, especially disorganized behavior and visual-auditory hallucinations), with agitation even more commonly being the presenting symptom in children (66%). Where psychotic symptoms were detailed, visual (64%) and auditory (59%) hallucinations were the most common, as well as persecutory delusions (73%). However, delusions were not clearly characterized in most cases. Catatonia was described in 42% of adult patients and 35% of children. Of the patients with documented exposure to antipsychotics, 33% were suspected to have an adverse drug reaction (notably, neuroleptic malignant syndrome in 22% of the cases).

Conclusions: On the basis of these findings, it is important to consider anti-NMDAR encephalitis in the differential diagnosis of patients with an acute onset psychosis, especially in association with agitation, catatonia, or adverse response to antipsychotics. Furthermore, it is important to use antipsychotics with caution in patients with suspected or confirmed anti-NMDAR encephalitis.

Keywords: CSF Brain Fluids and Their Disorders; Hallucinations; Neuroimmunology; Neuroleptics; Psychosis.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / complications*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / epidemiology
  • Catatonia / epidemiology
  • Catatonia / etiology*
  • Child
  • Child, Preschool
  • Delusions / epidemiology
  • Delusions / etiology*
  • Hallucinations / epidemiology
  • Hallucinations / etiology*
  • Humans
  • Infant
  • Middle Aged
  • Neuropsychiatry
  • Psychomotor Agitation / epidemiology
  • Psychomotor Agitation / etiology*
  • Psychotic Disorders / epidemiology
  • Psychotic Disorders / etiology*
  • Societies, Medical
  • Young Adult