scholarly journals Neuropsychological And Psychopathological Profile Of Anti-Nmdar Encephalitis: A Possible Pathophysiological Model For Pediatric Neuropsychiatric Disorders

2018 ◽  
Vol 34 (8) ◽  
pp. 1309-1319 ◽  
Author(s):  
Elisa Cainelli ◽  
Margherita Nosadini ◽  
Stefano Sartori ◽  
Agnese Suppiej
Keyword(s):  
Executive Functions ◽  
Psychiatric Symptoms ◽  
Autoimmune Disorder ◽  
Neuropsychiatric Disorders ◽  
Cognitive Outcome ◽  
Obsessive Compulsive ◽  
Nmdar Encephalitis ◽  
Visual Motor ◽  
Comprehensive Framework

Abstract Objective Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a severe, but treatable, autoimmune disorder, characterized by autoantibodies causing hypofunction of blocking NMDA receptors leading to a unique constellation of cognitive, motor, and psychiatric symptoms. Neuropsychological and psychopathological outcome has not been fully explored, particularly in children. Aim of this study was to investigate pediatric anti-NMDAR encephalitis as a model of impairment of the complex frontal-subcortical circuits who are implicated in several of the childhood neuropsychiatric disorders. Method Seven children diagnosed with anti-NMDAR encephalitis at our department underwent an evaluation of the global mental functioning before discharge, a neuropsychological and psychological/behavioral standardized examination within one month after discharge and subsequently were followed up longitudinally for mean 35 months (range 24–48 months). Collected neuropsychological data were evaluated retrospectively. Results Deficits in attention, executive functions and/or visual motor functions involving executive functions were seen in all children within one month after discharge. These deficits were long lasting in about a half of the patients. In addition, four patients developed persistent psychopathological dysfunctions: difficulties to regulate their own behavior, impulsivity, hyperactivity, irritability, apathy, and obsessive-compulsive symptoms. Conclusions Our data are in line with research suggesting a crucial role of the executive functions impairments in cognitive outcome disturbance of anti-NMDAR encephalitis. We found also behavioral and psychological deficits pointing to a more comprehensive framework of frontal-subcortical dysfunction, in which the NMDA mediated transmission appear to have a role, as suggested by neurobiological, pharmacological, and neuroimaging studies.

scholarly journals Exploration-related strategy mediates negative coupling between decision-making performance and psychiatric symptoms

2019 ◽  
Author(s):  
Shinsuke Suzuki ◽  
Yuichi Yamashita ◽  
Kentaro Katahira
Keyword(s):  
Decision Making ◽  
Psychiatric Symptoms ◽  
Two Dimensions ◽  
Depression And Anxiety ◽  
Obsessive Compulsive ◽  
Overall Performance ◽  
Negative Coupling ◽  
High Comorbidity ◽  
Model Based Analysis

AbstractVarious psychiatric symptoms are often accompanied by impairments in decision-making. Given the high comorbidity of psychiatric disorders, symptoms that specifically couple with the impairment remain unidentified. The computations involved in decision-making that mediate the coupling are also elusive. Here, we conducted an online experiment with healthy individuals (n=939), participating in a decision-making task and completing questionnaires about psychiatric symptoms. The questionnaire data identified two dimensions underlying various symptoms: the first is mainly associated with obsessive-compulsive traits whereas the second is associated with depression and anxiety. Furthermore, by model-based analysis, we found only the first dimension was negatively correlated with the overall performance of the decision-making task, and the negative correlation was mediated by choice stochasticity (random exploration) and propensity to choose options previously unchosen. Given that the preference for previously unchosen options can reflect uncertainty-driven exploration, our findings highlight a key role of exploration-related strategies in psychiatric deficits of decision-making.

Management And Psychiatric Manifestations Of Anti-NMDA Receptor Encephalitis, A Case Report

2016 ◽  
Vol 33 (S1) ◽  
pp. S525-S526
Author(s):  
R. Gallego ◽  
A. Flores
Keyword(s):  
Case Report ◽  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Multidisciplinary Treatment ◽  
Autoimmune Disorder ◽  
Clonic Seizure ◽  
Nmda Receptor Encephalitis ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Psychiatric Manifestations

IntroductionAnti-NMDA receptor (NMDAR) encephalitis, formally recognized in 2007 by Dalmau et al, is an autoimmune disorder with a complex presentation that includes psychiatric symptoms, memory deficits, and autonomic instability. The exact incidence is unknown but age, gender, and ethnicity may all play a role. Presence of antibodies against the GluN1 subunit of the NMDAR in the CSF and serum confirm the diagnosis of NMDAR encephalitis.Case reportWe report the case of a previously healthy, 19-year-old woman, 6 weeks pregnant. She had a generalized tonic-clonic seizure followed by psychiatric symptoms, including insomnia, emotional lability, delusions, and disorganized behavior. During the course of the disease, she demonstrated speech impairments and catatonic features associated with abnormal movements.She was provided lorazepam 1 mg twice a day to treat her catatonic symptoms, her insomnia and her speech improved. Olanzapine was introduced, reaching a dose of 20 mg/day for managing psychosis and agitation.DiscussionNMDA-R encephalitis is a novel disorder with prominent psychiatric manifestations that is widely underdiagnosed. Neuroleptics may be helpful for managing psychosis and agitation, but may exacerbate movement abnormalities. Benzodiazepines are helpful for agitation, insomnia and catatonia associated with this condition.ConclusionEarlier recognition of this illness is crucial as prompt diagnosis and multidisciplinary treatment, can potentially improve prognosis. There is an increasing need for psychiatrists to become aware of the disorder and consider it in their differential diagnosis, specially in patients with new onset psychosis, history of encephalitis or subtle neurological symptoms. Careful selection of psychopharmacological interventions may reduce suffering.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The centennial lesson of encephalitis lethargica

Neurology ◽  
2018 ◽  
Vol 90 (12) ◽  
pp. 563-567 ◽  
Author(s):  
Bart Lutters ◽  
Paul Foley ◽  
Peter J. Koehler
Keyword(s):  
Mental Illness ◽  
Substantia Nigra ◽  
Mood Disorders ◽  
Psychiatric Symptoms ◽  
Organic Basis ◽  
Compulsive Behavior ◽  
Obsessive Compulsive ◽  
Encephalitis Lethargica ◽  
Postencephalitic Parkinsonism

We commemorate the centenary of Constantin von Economo's description of encephalitis lethargica, a mysterious disease that had a significant effect on 20th-century neuroscience. In the acute phase, encephalitis lethargica was marked by intractable somnolence, which von Economo attributed to lesions in the diencephalon, thereby paving the way for future efforts to localize the regulation of sleep in the subcortical brain. At the same time, neuropathologic findings in postencephalitic parkinsonism affirmed the role of the substantia nigra in the pathophysiology of parkinsonism. The occurrence of psychiatric symptoms in patients with encephalitis lethargica—such as mood disorders, obsessive-compulsive behavior, and bradyphrenia—drew attention to the organic basis of mental illness.

scholarly journals The Microbiota/Microbiome and the Gut–Brain Axis: How Much Do They Matter in Psychiatry?

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 760
Author(s):  
Donatella Marazziti ◽  
Beatrice Buccianelli ◽  
Stefania Palermo ◽  
Elisabetta Parra ◽  
Alessandro Arone ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Neuropsychiatric Disorders ◽  
Autism Spectrum ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Brain Functions ◽  
The Central Nervous System ◽  
The Brain ◽  
Gut Microbiota Composition

The functioning of the central nervous system (CNS) is the result of the constant integration of bidirectional messages between the brain and peripheral organs, together with their connections with the environment. Despite the anatomical separation, gut microbiota, i.e., the microorganisms colonising the gastrointestinal tract, is highly related to the CNS through the so-called “gut–brain axis”. The aim of this paper was to review and comment on the current literature on the role of the intestinal microbiota and the gut–brain axis in some common neuropsychiatric conditions. The recent literature indicates that the gut microbiota may affect brain functions through endocrine and metabolic pathways, antibody production and the enteric network while supporting its possible role in the onset and maintenance of several neuropsychiatric disorders, neurodevelopment and neurodegenerative disorders. Alterations in the gut microbiota composition were observed in mood disorders and autism spectrum disorders and, apparently to a lesser extent, even in obsessive-compulsive disorder (OCD) and related conditions, as well as in schizophrenia. Therefore, gut microbiota might represent an interesting field of research for a better understanding of the pathophysiology of common neuropsychiatric disorders and possibly as a target for the development of innovative treatments that some authors have already labelled “psychobiotics”.

scholarly journals Anti- NMDAR Autoimmune Encephalitis Presenting as Acute Psychosis: A Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 59-61
Author(s):  
Bibek Rajbhandari ◽  
Minani Gurung
Keyword(s):  
Behavioral Change ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Autoimmune Disorder ◽  
Clinical Findings ◽  
Acute Psychosis ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Long Time ◽  
Autonomic Instability

Anti-NMDA receptor (NMDAR) encephalitis is a recently identified autoimmune disorder with prominent psychiatric symptoms. Patients usually present with acute behavioral change, psychosis, catatonic symptoms, memory deficits, seizures, dyskinesias, and autonomic instability. We present a case of a 13-year old who presented with noticeably chirpiness, excessive talking with unknown people and wandering around the neighborhood without purpose.The main symptoms of the patient and the important clinical findings were irrelevant talking which later developed into slurring of speech, abnormal movements and memory loss.This case is an example of how easily we are misled towards diagnosis based on the present symptoms. The patient suffered the unnecessary stigma of a psychiatric illness, which might stay imprinted on her for a long time. In this report we call for attention to the inclusion of anti-NMDAR encephalitis in the differential diagnosis of acute psychosis. It adds on to show that NMDAR might present in the most unexpected and unpredictable ways, sometimes misleading the patient away from medical help.Prompt diagnosis is critical as early immunotherapy and tumor removal could dramatically affect outcomes.

scholarly journals Insights into the Pathophysiology of Psychiatric Symptoms in Central Nervous System Disorders: Implications for Early and Differential Diagnosis

2021 ◽  
Vol 22 (9) ◽  
pp. 4440
Author(s):  
Giulia Menculini ◽  
Elena Chipi ◽  
Federico Paolini Paoletti ◽  
Lorenzo Gaetani ◽  
Pasquale Nigro ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Impulse Control ◽  
Psychiatric Symptoms ◽  
Neurological Diseases ◽  
Clinical Manifestations ◽  
Obsessive Compulsive ◽  
Clinical Onset ◽  
Brain Circuits

Different psychopathological manifestations, such as affective, psychotic, obsessive-compulsive symptoms, and impulse control disturbances, may occur in most central nervous system (CNS) disorders including neurodegenerative and neuroinflammatory diseases. Psychiatric symptoms often represent the clinical onset of such disorders, thus potentially leading to misdiagnosis, delay in treatment, and a worse outcome. In this review, psychiatric symptoms observed along the course of several neurological diseases, namely Alzheimer’s disease, fronto-temporal dementia, Parkinson’s disease, Huntington’s disease, and multiple sclerosis, are discussed, as well as the involved brain circuits and molecular/synaptic alterations. Special attention has been paid to the emerging role of fluid biomarkers in early detection of these neurodegenerative diseases. The frequent occurrence of psychiatric symptoms in neurological diseases, even as the first clinical manifestations, should prompt neurologists and psychiatrists to share a common clinico-biological background and a coordinated diagnostic approach.

Autoimmune Basal Ganglia Disorders

2012 ◽  
Vol 27 (11) ◽  
pp. 1470-1481 ◽  
Author(s):  
Russell C. Dale ◽  
Fabienne Brilot
Keyword(s):  
Basal Ganglia ◽  
Lupus Erythematosus ◽  
Autoimmune Disorder ◽  
Neuropsychiatric Disorders ◽  
Autoimmune Disorders ◽  
Obsessive Compulsive ◽  
Encephalitis Lethargica ◽  
Compulsive Disorder ◽  
Sydenham Chorea ◽  
Basal Ganglia Disorders

The basal ganglia are deep nuclei in the brain that include the caudate, putamen, globus pallidus, and substantia nigra. Pathological processes involving the basal ganglia often result in disorders of movement and behavior. A number of different autoimmune disorders predominantly involve the basal ganglia and can result in movement and psychiatric disorders. The classic basal ganglia autoimmune disorder is Sydenham chorea, a poststreptococcal neuropsychiatric disorder. Resurgence in the interest in Sydenham chorea is the result of the descriptions of other poststreptococcal neuropsychiatric disorders including tics and obsessive-compulsive disorder, broadly termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection. Encephalitic processes affecting the basal ganglia are also described including the syndromes basal ganglia encephalitis, encephalitis lethargica, and bilateral striatal necrosis. Last, systemic autoimmune disorders such as systemic lupus erythematosus and antiphospholipid syndrome can result in chorea or parkinsonism. Using paradigms learned from other autoantibody associated disorders, the authors discuss the autoantibody hypothesis and the role of systemic inflammation in autoimmune basal ganglia disorders. Identification of these entities is important as the clinician has an increasing therapeutic repertoire to modulate or suppress the aberrant immune system.

Obsessive compulsive symptoms, social functioning and executive functions in chronic schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. S386-S386 ◽  
Author(s):  
E. Theochari ◽  
E. Tsaltas ◽  
D. Kontis
Keyword(s):  
Executive Function ◽  
Executive Functioning ◽  
Executive Functions ◽  
Social Functioning ◽  
Chronic Schizophrenia ◽  
Compensatory Mechanism ◽  
Obsessive Compulsive ◽  
Cross Sectional ◽  
Obsessive Compulsive Symptoms

IntroductionSchizophrenia leads to functional deficits. A third of schizophrenia patients have obsessive compulsive symptoms (OCSs). The existing studies, which have investigated the effect of OCSs on social functioning (SF) of schizophrenia patients have produced contradictory findings and, interestingly, they have not adjusted for the role of executive functioning.ObjectivesTo investigate the predictive role of OCSs on SF in schizophrenia controlling for the effects of executive functioning.MethodsIn a cross-sectional study of 110 chronic schizophrenia patients we assessed OCSs (Yale-Brown Scale), SF (Strauss Carpenter Scale) and composite executive function (cognitive flexibility: Intra–extra dimensional set shifting task and planning: Stockings of Cambridge task) using the Cambridge Neuropsychological Test Automated Battery (CANTAB). We also measured total symptoms (PANSS total scores) and illness duration. Regression analysis tested the predicting role of OCSs (YBOCS total score) on functioning taking into account executive function (composite score) duration of illness and schizophrenia symptoms.ResultsOCSs were associated with better SF (B = 0.099; 95% CI = 0.019, 0.180; t = 2.449; df = 88; P = 0.016). This result was driven by the association of OCSs with job functioning (B = 0.043; 95% CI = 0.006, 0.081; t = 2.289; df = 88; P = 0.024). Executive functions were not significantly associated with social functioning.ConclusionsOCSs and not executive functions are associated with social functioning in schizophrenia. Future studies should examine whether OCSs represent a compensatory mechanism aiming at preserving social functioning in the disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals A patient with a long history of relapsing psychosis and mania presenting with anti-NMDA receptor encephalitis ten years after first episode

2015 ◽  
Vol 9 (3) ◽  
pp. 311-314 ◽  
Author(s):  
Mateus Mistieri Simabukuro ◽  
Christian Henrique de Andrade Freitas ◽  
Luiz Henrique Martins Castro
Keyword(s):  
Psychiatric Disorders ◽  
Psychiatric Symptoms ◽  
Bipolar Affective Disorder ◽  
Autoimmune Encephalitis ◽  
Autoimmune Disorder ◽  
First Episode ◽  
Nmda Receptor Encephalitis ◽  
Nmdar Encephalitis ◽  
Lack Of Information ◽  
History Of

Anti-N-methyl- D-aspartate receptor (NMDAR) encephalitis is a recently discovered autoimmune disorder, in which antibodies target NMDARs in the brain, leading to their removal from synapses. Early in the disease course, patients often present with marked psychosis and mood disturbances (i.e. mania, depression), explaining why most of these patients are first seen by psychiatrists. Hence, autoimmune encephalitis is receiving growing attention from psychiatry, mainly owing to concerns over misdiagnosing immunomediated and potentially curable disorders as primary psychiatric disorders, such as schizophrenia or major depressive disorder. Although anti-NMDAR encephalitis occurs in the context of new-onset psychiatric symptoms, there is a lack of information on differential diagnosis and treatment of this disorder after a long-term diagnostic history of functional psychiatric disorders. We report a case of a patient with a long history of bipolar affective disorder evolving with anti-NMDAR encephalitis, initially misdiagnosed as non-organic psychosis.

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

2015 ◽  
Vol 37 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Vanina Lima Monteiro ◽  
Felipe José Nascimento Barreto ◽  
Paulo Marcos Brasil Rocha ◽  
Paulo Henrique Teixeira do Prado ◽  
Frederico Duarte Garcia ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Behavioral Symptoms ◽  
Healthcare Team ◽  
Liaison Psychiatry ◽  
Neuropsychiatric Complications ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Consultation Liaison Psychiatry ◽  
High Doses

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.

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