Characterisation and outcome of neuropsychiatric symptoms in patients with anti-NMDAR encephalitis
Encephalitis due to anti-N-methyl-D-aspartate receptor antibodies (ANMDARE) is the most frequent immune-mediated encephalitis. It is distinguished by the subacute onset of neuropsychiatric symptoms. To evaluate the characteristic neuropsychiatric symptoms and their outcome in patients diagnosed with...
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| Veröffentlicht in: | Acta neuropsychiatrica 2020-04, Vol.32 (2), p.92-98 |
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| creator | Restrepo-Martinez, Miguel Ramirez-Bermudez, Jesus Bayliss, Leo Espinola-Nadurille, Mariana |
| description | Encephalitis due to anti-N-methyl-D-aspartate receptor antibodies (ANMDARE) is the most frequent immune-mediated encephalitis. It is distinguished by the subacute onset of neuropsychiatric symptoms.
To evaluate the characteristic neuropsychiatric symptoms and their outcome in patients diagnosed with ANMDARE.
This was a prospective, longitudinal study in patients with a diagnostic suspicion of ANMDARE that presented to the National Institute of Neurology from March 2018 to February 2019. A comparative analysis of two groups (positive N-methyl-D-aspartate receptor [NMDAR] vs. negative NMDAR antibodies in cerebrospinal fluid [CSF]) was done on admission and at discharge. Neuropsychiatric systematic assessments included the Neuropsychiatric Inventory Questionnaire, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method Severity, the Montreal Cognitive Assessment, and the Overt Agitation Severity Scale.
24 individuals were analysed: 14 had positive NMDAR antibodies, and 10 had negative NMDAR antibodies in CSF. On admission, agitation/aggression, euphoria/exaltation, and disinhibition were more common in patients with positive antibodies. Excited catatonia and delirium were diagnosed more frequently in patients with positive antibodies. At discharge, there was an important decrease in neuropsychiatric symptoms, but substantial cognitive impairment remained. The mean hospitalisation length was 41.71 (SD 39.33) days for patients with definitive ANMDARE (p 0.259).
Neuropsychiatric symptoms profile in ANMDARE was associated with the early onset of euphoria/exaltation and disinhibition, accompanied by marked psychomotor agitation. When ANMDARE was suspected, the presence of excited-type catatonia and delirium showed a tendency to predict definitive ANMDARE. At discharged, most patients recovered from catatonia, delirium, and psychosis, but marked cognitive symptoms, anxiety, and depression persisted at discharge. |
| doi_str_mv | 10.1017/neu.2019.46 |
| format | Article |
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To evaluate the characteristic neuropsychiatric symptoms and their outcome in patients diagnosed with ANMDARE.
This was a prospective, longitudinal study in patients with a diagnostic suspicion of ANMDARE that presented to the National Institute of Neurology from March 2018 to February 2019. A comparative analysis of two groups (positive N-methyl-D-aspartate receptor [NMDAR] vs. negative NMDAR antibodies in cerebrospinal fluid [CSF]) was done on admission and at discharge. Neuropsychiatric systematic assessments included the Neuropsychiatric Inventory Questionnaire, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method Severity, the Montreal Cognitive Assessment, and the Overt Agitation Severity Scale.
24 individuals were analysed: 14 had positive NMDAR antibodies, and 10 had negative NMDAR antibodies in CSF. On admission, agitation/aggression, euphoria/exaltation, and disinhibition were more common in patients with positive antibodies. Excited catatonia and delirium were diagnosed more frequently in patients with positive antibodies. At discharge, there was an important decrease in neuropsychiatric symptoms, but substantial cognitive impairment remained. The mean hospitalisation length was 41.71 (SD 39.33) days for patients with definitive ANMDARE (p 0.259).
Neuropsychiatric symptoms profile in ANMDARE was associated with the early onset of euphoria/exaltation and disinhibition, accompanied by marked psychomotor agitation. When ANMDARE was suspected, the presence of excited-type catatonia and delirium showed a tendency to predict definitive ANMDARE. At discharged, most patients recovered from catatonia, delirium, and psychosis, but marked cognitive symptoms, anxiety, and depression persisted at discharge.</description><identifier>ISSN: 0924-2708</identifier><identifier>EISSN: 1601-5215</identifier><identifier>DOI: 10.1017/neu.2019.46</identifier><identifier>PMID: 31753060</identifier><language>eng</language><publisher>England: Cambridge University Press</publisher><subject>Adult ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - cerebrospinal fluid ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - complications ; Antibodies ; Autoantibodies - cerebrospinal fluid ; Autoimmune diseases ; Behavioral Symptoms - etiology ; Catatonia ; Catatonia - etiology ; Cognitive Dysfunction - etiology ; Consciousness ; Convulsions & seizures ; Delirium ; Delirium - etiology ; Disease ; Encephalitis ; Euphoria ; Female ; Humans ; Hypoventilation ; Length of Stay ; Longitudinal Studies ; Male ; Mental disorders ; Psychomotor Agitation - etiology ; Psychosis ; Sociodemographics</subject><ispartof>Acta neuropsychiatrica, 2020-04, Vol.32 (2), p.92-98</ispartof><rights>Scandinavian College of Neuropsychopharmacology 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c317t-410b59341b4b15dd52602bcb284e08265cae1d6612e9b199e314a3b6c168dffd3</citedby><cites>FETCH-LOGICAL-c317t-410b59341b4b15dd52602bcb284e08265cae1d6612e9b199e314a3b6c168dffd3</cites><orcidid>0000-0002-6382-2699 ; 0000-0003-2879-5258</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31753060$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Restrepo-Martinez, Miguel</creatorcontrib><creatorcontrib>Ramirez-Bermudez, Jesus</creatorcontrib><creatorcontrib>Bayliss, Leo</creatorcontrib><creatorcontrib>Espinola-Nadurille, Mariana</creatorcontrib><title>Characterisation and outcome of neuropsychiatric symptoms in patients with anti-NMDAR encephalitis</title><title>Acta neuropsychiatrica</title><addtitle>Acta Neuropsychiatr</addtitle><description>Encephalitis due to anti-N-methyl-D-aspartate receptor antibodies (ANMDARE) is the most frequent immune-mediated encephalitis. It is distinguished by the subacute onset of neuropsychiatric symptoms.
To evaluate the characteristic neuropsychiatric symptoms and their outcome in patients diagnosed with ANMDARE.
This was a prospective, longitudinal study in patients with a diagnostic suspicion of ANMDARE that presented to the National Institute of Neurology from March 2018 to February 2019. A comparative analysis of two groups (positive N-methyl-D-aspartate receptor [NMDAR] vs. negative NMDAR antibodies in cerebrospinal fluid [CSF]) was done on admission and at discharge. Neuropsychiatric systematic assessments included the Neuropsychiatric Inventory Questionnaire, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method Severity, the Montreal Cognitive Assessment, and the Overt Agitation Severity Scale.
24 individuals were analysed: 14 had positive NMDAR antibodies, and 10 had negative NMDAR antibodies in CSF. On admission, agitation/aggression, euphoria/exaltation, and disinhibition were more common in patients with positive antibodies. Excited catatonia and delirium were diagnosed more frequently in patients with positive antibodies. At discharge, there was an important decrease in neuropsychiatric symptoms, but substantial cognitive impairment remained. The mean hospitalisation length was 41.71 (SD 39.33) days for patients with definitive ANMDARE (p 0.259).
Neuropsychiatric symptoms profile in ANMDARE was associated with the early onset of euphoria/exaltation and disinhibition, accompanied by marked psychomotor agitation. When ANMDARE was suspected, the presence of excited-type catatonia and delirium showed a tendency to predict definitive ANMDARE. At discharged, most patients recovered from catatonia, delirium, and psychosis, but marked cognitive symptoms, anxiety, and depression persisted at discharge.</description><subject>Adult</subject><subject>Anti-N-Methyl-D-Aspartate Receptor Encephalitis - cerebrospinal fluid</subject><subject>Anti-N-Methyl-D-Aspartate Receptor Encephalitis - complications</subject><subject>Antibodies</subject><subject>Autoantibodies - cerebrospinal fluid</subject><subject>Autoimmune diseases</subject><subject>Behavioral Symptoms - etiology</subject><subject>Catatonia</subject><subject>Catatonia - etiology</subject><subject>Cognitive Dysfunction - etiology</subject><subject>Consciousness</subject><subject>Convulsions & seizures</subject><subject>Delirium</subject><subject>Delirium - etiology</subject><subject>Disease</subject><subject>Encephalitis</subject><subject>Euphoria</subject><subject>Female</subject><subject>Humans</subject><subject>Hypoventilation</subject><subject>Length of Stay</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Mental disorders</subject><subject>Psychomotor Agitation - etiology</subject><subject>Psychosis</subject><subject>Sociodemographics</subject><issn>0924-2708</issn><issn>1601-5215</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkEtLxDAUhYMoOj5W7iXgRpCOuWmaTpYyPsEHiK5DkqZMZNrUJEXm35thRheu7uY7h3M_hE6BTIFAfdXbcUoJiCnjO2gCnEBRUah20YQIygpak9kBOozxk2RaELqPDkqoq5JwMkF6vlBBmWSDiyo532PVN9iPyfjOYt_i3B78EFdm4VQKzuC46obku4hdj4ccsX2K-NulRU4mV7w831y_YdsbOyzU0iUXj9Feq5bRnmzvEfq4u32fPxRPr_eP8-unwuQ5qWBAdCVKBpppqJqmopxQbTSdMUtmlFdGWWg4B2qFBiFsCUyVmhvgs6Ztm_IIXWx6h-C_RhuT7Fw0drlUvfVjlHT9tahrqDN6_g_99GPo8zpJ65oJyCTJ1OWGMsHHGGwrh-A6FVYSiFyrl1mOXKuXjGf6bNs56s42f-yv6_IHdMF_Sg</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Restrepo-Martinez, Miguel</creator><creator>Ramirez-Bermudez, Jesus</creator><creator>Bayliss, Leo</creator><creator>Espinola-Nadurille, Mariana</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M2M</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6382-2699</orcidid><orcidid>https://orcid.org/0000-0003-2879-5258</orcidid></search><sort><creationdate>202004</creationdate><title>Characterisation and outcome of neuropsychiatric symptoms in patients with anti-NMDAR encephalitis</title><author>Restrepo-Martinez, Miguel ; Ramirez-Bermudez, Jesus ; Bayliss, Leo ; Espinola-Nadurille, Mariana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c317t-410b59341b4b15dd52602bcb284e08265cae1d6612e9b199e314a3b6c168dffd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Anti-N-Methyl-D-Aspartate Receptor Encephalitis - cerebrospinal fluid</topic><topic>Anti-N-Methyl-D-Aspartate Receptor Encephalitis - complications</topic><topic>Antibodies</topic><topic>Autoantibodies - cerebrospinal fluid</topic><topic>Autoimmune diseases</topic><topic>Behavioral Symptoms - etiology</topic><topic>Catatonia</topic><topic>Catatonia - etiology</topic><topic>Cognitive Dysfunction - etiology</topic><topic>Consciousness</topic><topic>Convulsions & seizures</topic><topic>Delirium</topic><topic>Delirium - etiology</topic><topic>Disease</topic><topic>Encephalitis</topic><topic>Euphoria</topic><topic>Female</topic><topic>Humans</topic><topic>Hypoventilation</topic><topic>Length of Stay</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Mental disorders</topic><topic>Psychomotor Agitation - etiology</topic><topic>Psychosis</topic><topic>Sociodemographics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Restrepo-Martinez, Miguel</creatorcontrib><creatorcontrib>Ramirez-Bermudez, Jesus</creatorcontrib><creatorcontrib>Bayliss, Leo</creatorcontrib><creatorcontrib>Espinola-Nadurille, Mariana</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Psychology</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neuropsychiatrica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Restrepo-Martinez, Miguel</au><au>Ramirez-Bermudez, Jesus</au><au>Bayliss, Leo</au><au>Espinola-Nadurille, Mariana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterisation and outcome of neuropsychiatric symptoms in patients with anti-NMDAR encephalitis</atitle><jtitle>Acta neuropsychiatrica</jtitle><addtitle>Acta Neuropsychiatr</addtitle><date>2020-04</date><risdate>2020</risdate><volume>32</volume><issue>2</issue><spage>92</spage><epage>98</epage><pages>92-98</pages><issn>0924-2708</issn><eissn>1601-5215</eissn><abstract>Encephalitis due to anti-N-methyl-D-aspartate receptor antibodies (ANMDARE) is the most frequent immune-mediated encephalitis. It is distinguished by the subacute onset of neuropsychiatric symptoms.
To evaluate the characteristic neuropsychiatric symptoms and their outcome in patients diagnosed with ANMDARE.
This was a prospective, longitudinal study in patients with a diagnostic suspicion of ANMDARE that presented to the National Institute of Neurology from March 2018 to February 2019. A comparative analysis of two groups (positive N-methyl-D-aspartate receptor [NMDAR] vs. negative NMDAR antibodies in cerebrospinal fluid [CSF]) was done on admission and at discharge. Neuropsychiatric systematic assessments included the Neuropsychiatric Inventory Questionnaire, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method Severity, the Montreal Cognitive Assessment, and the Overt Agitation Severity Scale.
24 individuals were analysed: 14 had positive NMDAR antibodies, and 10 had negative NMDAR antibodies in CSF. On admission, agitation/aggression, euphoria/exaltation, and disinhibition were more common in patients with positive antibodies. Excited catatonia and delirium were diagnosed more frequently in patients with positive antibodies. At discharge, there was an important decrease in neuropsychiatric symptoms, but substantial cognitive impairment remained. The mean hospitalisation length was 41.71 (SD 39.33) days for patients with definitive ANMDARE (p 0.259).
Neuropsychiatric symptoms profile in ANMDARE was associated with the early onset of euphoria/exaltation and disinhibition, accompanied by marked psychomotor agitation. When ANMDARE was suspected, the presence of excited-type catatonia and delirium showed a tendency to predict definitive ANMDARE. At discharged, most patients recovered from catatonia, delirium, and psychosis, but marked cognitive symptoms, anxiety, and depression persisted at discharge.</abstract><cop>England</cop><pub>Cambridge University Press</pub><pmid>31753060</pmid><doi>10.1017/neu.2019.46</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6382-2699</orcidid><orcidid>https://orcid.org/0000-0003-2879-5258</orcidid></addata></record> |
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| subjects | Adult Anti-N-Methyl-D-Aspartate Receptor Encephalitis - cerebrospinal fluid Anti-N-Methyl-D-Aspartate Receptor Encephalitis - complications Antibodies Autoantibodies - cerebrospinal fluid Autoimmune diseases Behavioral Symptoms - etiology Catatonia Catatonia - etiology Cognitive Dysfunction - etiology Consciousness Convulsions & seizures Delirium Delirium - etiology Disease Encephalitis Euphoria Female Humans Hypoventilation Length of Stay Longitudinal Studies Male Mental disorders Psychomotor Agitation - etiology Psychosis Sociodemographics |
| title | Characterisation and outcome of neuropsychiatric symptoms in patients with anti-NMDAR encephalitis |
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