Kruse Jennifer L, Jeffrey Jessica K, Davis Michael C, Dearlove Joanna, IsHak Waguih W, Brooks John O
Department of Psychiatry and Biobehavioral Sciences, The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Ann Clin Psychiatry. 2014 May;26(2):111-9.
Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis was formally described in 2007 and includes a range of psychiatric and neurologic symptoms. Most patients with anti-NMDAR encephalitis initially present to psychiatrists for diagnosis and treatment. However, there is limited literature summarizing treatment strategies for psychiatric symptoms. In an effort to improve identification and treatment, this review article provides an overview of anti-NMDAR encephalitis, with a focus on psychopharmacologic treatment strategies. Two case reports provide a clinical context for the literature review.
The authors conducted a PubMed search.
Prominent psychiatric symptoms of anti-NMDAR encephalitis include psychosis, agitation, insomnia, and catatonia. Neuroleptics may be helpful for managing psychosis and agitation, but may exacerbate movement abnormalities. Diphenhydramine and benzodiazepines are helpful for agitation and insomnia. In addition, the anticholinergic affinity of diphenhydramine can improve dystonia or rigidity attributable to anti-NMDAR encephalitis, while benzodiazepines and electroconvulsive therapy have been used for catatonia associated with this condition.
Psychiatrists play an important role in the diagnosis and treatment of anti-NMDAR encephalitis. Recognizing the typical clinical progression and closely monitoring for accompanying neurologic symptoms will facilitate diagnosis and timely treatment. Careful selection of psychopharmacological interventions may reduce suffering.
抗N-甲基-D-天冬氨酸受体（抗NMDAR）脑炎于2007年被正式描述，包括一系列精神和神经症状。大多数抗NMDAR脑炎患者最初会去找精神科医生进行诊断和治疗。然而，总结精神症状治疗策略的文献有限。为了改善识别和治疗，这篇综述文章概述了抗NMDAR脑炎，重点是精神药物治疗策略。两个病例报告为文献综述提供了临床背景。
作者进行了PubMed检索。
抗NMDAR脑炎的突出精神症状包括精神病、激越、失眠和紧张症。抗精神病药物可能有助于控制精神病和激越，但可能会加重运动异常。苯海拉明和苯二氮䓬类药物有助于缓解激越和失眠。此外，苯海拉明的抗胆碱能亲和力可改善抗NMDAR脑炎所致的肌张力障碍或强直，而苯二氮䓬类药物和电休克治疗已用于治疗与此病症相关的紧张症。
精神科医生在抗NMDAR脑炎的诊断和治疗中发挥着重要作用。认识典型的临床病程并密切监测伴随的神经症状将有助于诊断和及时治疗。谨慎选择精神药物干预措施可能会减轻痛苦。
