Huang Chaohua, Kang Yukun, Zhang Bo, Li Bin, Qiu Changjian, Liu Shanming, Ren Hongyan, Yang Yanchun, Liu Xiehe, Li Tao, Guo Wanjun
Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; State Key Laboratory of Biotherapy, Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; Mental Health Center, Affiliated Hospital of Luzhou Medical College, Luzhou, People's Republic of China.
Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Neuropsychiatr Dis Treat. 2015 Jun 11;11:1437-42. doi: 10.2147/NDT.S82930. eCollection 2015.
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune encephalitis associated with antibodies against the NR1 subunits of NMDARs. Although new-onset acute prominent psychotic syndromes in patients with NMDAR encephalitis have been well documented, there is a lack of case studies on differential diagnosis and treatment of anti-NMDAR encephalitis after a long-term diagnostic history of functional psychotic disorders. The present study reports an unusual case of anti-NMDAR encephalitis. The patient had been diagnosed with schizophrenia 7 years earlier, and was currently hospitalized for acute-onset psychiatric symptoms. The diagnosis became unclear when the initial psychosis was confounded with considerations of other neurotoxicities (such as neuroleptic malignant syndrome). Finally, identification of specific immunoglobulin G NR1 autoantibodies in the cerebrospinal fluid and greater effectiveness of immunotherapy over antipsychotics alone (which has been well documented in anti-NMDAR encephalitis) indicated the diagnosis of anti-NMDAR encephalitis in this case. Based on the available evidence, however, the relationship between the newly diagnosed anti-NMDAR encephalitis and the seemingly clear, long-term history of schizophrenia in the preceding 7 years is uncertain. This case report illustrates that psychiatrists should consider anti-NMDAR encephalitis and order tests for specific immunoglobulin G NR1 autoantibodies in patients presenting with disorientation, disturbance of consciousness, cognitive deficit, dyskinesia, autonomic disturbance, or rapid deterioration, even with a seemingly clear history of a psychiatric disorder and no specific findings on routine neuroimaging, electroencephalography, or cerebrospinal fluid tests in the early stage of the illness.
抗 N-甲基-D-天冬氨酸受体（NMDAR）脑炎是一种自身免疫性脑炎，与抗 NMDARs 的 NR1 亚基抗体相关。尽管 NMDAR 脑炎患者新发急性突出精神综合征已有充分记录，但对于有长期功能性精神障碍诊断史的抗 NMDAR 脑炎的鉴别诊断和治疗，缺乏病例研究。本研究报告了一例不寻常的抗 NMDAR 脑炎病例。该患者 7 年前被诊断为精神分裂症，目前因急性起病的精神症状住院。当最初的精神病症状与其他神经毒性（如抗精神病药物恶性综合征）的考虑因素相混淆时，诊断变得不明确。最后，脑脊液中特异性免疫球蛋白 G NR1 自身抗体的鉴定以及免疫治疗比单独使用抗精神病药物更有效（抗 NMDAR 脑炎中已有充分记录），表明该病例诊断为抗 NMDAR 脑炎。然而，根据现有证据，新诊断的抗 NMDAR 脑炎与之前 7 年看似明确的长期精神分裂症病史之间的关系尚不确定。本病例报告表明，精神科医生在面对出现定向障碍、意识障碍、认知缺陷、运动障碍、自主神经功能紊乱或病情迅速恶化的患者时，即使在疾病早期有看似明确的精神障碍病史且常规神经影像学、脑电图或脑脊液检查无特异性发现，也应考虑抗 NMDAR 脑炎并安排检测特异性免疫球蛋白 G NR1 自身抗体。
