Rong Xia, Xiong Zhenzhen, Cao Bingrong, Chen Juan, Li Mingli, Li Zhe
Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
School of Nursing, Chengdu Medical College, Chengdu, Sichuan, 610083, China.
BMC Psychiatry. 2017 Aug 31;17(1):320. doi: 10.1186/s12888-017-1477-x.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease involving antibodies against the NR1 subunits of NMDARs. The disease shows variable clinical presentation, and involves new-onset acute psychotic symptoms, making it difficult to differentiate from major depressive disorder with psychotic symptoms. Potential associations between this autoimmune disorder and onset or progression of major depressive disorder remains unclear.
We present a rare case of a patient who had both major depressive disorder and anti-NMDAR encephalitis and in whom the encephalitis initially went undetected. The patient had been suffering from depressive disorder for more than 6 years without any treatment, when she was hospitalized for new-onset psychotic symptoms. She was initially diagnosed only with major depressive disorder with psychotic symptoms, but antipsychotics did not alleviate symptoms and the patient's psychiatric course began to fluctuate rapidly. Anti-NR1 IgG autoantibodies were detected in cerebrospinal fluid, and the combination of immunotherapy and antipsychotics proved more effective than antipsychotics alone. The patient was then also diagnosed with anti-NMDAR encephalitis.
Our case suggests that clinicians should consider anti-NMDAR encephalitis when a patient with depressive disorder shows sudden fluctuations in psychiatric symptoms. It also highlights the need for research into possible relationships between anti-NMDAR encephalitis and major depressive disorder.
抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎是一种自身免疫性疾病，涉及针对NMDARs的NR1亚基的抗体。该疾病临床表现多样，包括新发急性精神病性症状，这使得其难以与伴有精神病性症状的重度抑郁症相鉴别。这种自身免疫性疾病与重度抑郁症的发病或进展之间的潜在关联仍不明确。
我们报告一例罕见病例，该患者同时患有重度抑郁症和抗NMDAR脑炎，且脑炎最初未被发现。该患者患有抑郁症6年多未接受任何治疗，因新发精神病性症状入院。她最初仅被诊断为伴有精神病性症状的重度抑郁症，但抗精神病药物未能缓解症状，且患者的精神病情开始迅速波动。脑脊液中检测到抗NR1 IgG自身抗体，免疫治疗与抗精神病药物联合使用比单独使用抗精神病药物更有效。随后该患者也被诊断为抗NMDAR脑炎。
我们的病例表明，当抑郁症患者出现精神症状突然波动时，临床医生应考虑抗NMDAR脑炎。它还强调了对抗NMDAR脑炎与重度抑郁症之间可能关系进行研究的必要性。
