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精神科中的抗 N-甲基-D-天冬氨酸受体脑炎

Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Psychiatry.

作者信息

Sakamoto Shinji, Kawai Hiroki, Okahisa Yuko, Tsutsui Ko, Kanbayashi Takashi, Tanaka Keiko, Mizuki Yutaka, Takaki Manabu, Yamada Norihito

机构信息

Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558,

出版信息

Acta Med Okayama. 2019 Jun;73(3):189-195. doi: 10.18926/AMO/56860.

Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently-discovered autoimmune disorder in which antibodies target NMDAR in the brain. The number of reported cases of anti-NMDAR encephalitis has increased rapidly. Anti-NMDAR encephalitis can be mistakenly diagnosed as psychiatric disorders because many patients present with prominent psychiatric symptoms and visit psychiatric institutions first. Thus, psychiatrists should cultivate a better understanding of anti-NMDAR encephalitis. In this review, we present the mechanisms, epidemiology, symptoms and clinical course, diagnostic tests, treatment and outcomes of patients with anti-NMDAR encephalitis. Furthermore, we discuss the diversity of clinical spectra of anti-NMDAR encephalitis, and demonstrate a differential diagnosis of psychiatric disease from the perspective of psychiatry.

摘要

抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎是一种最近发现的自身免疫性疾病,其抗体靶向大脑中的NMDAR。抗NMDAR脑炎的报告病例数迅速增加。抗NMDAR脑炎可能会被误诊为精神疾病,因为许多患者表现出突出的精神症状并首先就诊于精神科机构。因此,精神科医生应该更好地了解抗NMDAR脑炎。在本综述中,我们介绍了抗NMDAR脑炎患者的发病机制、流行病学、症状和临床病程、诊断测试、治疗及预后。此外,我们讨论了抗NMDAR脑炎临床谱的多样性,并从精神病学角度阐述了与精神疾病的鉴别诊断。

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