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抗N-甲基-D-天冬氨酸(NMDA)受体脑炎中的紧张症被误诊为精神分裂症。

Catatonia in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis Misdiagnosed as Schizophrenia.

作者信息

Ponte André, Brito Ana, Nóbrega Camila, Pinheiro Sofia, Gama Marques João

机构信息

Hospital Júlio de Matos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa; Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal.

Hospital Santo António dos Capuchos. Centro Hospitalar Lisboa Central. Lisboa. Portugal.

出版信息

Acta Med Port. 2020 Mar 2;33(3):208-211. doi: 10.20344/amp.11077.

Abstract

Anti-N-Mmethyl-D-aspartate receptor encephalitis is an autoimmune disease of the central nervous system with prominent neurologic and psychiatric features. Symptoms appear progressively and sometimes with an exclusively psychiatric initial presentation. The patient's evaluation should be meticulous, and we should use all the diagnostic tests required for the exclusion of entities that can mimic this disease. We report the diagnostic investigation of a case of anti-N-methyl-D-aspartate receptor encephalitis in a patient with a previous diagnosis of schizophrenia with poor response to antipsychotics. The aim of this case report is to highlight the importance of close surveillance for neuropsychiatric symptoms, especially catatonia, and to recognize autoimmune encephalitis in the differential diagnosis of psychotic disorders with neurological symptoms and resistance or intolerance to antipsychotics. A prompt diagnosis will contribute to a faster onset of therapy and an overall improvement in prognosis.

摘要

抗N-甲基-D-天冬氨酸受体脑炎是一种中枢神经系统自身免疫性疾病,具有突出的神经和精神症状。症状逐渐出现,有时最初仅表现为精神症状。对患者的评估应细致入微,我们应使用所有必要的诊断测试以排除可能模仿这种疾病的病症。我们报告了一例抗N-甲基-D-天冬氨酸受体脑炎患者的诊断调查情况,该患者先前被诊断为精神分裂症,对抗精神病药物反应不佳。本病例报告的目的是强调密切监测神经精神症状(尤其是紧张症)的重要性,并在伴有神经症状且对抗精神病药物耐药或不耐受的精神障碍的鉴别诊断中识别自身免疫性脑炎。及时诊断将有助于更快开始治疗并总体改善预后。

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