抗 NMDAR 脑炎患者中频繁且可识别的神经精神综合征——谵妄性躁狂。
Delirious mania as a frequent and recognizable neuropsychiatric syndrome in patients with anti-NMDAR encephalitis.
机构信息
Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur No. 3877 ZC, 14269 Mexico, Mexico.
Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur No. 3877 ZC, 14269 Mexico, Mexico; Department of Neurology, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur No. 3877 ZC, 14269 Mexico, Mexico.
出版信息
Gen Hosp Psychiatry. 2020 May-Jun;64:50-55. doi: 10.1016/j.genhosppsych.2020.03.003. Epub 2020 Mar 14.
BACKGROUND
Previous case reports showed that delirious mania could be one of the many neuropsychiatric presentations of Anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE).
OBJECTIVE
To evaluate the frequency of delirious mania and its associated factors in ANMDARE.
METHOD
A prospective study, including all patients with ANMDARE admitted to the National Institute of Neurology and Neurosurgery of Mexico, from January 2014 to April 2019. The diagnosis of delirious mania was established when diagnostic criteria for mania and delirium were fulfilled simultaneously.
RESULTS
79 patients with definitive ANMDARE were included. Delirious mania was identified in 20 (25.3%) of these patients. Catatonia, psychomotor agitation, disinhibition, impulsivity, and grandiose delusions were significantly associated with delirious mania. Also, a lower frequency of EEG abnormalities, absence of extreme delta brush, and a shorter hospital stay was observed in these patients.
CONCLUSION
Delirious mania proved to be a frequent neuropsychiatric presentation of ANMDARE, and its presence should warn the physician about the possibility of this diagnosis. It was mainly associated with higher rates of catatonia, psychomotor agitation, disinhibition, and psychotic symptoms. The lack of recognition of delirious mania as a neuropsychiatric presentation in ANMDARE may be a source of diagnostic and therapeutic errors, as most physicians associate this with bipolar disorder.
背景
先前的病例报告表明，谵妄性躁狂可能是抗 N-甲基-D-天冬氨酸受体脑炎（Anti-N-methyl-d-aspartate receptor encephalitis，ANMDARE）的多种神经精神表现之一。
目的
评估 ANMDARE 中谵妄性躁狂的频率及其相关因素。
方法
一项前瞻性研究，纳入了 2014 年 1 月至 2019 年 4 月期间在墨西哥国家神经病学和神经外科研究所住院的所有 ANMDARE 患者。当满足躁狂和谵妄的诊断标准时，即可诊断为谵妄性躁狂。
结果
纳入了 79 例明确的 ANMDARE 患者，其中 20 例（25.3%）患者存在谵妄性躁狂。这些患者明显伴有紧张症、精神运动激越、行为失抑制、冲动和夸大妄想。此外，这些患者的脑电图异常频率较低、无极度德尔塔刷（extreme delta brush），且住院时间较短。
结论
谵妄性躁狂是 ANMDARE 的一种常见神经精神表现，其存在应引起医生警惕这种诊断的可能性。它主要与较高的紧张症、精神运动激越、行为失抑制和精神病症状相关。未能认识到谵妄性躁狂是 ANMDARE 的一种神经精神表现可能是诊断和治疗错误的根源，因为大多数医生将其与双相情感障碍相关联。
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