Augusta University Medical College of Georgia, Athens, GA.
Department of Psychiatry and Behavioral Science, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
J Acad Consult Liaison Psychiatry. 2024 Jan-Feb;65(1):66-75. doi: 10.1016/j.jaclp.2023.08.005. Epub 2023 Aug 23.
We present the case of a 9-year-old girl who presented to a tertiary-care academic children's hospital with acute onset of severe obsessive-compulsive symptoms, perseveration, grimacing, and personality changes with resultant agitation. Extensive multidisciplinary workup led to a diagnosis of seronegative autoimmune encephalitis. The clinical course included multiple general pediatric and inpatient psychiatric unit admissions that were complicated by severe affective dysregulation with physical aggression towards staff and family. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of available literature. Key teaching points include assessment and management of seronegative autoimmune encephalitis and catatonia. We discuss the system-level challenges of management of aggression in health care settings and ways to improve care for patients presenting with behavioral manifestations (aggression) of physical illness.
我们呈现了一例 9 岁女孩的病例，她因急性发作严重的强迫症症状、固执、鬼脸和人格改变而导致烦躁不安，到三级保健学术儿童医院就诊。广泛的多学科检查导致血清阴性自身免疫性脑炎的诊断。临床过程包括多次儿科和住院精神科的入院治疗，由于严重的情感失调，她对工作人员和家人表现出身体攻击。咨询联络领域的专家根据他们的经验和对现有文献的回顾，为这个常见的临床病例提供指导。关键的教学要点包括血清阴性自身免疫性脑炎和紧张症的评估和管理。我们讨论了在医疗保健环境中管理攻击性的系统层面挑战，以及改善对表现出身体疾病行为表现（攻击性）的患者的护理的方法。
