PMID- 31739809
OWN - NLM
STAT- MEDLINE
DCOM- 20211112
LR  - 20211112
IS  - 1469-8978 (Electronic)
IS  - 0033-2917 (Linking)
VI  - 51
IP  - 3
DP  - 2021 Feb
TI  - Psychiatric management of anti-NMDAR encephalitis: a cohort analysis.
PG  - 435-440
LID - 10.1017/S0033291719003283 [doi]
AB  - BACKGROUND: Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an 
      immune-mediated disorder which requires multi-disciplinary treatment including 
      immunomodulation therapy. First presentation is most commonly to psychiatric 
      services and continuing psychiatric care is required to treat disabling symptoms, 
      such as behaviour disturbance, psychosis and catatonia. There is minimal 
      available evidence to guide symptomatic treatment and concern for increased 
      sensitivity to antipsychotics complicates traditional approaches. METHODS: All 
      cases of cerebrospinal fluid positive anti-NMDAR encephalitis tested in 
      Queensland, Australia were identified. Demographic, clinical and therapeutic data 
      were collected and reviewed by two independent clinicians. Pre-specified 
      variables reflecting possible treatment side effects were compared. RESULTS: The 
      majority of the 30 cases (83%) had early psychiatric symptoms and were treated 
      with antipsychotics (67%), average daily olanzapine equivalence dose of 11.5 mg, 
      prior to immunomodulation therapy. Although there was an 88% reduction in cases 
      with aggression, there was little improvement in psychosis, affective symptoms or 
      catatonia with antipsychotics alone. In the cases with psychiatric symptoms, 
      there was no significant difference in the rate of occurrence of neurological and 
      autonomic symptoms between cases prescribed and not prescribed antipsychotics. 
      CONCLUSIONS: Psychiatric input is imperative for both acute and longer-term 
      management of anti-NMDAR encephalitis. Primary symptomatic treatment should 
      remain immunotherapy and surgery. Antipsychotic medications have particular value 
      in managing agitation and aggression. Potential side effects from antipsychotic 
      treatment are difficult to differentiate from progression of anti-NMDAR 
      encephalitis but there was no evidence in this cohort of increased antipsychotic 
      sensitivity. Treatment with psychotropic medication should be individualised and 
      adjusted during the course of the illness.
FAU - Warren, Nicola
AU  - Warren N
AUID- ORCID: 0000-0002-0805-1182
AD  - Metro South Addiction and Mental Health, Brisbane, Australia.
AD  - University of Queensland, Brisbane, Australia.
FAU - O'Gorman, Cullen
AU  - O'Gorman C
AD  - University of Queensland, Brisbane, Australia.
AD  - Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia.
AD  - Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia.
FAU - McKeon, Gemma
AU  - McKeon G
AD  - Metro South Addiction and Mental Health, Brisbane, Australia.
AD  - University of Queensland, Brisbane, Australia.
FAU - Swayne, Andrew
AU  - Swayne A
AD  - University of Queensland, Brisbane, Australia.
AD  - Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia.
AD  - Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia.
FAU - Blum, Stefan
AU  - Blum S
AD  - University of Queensland, Brisbane, Australia.
AD  - Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia.
AD  - Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia.
FAU - Siskind, Dan
AU  - Siskind D
AD  - Metro South Addiction and Mental Health, Brisbane, Australia.
AD  - University of Queensland, Brisbane, Australia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20191119
PL  - England
TA  - Psychol Med
JT  - Psychological medicine
JID - 1254142
RN  - 0 (Antipsychotic Agents)
SB  - IM
MH  - Adult
MH  - Aggression/drug effects
MH  - Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis/*psychology
MH  - Antipsychotic Agents/*therapeutic use
MH  - Catatonia/*drug therapy/etiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Psychotic Disorders/*drug therapy/etiology
MH  - Queensland
MH  - Retrospective Studies
MH  - Young Adult
OTO - NOTNLM
OT  - Antipsychotics
OT  - NMDA
OT  - autoimmune
OT  - encephalitis
OT  - psychosis
EDAT- 2019/11/20 06:00
MHDA- 2021/11/16 06:00
CRDT- 2019/11/20 06:00
PHST- 2019/11/20 06:00 [pubmed]
PHST- 2021/11/16 06:00 [medline]
PHST- 2019/11/20 06:00 [entrez]
AID - S0033291719003283 [pii]
AID - 10.1017/S0033291719003283 [doi]
PST - ppublish
SO  - Psychol Med. 2021 Feb;51(3):435-440. doi: 10.1017/S0033291719003283. Epub 2019 
      Nov 19.