Abstract: "Psychiatrists need to be vigilant for the newly recognised and treatable disorder of antibody-mediated encephalitis. Psychiatric symptoms are common, and individuals with the disorder often present initially to psychiatric services. We describe the clinical features of the disorder and make recommendations for further investigations. Psychiatry has been progressively demedicalised in the UK. The speciality has separated from the rest of medicine and there has been discussion about the relevance of biological models of psychiatric illness among some psychiatrists.1 This dangerous position is now exposed as new brain disorders have been described that are affecting patients currently under our management, which require medical investigation and management."
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Abstract: "Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is an autoimmune condition caused by immunoglobulin (Ig)G antibodies directed against the NR1 subunit of the NMDA glutamate receptor. Approximately 65% of cases present with psychiatric symptoms, particularly psychosis. It remains to be established whether anti-NMDA receptor antibodies can cause a ‘purely’ psychotic illness without overt neurological symptoms. We conducted a systematic literature search to establish what proportion of patients with schizophrenia and related psychoses have antibodies directed against the NMDA receptor. Studies were included if (a) subjects had a diagnosis of schizophrenia, schizophrenia spectrum disorder or first-episode psychosis (FEP) using standard criteria, (b) serum was analysed for the presence of anti-NMDA receptor antibodies; and (c) the purpose of the study was to look for the presence of anti-NMDA receptor antibodies in patients with a primary psychiatric diagnosis without clinical signs of encephalitis. Seven studies were included, comprising 1441 patients, of whom 115 [7.98%, 95% confidence interval (CI) 6.69–9.50] were anti-NMDA receptor antibody positive. Of these, 21 (1.46%, 95% CI 0.94–2.23) patients were positive for antibodies of the IgG subclass. Prevalence rates were greater in cases than controls only for IgG antibodies; other subclasses are of less certain aetiological relevance. There was significant heterogeneity in terms of patient characteristics and the antibody assay used. A minority of patients with psychosis are anti-NMDA receptor antibody positive. It remains to be established whether this subset of patients differs from antibody-negative patients in terms of underlying pathology and response to antipsychotic treatment, and whether immunomodulatory treatments are effective in alleviating psychotic symptoms in this group."
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Abstract: "Autoantibodies against the N-methyl-D-aspartate receptor (NMDAR) have been associated with a complex encephalitis syndrome, which was first described in a case series of 12 young women presenting with a consistent clinical course including movement disorder, psychiatric disturbance and encephalopathy, in whom ovarian teratomas were subsequently found. Since then, it has been shown that many cases are not associated with tumours, and the condition may also affect male patients and children. NMDAR antibodies may be associated with diverse clinical pictures, including isolated psychosis. The spectrum of disease associated with NMDAR antibodies and the optimal immunomodulatory management of these patients is not yet well understood. We present three cases: a patient with musical hallucinations and seizures who responded to treatment with rituximab and intravenous immunoglobulin, a case of Rasmussen's encephalitis who showed no response to treatment with steroids and plasma exchange, and a complex seronegative case with ovarian teratoma, auditory perceptual changes, dystonia and a rapidly progressive CNS syndrome who died despite treatment. The clinical features and responses to therapy are described and discussed."
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