Derek Mongold, MD Former Director of Psychiatric Consultation-Liaison Services
University of Virginia Charlottesville, Virginia
Ms. L, age 38, rapidly becomes confused and agitated, and expresses suicidal ideation. Her history is not consistent with a typical course of mental illness. How would you treat her?
Bottom Line Psychosis is a symptom of various pathologies, not only psychiatric disorders, and could indicate a disease process that requires treatment by other specialists. Normal basic lab results, vital signs, and physical examination should not supersede a careful history when considering a further medical workup. Anti-N-methyl-D-aspartate receptor encephalitis can cause psychosis and should be considered in the evaluation of patients who present with an atypical psychotic prodrome.
Related Resources
The Anti-NMDA Receptor Encephalitis Foundation Inc. What is anti-NMDA receptor encephalitis? www.antinmdafoundation.org/the-illness/what-is-anti-nmda-receptor-encephalitis.
Kruse JL, Jeffrey JK, Davis MC, et al. Anti-N-methyl-D-aspartate receptor encephalitis: a targeted review of clinical presentation, diagnosis, and approaches to psychopharmacologic management. Ann Clin Psychiatry. 2014;26(2):111-119.
Kruse JL, Jeffrey JK, Davis MC, et al. Anti-N-methyl-D-aspartate receptor encephalitis: a targeted review of clinical presentation, diagnosis, and approaches to psychopharmacologic management. Ann Clin Psychiatry. 2014;26(2):111-119.
Acknowledgement The authors acknowledge and thank Evan Kudron, a fourth-year medical student at the University of Virginia, for his contributions to this paper and the care of Ms. L.
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
