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Case Reports
. 2020 Mar 2;33(3):208-211.
doi: 10.20344/amp.11077. Epub 2020 Mar 2.

Catatonia in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis Misdiagnosed as Schizophrenia

André Ponte  1 , Ana Brito  2 , Camila Nóbrega  3 , Sofia Pinheiro  2 , João Gama Marques  4
Affiliations
Free article
Case Reports

Catatonia in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis Misdiagnosed as Schizophrenia

André Ponte et al. Acta Med Port. .
Free article

Abstract
in English, Portuguese

Anti-N-Mmethyl-D-aspartate receptor encephalitis is an autoimmune disease of the central nervous system with prominent neurologic and psychiatric features. Symptoms appear progressively and sometimes with an exclusively psychiatric initial presentation. The patient's evaluation should be meticulous, and we should use all the diagnostic tests required for the exclusion of entities that can mimic this disease. We report the diagnostic investigation of a case of anti-N-methyl-D-aspartate receptor encephalitis in a patient with a previous diagnosis of schizophrenia with poor response to antipsychotics. The aim of this case report is to highlight the importance of close surveillance for neuropsychiatric symptoms, especially catatonia, and to recognize autoimmune encephalitis in the differential diagnosis of psychotic disorders with neurological symptoms and resistance or intolerance to antipsychotics. A prompt diagnosis will contribute to a faster onset of therapy and an overall improvement in prognosis.

A encefalite anti-receptor N-metil-D-aspartato é uma doença auto-imune do sistema nervoso central com características neurológicas e psiquiátricas proeminentes. Os sintomas surgem progressivamente e por vezes com uma apresentação inicial exclusivamente psiquiátrica. A avaliação do doente deve ser meticulosa e devem ser realizados todos os meios complementares de diagnóstico necessários à exclusão das entidades que podem mimetizar aquela patologia. Apresenta-se a evolução diagnóstica de um caso de encefalite anti-receptor N-metil-D-aspartato num doente com diagnóstico prévio de esquizofrenia sem resposta à terapêutica anti-psicótica. Pretende-se com este caso realçar a importância de uma vigilância apertada para sintomas neuropsiquiátricos, especialmente no caso de catatonia, e de ter em consideração as encefalites auto-imunes no diagnóstico diferencial de quadros psicóticos associados a sintomas neurológicos e resistência ou intolerância a anti-psicóticos. Um diagnóstico célere contribuirá para a instituição de terapêutica atempadamente e uma melhoria global do prognóstico.

Keywords: Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Catatonia; Psychosis; Schizophrenia.

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