Cargando…

Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure

INTRODUCTION: Catatonia is a severe syndrome associated with a high proportion of underlying organic conditions including autoimmune encephalitis. The link between catatonia and psychiatric conditions such as mood disorders and schizophrenia spectrum disorders is well established while the causative...

Descripción completa

Detalles Bibliográficos
Autores principales: Bogdan, Anamaria, Askenazy, Florence, Richelme, Christian, Gindt, Morgane, Thümmler, Susanne, Fernandez, Arnaud
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8831908/
https://www.ncbi.nlm.nih.gov/pubmed/35153875
http://dx.doi.org/10.3389/fpsyt.2022.784306
_version_ 1784648609221836800
author Bogdan, Anamaria
Askenazy, Florence
Richelme, Christian
Gindt, Morgane
Thümmler, Susanne
Fernandez, Arnaud
author_facet Bogdan, Anamaria
Askenazy, Florence
Richelme, Christian
Gindt, Morgane
Thümmler, Susanne
Fernandez, Arnaud
author_sort Bogdan, Anamaria
collection PubMed
description INTRODUCTION: Catatonia is a severe syndrome associated with a high proportion of underlying organic conditions including autoimmune encephalitis. The link between catatonia and psychiatric conditions such as mood disorders and schizophrenia spectrum disorders is well established while the causative effect of Post-Traumatic Stress Disorders and stress related disorders remains speculative. CASE REPORT: Here we describe the clinical case of a 14-year-old female patient presenting to the Emergency Department of a Pediatric University Hospital with acute changes in behavior five days after a sexual abuse. Acute stress reaction was suspected. Afterwards she developed catatonic symptoms alternating from stupor to excitement, resistant to the usual treatment with benzodiazepines. The first line examinations (PE, MRI, EEG) were inconclusive. The final diagnosis of anti-NMDARE was made 22 days after her admission in a University Department of Child and Adolescent Psychiatry. Her state improved after first- and second-line immunotherapy, with no signs of relapse at this day (8 months of clinical follow-up). DISCUSSION: The diagnosis of anti-NMDARE is challenging, involving a multidisciplinary approach. The neuropsychiatric features are complex, with no specific psychiatric phenotype. Several hypotheses are discussed to determine the role of an acute environmental stressors in the emergence of such complex neuropsychiatric clinical presentation (i.e., shared vulnerability, precipitators, consequences of preexisting psychiatric symptoms). CONCLUSION: Child and adolescent psychiatrists and pediatricians should be aware of the overlap between neurological and psychiatric features in the setting of anti-NMDARE. Catatonia should not be dismissed as a primary psychiatric disorder even in the context of recent traumatic exposure.
format Online
Article
Text
id pubmed-8831908
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-88319082022-02-12 Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure Bogdan, Anamaria Askenazy, Florence Richelme, Christian Gindt, Morgane Thümmler, Susanne Fernandez, Arnaud Front Psychiatry Psychiatry INTRODUCTION: Catatonia is a severe syndrome associated with a high proportion of underlying organic conditions including autoimmune encephalitis. The link between catatonia and psychiatric conditions such as mood disorders and schizophrenia spectrum disorders is well established while the causative effect of Post-Traumatic Stress Disorders and stress related disorders remains speculative. CASE REPORT: Here we describe the clinical case of a 14-year-old female patient presenting to the Emergency Department of a Pediatric University Hospital with acute changes in behavior five days after a sexual abuse. Acute stress reaction was suspected. Afterwards she developed catatonic symptoms alternating from stupor to excitement, resistant to the usual treatment with benzodiazepines. The first line examinations (PE, MRI, EEG) were inconclusive. The final diagnosis of anti-NMDARE was made 22 days after her admission in a University Department of Child and Adolescent Psychiatry. Her state improved after first- and second-line immunotherapy, with no signs of relapse at this day (8 months of clinical follow-up). DISCUSSION: The diagnosis of anti-NMDARE is challenging, involving a multidisciplinary approach. The neuropsychiatric features are complex, with no specific psychiatric phenotype. Several hypotheses are discussed to determine the role of an acute environmental stressors in the emergence of such complex neuropsychiatric clinical presentation (i.e., shared vulnerability, precipitators, consequences of preexisting psychiatric symptoms). CONCLUSION: Child and adolescent psychiatrists and pediatricians should be aware of the overlap between neurological and psychiatric features in the setting of anti-NMDARE. Catatonia should not be dismissed as a primary psychiatric disorder even in the context of recent traumatic exposure. Frontiers Media S.A. 2022-01-28 /pmc/articles/PMC8831908/ /pubmed/35153875 http://dx.doi.org/10.3389/fpsyt.2022.784306 Text en Copyright © 2022 Bogdan, Askenazy, Richelme, Gindt, Thümmler and Fernandez. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Bogdan, Anamaria
Askenazy, Florence
Richelme, Christian
Gindt, Morgane
Thümmler, Susanne
Fernandez, Arnaud
Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure
title Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure
title_full Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure
title_fullStr Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure
title_full_unstemmed Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure
title_short Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure
title_sort case report: anti-nmdar encephalitis presenting with catatonic symptoms in an adolescent female patient with a history of traumatic exposure
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8831908/
https://www.ncbi.nlm.nih.gov/pubmed/35153875
http://dx.doi.org/10.3389/fpsyt.2022.784306
work_keys_str_mv AT bogdananamaria casereportantinmdarencephalitispresentingwithcatatonicsymptomsinanadolescentfemalepatientwithahistoryoftraumaticexposure
AT askenazyflorence casereportantinmdarencephalitispresentingwithcatatonicsymptomsinanadolescentfemalepatientwithahistoryoftraumaticexposure
AT richelmechristian casereportantinmdarencephalitispresentingwithcatatonicsymptomsinanadolescentfemalepatientwithahistoryoftraumaticexposure
AT gindtmorgane casereportantinmdarencephalitispresentingwithcatatonicsymptomsinanadolescentfemalepatientwithahistoryoftraumaticexposure
AT thummlersusanne casereportantinmdarencephalitispresentingwithcatatonicsymptomsinanadolescentfemalepatientwithahistoryoftraumaticexposure
AT fernandezarnaud casereportantinmdarencephalitispresentingwithcatatonicsymptomsinanadolescentfemalepatientwithahistoryoftraumaticexposure