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Psychiatry Clin Neurosci. 2019 May 22. doi: 10.1111/pcn.12867. [Epub ahead of print]

Catatonia in Patients With Anti-Nmda Receptor Encephalitis.

Author information

1
Neuropsychiatric Unit. National Institute of Neurology and Neurosurgery of Mexico (NINN), Mexico City, Mexico.
2
Centro de Neurología y Neurocirugía. Medica Sur, Mexico City, Mexico.
3
Neurology Department. NINN, Mexico City, Mexico.
4
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
5
Epilepsy Clinic, NINN, Mexico City, Mexico.
6
Intensive Care Unit. NINN, Mexico City, Mexico.
7
Neuropsychology Department, NINN, Mexico City, Mexico.
8
School of Psychology, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
9
Addiction Research Laboratory, NINN, Mexico City, Mexico.
10
Neuromedica, Medellin, Colombia.
11
CES University, Medellin, Colombia.

Abstract

There is a lack of studies related to the frequency, phenomenology, and associated features of catatonic syndrome in patients with anti-NMDAR encephalitis.

AIM:

To measure the frequency of catatonia in this condition, and to delineate its particular symptoms METHOD: A prospective study was done with all inpatients who fulfilled the criteria of definite anti-NMDAR encephalitis, admitted to the National Institute of Neurology and Neurosurgery of Mexico, from January 2014 to September 2018. Bush and Francis Catatonia Rating Scale and Braünig Catatonia Rating Scale were administered at admission.

RESULTS:

58 patients were included. Catatonia was diagnosed in 41 patients (70.6%). Immobility, staring, mutism and posturing were the most frequent catatonic signs. Catatonia was associated to delirium, hallucinations, psychomotor agitation, generalized EEG dysfunction, and previous use of antipsychotics. Mortality was present in 10% of the total sample, it was associated to status epilepticus, and was less frequent in the catatonia group. After immunotherapy all cases showed a complete recovery from catatonic signs.

CONCLUSION:

This systematic assessment of catatonic syndrome shows it is a frequent feature in patients with anti-NMDAR encephalitis, as part of a clinical pattern that includes delirium, psychomotor agitation, and hallucinations. The lack of recognition of this pattern may be a source of diagnostic and therapeutic errors, as most physicians associate catatonia to schizophrenia and affective disorders. This article is protected by copyright. All rights reserved.

KEYWORDS:

Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Autoimmune encephalitis; Catatonia; Delirium; Limbic Encephalitis; Psychosis

PMID:
31115962
DOI:
10.1111/pcn.12867

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