Cases That Test Your Skills

Precipitously and certainly psychotic—but what’s the cause?

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References


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.


Drug Brand Names
Acyclovir • Zovirax
Alprazolam • Xanax
Buspirone • Buspar
Ceftriaxone • Rocephin
Doxycycline • Vibramycin
Haloperidol • Haldol
Ketamine • Ketalar
Levetiracetam • Keppra
Lorazepam • Ativan


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.

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