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Tijdschrift voor Psychiatrie 57 (2015) 6, 446 - 451

Short report

Auto-immune encephalitis in psychiatric practice

L. de Witte, M. Kromkamp, N. Schoenmaker, H.C. van Mierlo, P. Martinez-Martínez, S.J.M. Palmen, I.E.C. Sommer

background Our knowledge about auto-immune limbic encephalitis is increasing rapidly and it is now evident that patients with this disease can present with psychiatric symptoms.
aim To propose practical guidelines for the recognition and diagnosis of an underlying auto-immune limbic encephalitis in patients with acute psychiatric symptoms.
method We studied recent reviews on the topic and had discussions with psychiatrists, a neurologist and a neuroimmunologist in order to reach consensus.
results Auto-immune limbic encephalitis is a rather rare but important diagnostic consideration in patients with acute psychiatric symptoms. We describe the different steps in the diagnostic work-up and mention features that can point to an underlying auto-immune encephalitis. These include atypical psychiatric symptoms, seizures, movement disorders and autonomic instability.
conclusion Since patients with autoimmune limbic encephalitis often present with psychiatric symptoms, curative treatment is often available and the prognosis depends on the delay from presentation to treatment, psychiatrists should be aware of the signs of an underlying autoimmune encephalitis which have been described in this article.

keywords auto-immune encephalitis, N-methyl-3-aspartate-receptor (NMDAR), psychosis