Schizophrenia after remission of anti-NMDA receptor encephalitis

Kasumi Yasuda; Shinya Uenishi; Hiroshi Sakamoto; Kohei Hori; Jinsoo Koh; Shun Takahashi

doi:10.1016/j.ajp.2022.103027

Schizophrenia after remission of anti-NMDA receptor encephalitis

Asian J Psychiatr. 2022 Apr:70:103027. doi: 10.1016/j.ajp.2022.103027. Epub 2022 Feb 12.

Authors

Kasumi Yasuda¹, Shinya Uenishi², Hiroshi Sakamoto³, Kohei Hori⁴, Jinsoo Koh⁴, Shun Takahashi⁵

Affiliations

¹ Department of Neuropsychiatry, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8510, Japan. Electronic address: y-kasumi@wakayama-med.ac.jp.
² Department of Neuropsychiatry, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8510, Japan; Department of Psychiatry, Hidaka Hospital, 116-2 Sono, Gobo, Wakayama 644-0002, Japan.
³ Department of Neuropsychiatry, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8510, Japan; Department of Psychiatry, Wakayama Prefectural Mental Health Care Center, 31 Sho, Aridagawa, Wakayama 643-0831, Japan.
⁴ Department of Neurology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8510, Japan.
⁵ Department of Neuropsychiatry, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8510, Japan; Clinical Research and Education Center, Asakayama General Hospital, 3-3-16 Imaike-chou, Sakai-ku, Sakai, Osaka 590-0018, Japan; Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, 3-7-30 Habikino, Habikino, Osaka 583-8555, Japan.

PMID: 35180463
DOI: 10.1016/j.ajp.2022.103027

Abstract

N-methyl-D-aspartate receptor (NMDAR) dysfunction is an attractive hypothesis regarding the etiology of schizophrenia. We present the unprecedented case of a woman diagnosed with schizophrenia without anti-NMDAR antibodies after history of NMDAR encephalitis. A first episode of psychosis was antibody-positive and was improved with steroid and immunoglobulin treatment. Second and third episodes were antibody-negative, each about three months postpartum (different pregnancies) and were improved with antipsychotics. Without NMDAR encephalitis-related findings, we diagnosed schizophrenia. After anti-NMDAR encephalitis, NMDAR dysfunction may decrease the threshold for the onset of psychosis. This case provides insight into NMDAR dysfunction on etiology of schizophrenia.

Keywords: NMDA receptor; NMDAR encephalitis; Schizophrenia.

Publication types

Case Reports

MeSH terms

Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / complications
Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / diagnosis
Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / drug therapy
Antipsychotic Agents* / therapeutic use
Female
Humans
Psychotic Disorders* / drug therapy
Psychotic Disorders* / etiology
Receptors, N-Methyl-D-Aspartate
Schizophrenia* / complications
Schizophrenia* / drug therapy

Substances

Antipsychotic Agents
Receptors, N-Methyl-D-Aspartate