md-medicaldata

Authors

Teodora Inić¹, Nemanja Stanković Stevanović¹, Boško Čuturić¹, Mina Cvjetković Bošnjak^1,2, Vanja Meši Bosić<sup>1,2

1</sup>Klinika za psihijatriju, Univerzitetski klinički centar Vojvodine, Hajduk Veljkova 1, Novi Sad, Srbija
²Medicinski fakultet Univerziteta u Novom Sadu, Hajduk Veljkova 3, Novi Sad, Srbija

 

UDK: 616.831-002-071

The paper was received / Rad primljen 26.08.2025.

Accepted / Rad prihvaćen: 13.09.2025.

 

Correspondence to:

Teodora Inić
Univerzitetski klinički centar Vojvodine
Klinika za psihijatriju
Hajduk Veljkova 1,
21000 Novi Sad
e-mail: teodoraa.inic@gmail.com

 

 

Abstract

 

 

Autoimmune encephalitis (AE) is a group of inflammatory disorders of the central nervous system in which immune-mediated inflammation, caused by specific autoantibodies, leads to damage of various brain structures. The most common and best-studied form is AE associated with NMDA receptor antibodies. It is well recognized that psychiatric symptoms often represent the initial manifestation of anti-NMDAR encephalitis. In this context, it is essential to consider whether the presentation represents a first psychotic episode in affected patients, initiate treatment according to the current clinical picture, and continue close monitoring. If psychotic symptoms persist despite appropriate psychopharmacological treatment, especially with the emergence of accompanying neurological deficits such as cognitive impairment, new-onset seizures, and autonomic dysfunction, the possibility of AE must be considered.
Particular attention should be paid to younger female patients, especially those with a history of gynecological comorbidities, primarily ovarian teratoma. To establish an accurate diagnosis, initiate timely therapy, and avoid numerous complications, diagnostic procedures should be started as early as possible.
The aim of this report is to discuss the potential diagnosis of AE, particularly NMDA receptor encephalitis, in patients presenting with new-onset psychotic symptoms. Case presentation: To familiarize clinicians with immune-mediated neurological disorders that may predominantly manifest with psychiatric symptoms and facilitate further management, we present a case of NMDA receptor encephalitis viewed through the lens of its psychotic manifestations. Conclusion: Early recognition of autoimmune etiology in psychiatric disorders is crucial for prompt diagnosis and timely initiation of appropriate treatment, which is essential for a favorable disease course and outcome.

 

Keywords:

Autoimmune encephalitis; anti-NMDA receptor antibodies; psychosis; neuropsychiatric symptoms

 

 

 

Sažetak

 

Uvod: Autoimuni encefalitisi (AE) spadaju u inflamatorne bolesti centralnog nervnog sistema kod kojih imunski posredovana inflamacija posredovana specifičnim autoantitelima dovodi do oštećenja različitih struktura mozga. Najčešći i do sada najbolje proučen je AE udružen sa NMDA antitelima. Poznato je da psihijatrijska simptomatologija često može biti inicijalna manifestacija anti-NMDAR encefalitisa. U tom smislu je neophodno razmotriti da li je reč o prvoj psihotičnoj epizodi kod obolelih pacijenata, ordinirati terapiju u skladu sa aktuelnom kliničkom slikom, a potom nastaviti sa pažljivim praćenjem pacijenta. Ukoliko se psihotični simptomi ne povlače, uprkos primenjenoj odgovarajućoj psihofarmakoterapiji uz pojavu pridruženih neuroloških ispada u vidu kognitivnih poremećaja, novonastalih epileptičkih napada i autonomne disfunkcije, neophodno je razmotriti mogućnost postojanja AE. Posebnu pažnju je neophodno obratiti ukoliko se radi o obolelim osobama ženskog pola mlađe životne dobi, posebno sa medicinskom istorijom ginekoloških komorbiditeta, u prvom redu ovarijalnog teratoma. Da bi se postavila adekvatna dijagnoza, blagovremeno započela terapija i izbegle mnogobrojne komplikacije, dijagnostičke procedure je neophodno započeti što pre.
Cilj ovog rada je razmatranje moguće dijagnoze AE, posebno NMDA encefalitisa kod pacijenata sa novonastalom psihotičnom simptomatologijom. Prikaz slučaja: Kako bi se kliničarima približila oblast imunski posredovanih neuroloških oboljenja koja se mogu manifestovati predominantnom psihijatrijskom simptomatologijom i olakšao dalji rad, dat je prikaz slučaja jednog pacijenta sa NMDA AE kroz prizmu psihotičnih manifestacija bolesti. Zaključak: Pravovremeno prepoznavanje autoimune etiologije psihijatrijskih poremećaja je od velike važnosti u cilju što ranijeg postavljanja dijagnoze AE i pravovremenog započinjanja odgovarajućeg lečenja što je preduslov za povoljan tok i ishod ovih oboljenja.

 

Ključne reči:

Autoimuni encefalitis; anti-NMDAR antitela; psihoza; neuropsihijatrijski simptomi.

 

 

 

 

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