CPCP: Anti-NMDAR Encephalitis: Psychiatry’s Role

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Welcome to the young owls teaching the geezer owl!
Joseph Noack med student
Joseph Noack

Emma Killoran M2Frederick Ruckersfeldt med studentWe got a treat when the medical students gave an outstanding Clinical Problems in Consultation Psychiatry (CPCP) presentation on anti-NMDA receptor encephalitis and Psychiatry’s role in this devastating disorder. I get the biggest kick out of students teaching me for a change. A smaller example, incidentally, was Frederick letting me know that I don’t have to go through the annoying step of making sure I can safely remove my thumb drive from my computer by obeying the direction to click on the removable drive icon. I can just yank it out without fear of blowing up the tower!

All three handled the presentation by the tag team approach and I could tell they all worked hard on it. The syndrome is rare and, judging from the literature, and the prodrome, psychiatry’s most important role for now is learning how to be vigilant for it because often the patient’s first assessment by any physician will be from a psychiatrist. It typically begins as a flu-like syndrome followed by bizarre psychiatric symptoms which are usually an abrupt change from the person’s usual state.

Psychiatric medications can cause troubling and even dangerous side effects in these patients. Doctors should be very cautious and vigilant for worsening behaviors  or even neuroleptic malignant syndrome (NMS) after starting antipsychotics because they can be exquisitely sensitive to their adverse effects.

Hey, I can still teach them how to climb the stairs at least.

Pedometer Daze March 16 2016

They even used a couple of videos from my blog to demonstrate non-pharmacologic management of the challenging behaviors that we see. The TADA approach for patients with dementia complicated by disruptive behaviors can probably be adapted from the video below:

And there is a similar management video:


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