Anti-N-methyl-D-aspartate Receptor Antibody Encephalitis: A Psychiatric Presentation

On Serial Mental Status Examination The patient had a staring look, did not answer to the questions asked, and was smiling inappropriately at times. Initially he was walking with difficulty, was oriented, and had intact memory. He had persecutory delusion. Initial provisional diagnosis of organic psychosis was made and neurologic evaluation was obtained for his atypical presentation. Three to four days later, he had fever spikes with autonomic instability and gradually his cognitive and neurological status deteriorated significantly. He was transferred to neurology ward. He was disoriented to time, place, and person; became bedridden; progressively stopped taking diet; and became incontinent of bowel and bladder. Mental status waxed and waned. At times, he spoke, identified family members, and at other times he remained mute. He began to develop symptoms consistent with worsening catatonia, waxy flexibility, posturing, active negativism, and blank staring. He received lorazepam injection 1 mg IV for catatonia, he became drowsier, and no response was noted, hence stopped. in t r o d u c t i o n