Effect of Clozapine on Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Psychiatric Symptoms: A Series of Three Cases

Effect of Clozapine on Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Psychiatric Symptoms: A Series of Three Cases

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The main clinical manifestations of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis are acute or subacute seizures, cognition impairment, and psychiatric symptoms.Nowadays, the scheme of antipsychotic therapy for this disease has not been established.This study reports three cases of anti-NMDAR encephalitis with psychiatric symptoms.The anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum sophie allport zebra were positive.The psychiatric symptoms still existed after intravenous immunoglobulin (IVIG) treatment; thus, clozapine was used for antipsychotic therapy.

Case 1 was a 37-year-old man who suffered from bad mood and suicide behaviors for 1 month.Hallucination and delusion still existed after IVIG treatment and hormone therapy, and the symptoms were relieved when given clozapine for 12 months.Case 2 was a 28-year-old man who was admitted to our hospital due flexcon reverse osmosis water storage tank to injuring other people and destructive behaviors for 2 days.He showed irritability, bad temper, declined cognition, and severe delusion of persecution after IVIG treatment and hormone therapy, but the psychiatric symptoms disappeared when given clozapine for 3 months.Case 3 was a 23-year-old man who suffered from headache and babbing for 7 days.

Symptoms such as irritability, bad temper, babbing, and injuring other people still existed after IVIG treatment and hormone therapy, but they disappeared when given clozapine for 2 months.Therefore, we suggest that during the treatment of anti-NMDAR encephalitis with psychiatric symptoms, if the anti-NMDAR antibodies in CSF and serum were positive, and psychiatric symptoms could not be controlled after IVIG and hormone therapy, clozapine may work.