Patients with anti-NMDA encephalitis tend to show psychiatric symptoms in the first couple weeks of the disease. Afterwards follows neurological involvement (that may require care in the ICU). Symptoms of behavior and cognition are quite common. Most neurological symptoms include autonomic instability, hypoventilation, instability, and movement abnormalities.

University of Illinois at Chicago

Individuals with anti-NMDA encephalitis manifest significant psychiatric symptoms like psychosis early in the disease timeline. Evidence with this disease correlates with the glutamatergic model of schizophrenia, and contributes to the research on schizophrenic neural circuit dysfunction. Psychotic symptoms in anti-NMDAR encephalitis has been a topic of interest, as it questions whether it is an identifiable, treatable subtype of psychosis. There is a distinct relation between schizophrenia and autoimmunity disturbances. There is a lack of evidence for autoantibodies that may result in psychosis, however autoimmunity involving IgG GluN1 antibodies causes a state similar to schizophrenia. 

Psychosis, Autoimmunity and their relation to Anti-NMDA Receptor Encephalitis

Kayser, M. S., Dalmau, J., Matthew S. KayserView all articles by this author, & Josep DalmauView all articles by this author. (n.d.). Anti-NMDA receptor encephalitis, autoimmunity, and psychosis. Focus. https://psychiatryonline.org/doi/10.1176/appi.focus.140405#:~:text=Anti%2DNMDAR%20encephalitis%20demonstrates%20clearly,and%20other%20symptoms%20of%20schizophrenia. 

Anti-NMDA receptor encephalitis, autoimmunity, and psychosis

Demographics and course of anti-NMDA encephalitis

Examinations of hundreds of cases shows that some patients show only psychiatric symptoms without neurological action during relapse or the first disease episode. The following figure shows NMDA receptor antibodies during relapse and the first phase in a single patient. NMDAR titers (antibody level) were higher in relapse than the initial phase. These patients are no different to others with the disease in terms of presence/absence of tumor, demographics, psychiatric symptoms or outcomes of those with anti-NMDA encephalitis. Furthermore, those patients with antibodies (IgG subtype) reacting to the GluN1 subunit display psychiatric symptoms in solitarity. 

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