Acute psychiatric illness in a young woman: an unusual form of encephalitis

A 21-year-old woman was admitted to hospital with a diagnosis of acute psychotic mania, but developed, over approximately 6 weeks, seizures, delirium, catatonia, movement disorder and autonomic dysfunction. She was found to have antibodies to N-methyl-d-aspartate (NMDA) NR1–NR2 receptors in both serum and cerebrospinal fluid, consistent with anti-NMDA-receptor encephalitis, a severe, potentially lethal but treatment-responsive encephalitis often associated with ovarian tumour. With aggressive immunotherapy and bilateral oophorectomy, she recovered over a period of 14 months from her initial presentation. No ovarian tumour was identified. (MJA 2009; 191: 284-286)

A 21-year-old Indigenous woman was admitted to hospital with an acute change in mental state over the preceding 24 hours. She had become agitated, was pressured in speech and singing constantly. In the weeks before presentation, family members had noted increasingly disorganised behaviour and altered sleep patterns.