“SEARCH FOR NMDAR-A” DALAM DIAGNOSIS PSIKOTIK AUTOIMUN: SERIAL KASUS ENSEFALITIS NMDAR
DOI:
https://doi.org/10.51878/healthy.v5i2.10391Keywords:
Ensefalitis Anti-NMDAR, Psikosis Autoimun, Search For NMDAR-AAbstract
ABSTRACT
Anti-NMDAR encephalitis is an autoimmune disorder of the central nervous system that often presents initially with psychiatric symptoms, leading to a high risk of misdiagnosis as functional psychotic disorders. This study aims to evaluate the role of the “Search For NMDAR-A” approach in the early identification of autoimmune psychosis in acute psychotic episodes. The study employed a case series design involving 10 patients collected from November 2023 to June 2024 in the Department of Psychiatry. Evaluation was conducted through clinical psychiatric assessment, longitudinal observation, and cerebrospinal fluid (CSF) examination. Data were analyzed using qualitative descriptive analysis to identify key clinical patterns. The results indicate a dominant combination of symptoms, including sleep disturbances, agitation, and psychosis, with some cases accompanied by catatonia and cognitive impairment. The main finding highlights a consistent pattern of early symptoms accompanied by CSF abnormalities (elevated protein and pleocytosis) as indicators of suspected autoimmune psychosis. The “Search For NMDAR-A” approach shows potential as an initial clinical screening tool prior to definitive antibody testing. Conclusion: This approach is effective in enhancing clinicians’ awareness for the early detection of autoimmune psychosis. The novelty of this study lies in the systematic application of a mnemonic approach within psychiatric clinical practice.
ABSTRAK
Ensefalitis anti-NMDAR merupakan gangguan autoimun sistem saraf pusat yang sering diawali gejala psikiatri sehingga berisiko tinggi disalahdiagnosis sebagai gangguan psikotik fungsional. Penelitian ini bertujuan mengevaluasi peran pendekatan “Search For NMDAR-A” dalam identifikasi dini psikosis autoimun pada episode psikotik akut. Desain penelitian berupa serial kasus terhadap 10 pasien yang dikumpulkan pada November 2023–Juni 2024 di Departemen Psikiatri. Evaluasi dilakukan melalui asesmen klinis, observasi longitudinal, dan pemeriksaan cairan serebrospinal (CSF). Data dianalisis secara deskriptif kualitatif untuk mengidentifikasi pola klinis utama. Hasil menunjukkan kombinasi gejala dominan berupa gangguan tidur, agitasi, dan psikosis, dengan sebagian kasus disertai katatonia dan gangguan kognitif. Temuan utama adalah konsistensi pola gejala awal yang disertai abnormalitas CSF (peningkatan protein dan pleositosis) sebagai indikator kecurigaan psikosis autoimun. Pendekatan “Search For NMDAR-A” berpotensi sebagai alat skrining awal sebelum uji antibodi definitif. Simpulan: Pendekatan ini efektif meningkatkan kewaspadaan klinisi dalam deteksi dini psikosis autoimun. Kebaruan penelitian terletak pada penerapan sistematis mnemonic dalam praktik psikiatri.
References
Beattie, M., Goodfellow, J., Oto, M., & Krishnadas, R. (2022). Anti-NMDAR encephalitis for psychiatrists: the essentials. BJPsych Bulletin, 46(4), 235-241. https://doi.org/10.1192/bjb.2021.35
Cabrera-Maqueda, J. M., Planagumà, J., Guasp, M., & Dalmau, J. (2025). Autoimmune neuropsychiatric disorders manifesting with psychosis. The Journal of Clinical Investigation, 135(20). https://doi.org/10.1172/JCI196507
Chau, S.W.H., Lam, C.K., Yu, M.P. et al. Prevalence of anti-NMDA receptor antibodies among adult patients presenting with first-episode psychosis in Hong Kong. Schizophr 12, 35. https://doi.org/10.1038/s41537-026-00741-2
Ciano-Petersen, N. L., Villagrán-García, M., Muñiz-Castrillo, S., Farina, A., Vogrig, A., Goncalves, D., ... & Honnorat, J. (2025). Relapses in anti-NMDAR encephalitis: clinical characterization and predictive features. Neurology: Neuroimmunology & Neuroinflammation, 12(4), e200421. https://doi.org/10.1212/NXI.0000000000200421
Dalmau, J., & Graus, F. (2023). Autoimmune encephalitis misdiagnosis, misconceptions, and how to avoid them. JAMA neurology, 80(1), 12-14. https://doi.org/10.1001/jamaneurol.2022.4154
de Bruijn, M. A., Leypoldt, F., Dalmau, J., Lee, S. T., Honnorat, J., Clardy, S. L., ... & Titulaer, M. J. (2025). Autoimmune encephalitis. Nature Reviews Disease Primers, 11(1), 65.
https://doi.org/10.1038/s41572-025-00650-1
Di Cosmo, L., Mulic-Al Bunni, S., Goh, Y., Przybysz, J., Mgbachi, V. C., Fox, H., ... & Handel, A. E. (2026). Systematic Review and Meta-Analysis of the Clinical Features Associated With Seronegative Autoimmune Encephalitis. Neurology: Neuroimmunology & Neuroinflammation, 13(2), e200540. https://doi.org/10.1212/NXI.0000000000200540
Dimitrov, G., Deneva, V., & Mantarova-Valkova, S. (2025). Anti-NMDA receptor encephalitis unmasking Sjögren’s disease: a case report and literature review. Frontiers in Immunology, 16, 1673892. https://doi.org/10.3389/fimmu.2025.1673892
Dinov, D., Nguyen, L., Blackburn, K., & Vernino, S. (2025). Current and emerging therapies for autoimmune encephalitis. Expert review of neurotherapeutics, 25(5), 555-565. https://doi.org/10.1080/14737175.2025.2483925
Flammer, J., Neziraj, T., Rüegg, S., & Pröbstel, A. K. (2023). Immune mechanisms in epileptogenesis: update on diagnosis and treatment of autoimmune epilepsy syndromes. Drugs, 83(2), 135. https://doi.org/10.1007/s40265-022-01826-9
Flanagan, E. P., Geschwind, M. D., Lopez-Chiriboga, A. S., Blackburn, K. M., Turaga, S., Binks, S., ... & Irani, S. R. (2023). Autoimmune encephalitis misdiagnosis in adults. JAMA neurology, 80(1), 30-39. https://doi.org/10.1001/jamaneurol.2022.4251
Liu, Y., Tian, Y., Guo, R., Xu, X., Zhang, M., Li, Z., ... & Huang, X. (2022). Anti?NMDA receptor encephalitis: retrospective analysis of 15 cases, literature review, and implications for gynecologists. Journal of Healthcare Engineering, 2022(1), 4299791. https://doi.org/10.1155/2022/4299791
Marsters, C., Iskhakova, S., Powe, L., & Budhram, A. (2023). A young adult with first-episode psychosis: when to consider anti–N-methyl-D-aspartate receptor encephalitis. CMAJ, 195(9), E330-E332. https://doi.org/10.1503/cmaj.220938
Müller, N. (2025). Immunological approaches in the diagnosis and treatment of psychiatric disorders: a historical overview. Neuroimmunomodulation, 32(1), 16-23. https://doi.org/10.1159/000542784
Nguyen, L., & Wang, C. (2023). Anti-NMDA receptor autoimmune encephalitis: diagnosis and management strategies. International journal of general medicine, 7-21. https://doi.org/10.2147/IJGM.S397429
P?dureanu, V., Dop, D., P?dureanu, R., Pîr?coveanu, D. F. V., Olaru, G., Streata, I., & Bug?, A. M. (2025). Anti-NMDA receptor encephalitis: a narrative review. Brain Sciences, 15(5), 518. https://doi.org/10.3390/brainsci15050518
Russo, G., Jia, L., Kim, C. Y., Stojanovic, K., Wesley, S. F., Denfield, G. H., ... & Thakur, K. T. (2025). Developing a Clinical Workflow for Early Recognition and Diagnosis of Autoimmune Encephalitis in Patients Presenting With Atypical Psychosis. Journal of the Academy of Consultation-Liaison Psychiatry, 66(3), 251-260. https://doi.org/10.1016/j.jaclp.2025.02.001
Samanta, D., & Lui, F. (2024). Anti-NMDAR Encephalitis. [Updated 2023 Jul 17]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551672/
Seery, N., Butzkueven, H., O’Brien, T. J., & Monif, M. (2022). Contemporary advances in anti-NMDAR antibody (Ab)-mediated encephalitis. Autoimmunity Reviews, 21(4), 103057. https://doi.org/10.1016/j.autrev.2022.103057
Seery, N., Butzkueven, H., O’Brien, T. J., & Monif, M. (2022). Rare antibody-mediated and seronegative autoimmune encephalitis: an update. Autoimmunity Reviews, 21(7), 103118. https://doi.org/10.1016/j.autrev.2022.103118
Tan, Y. J., Ong, C. S., Siow, I., & Yong, K. P. (2023). Clinical characteristics of anti-NMDAR encephalitis in adult Southeast Asian males. Singapore Medical Journal, 67(1), S36-S41. https://doi.org/10.4103/singaporemedj.SMJ-2021-007
Uvais, N. A. (2026). Anti-NMDAR Encephalitis. In Autoimmune Diseases: Understanding, Management and Clinical Practice, 449-463. https://doi.org/10.1007/978-3-032-12937-6_18
van Elst, L. T., Runge, K., Meyer, P. T., Urbach, H., Venhoff, N., & Prüss, H. (2025). The neuropsychiatric checklist for autoimmune psychosis: A narrative review. Biological psychiatry. 9(1), 648-649. https://doi.org/10.1016/j.biopsych.2025.02.889
Wagner, J. N., Moser, T., Gruber, J., Mylonaki, E., Böhm, V., Schwarzenhofer, D., ... & von Oertzen, T. J. (2026). Characteristics of and risk factors for epilepsy after autoimmune and infectious encephalitis. BMC neurology. https://doi.org/10.1186/s12883-026-04680-4
Wu, P. Y., Chi, C. S., Tsai, C. R., Yang, Y. L., & Lee, H. F. (2023). Long-term outcome of pediatric patients with anti-NMDA receptor encephalitis in a single center. Children, 10(2), 182. https://doi.org/10.3390/children10020182
