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Neuroleptic intolerance in the context of anti‐N‐methyl‐D‐aspartate receptor encephalitis: A systematic review and synthesis of global case reports.

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Title: Neuroleptic intolerance in the context of anti‐N‐methyl‐D‐aspartate receptor encephalitis: A systematic review and synthesis of global case reports.
Authors: Pacheco‐Barrios, Kevin (AUTHOR), Navarro‐Flores, Alba (AUTHOR), de Melo, Paulo S. (AUTHOR), Rebello‐Sanchez, Ingrid (AUTHOR), Parente, Joao (AUTHOR), Asenjo, Elenit Diaz (AUTHOR), Gordillo, Ivan (AUTHOR), Zeña‐Ñañez, Sandra (AUTHOR), Failoc‐Rojas, Virgilio E. (AUTHOR)
Source: Acta Neurologica Scandinavica. Nov2022, Vol. 146 Issue 5, p410-428. 19p.
Subjects: Anti-NMDA receptor encephalitis, Disease progression, Emergency physicians, Delayed diagnosis, Neuroleptic malignant syndrome, People with mental illness
Abstract: Anti‐N‐methyl‐D‐aspartate receptor (anti‐NMDAR) encephalitis presents commonly with psychiatric symptoms. One cohort of these patients reported that antipsychotic administration led to neuroleptic intolerance (NI) in 19% of them, which was preventable by a prompt encephalitis diagnosis. To date, there is no clear description of the "neuroleptic intolerance" spectrum in general or during anti‐NMDAR encephalitis. We aimed to synthesize epidemiological and clinical characteristics of patients with NI and confirmed anti‐NMDAR encephalitis, the time to the encephalitis diagnosis, the disease course, outcomes at discharge, and associated factors. We systematically searched three databases, to include clinical cases, case series, and observational studies. Additionally, we reported one clinical case. Results were summarized using narrative synthesis and the quality of the included studies was assessed. We included 22 records representing 40 patients (28 females; mean age, 24.6). Overall, the evidence quality was low. Initially, most cases were admitted in psychiatric wards (70%) with purely psychiatric symptoms (37.5%). However, most of them developed subtle concomitant neurological symptoms. The mean time to anti‐NMDAR encephalitis diagnosis was 26.7 days, which was triggered by the NI in six patients. We found no association between clinical variables as delayed diagnosis, admission to psychiatric wards or the presence of malignancy with outcome variables as unfavorable outcomes at discharge, ICU, or mechanical ventilation requirement. A thorough neurological examination in young patients with new‐onset psychiatric symptoms could help emergency physicians, neurologists, and psychiatrists suspect anti‐NMDAR encephalitis earlier. Awareness of NI as a potential side effect during suspected or confirmed anti‐NMDAR encephalitis is encouraged. [ABSTRACT FROM AUTHOR]
Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Neuroleptic intolerance in the context of anti‐N‐methyl‐D‐aspartate receptor encephalitis: A systematic review and synthesis of global case reports.
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  Data: <searchLink fieldCode="AR" term="%22Pacheco‐Barrios%2C+Kevin%22">Pacheco‐Barrios, Kevin</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Navarro‐Flores%2C+Alba%22">Navarro‐Flores, Alba</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22de+Melo%2C+Paulo+S%2E%22">de Melo, Paulo S.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rebello‐Sanchez%2C+Ingrid%22">Rebello‐Sanchez, Ingrid</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Parente%2C+Joao%22">Parente, Joao</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Asenjo%2C+Elenit+Diaz%22">Asenjo, Elenit Diaz</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gordillo%2C+Ivan%22">Gordillo, Ivan</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zeña‐Ñañez%2C+Sandra%22">Zeña‐Ñañez, Sandra</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Failoc‐Rojas%2C+Virgilio+E%2E%22">Failoc‐Rojas, Virgilio E.</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Acta+Neurologica+Scandinavica%22">Acta Neurologica Scandinavica</searchLink>. Nov2022, Vol. 146 Issue 5, p410-428. 19p.
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  Data: <searchLink fieldCode="DE" term="%22Anti-NMDA+receptor+encephalitis%22">Anti-NMDA receptor encephalitis</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+progression%22">Disease progression</searchLink><br /><searchLink fieldCode="DE" term="%22Emergency+physicians%22">Emergency physicians</searchLink><br /><searchLink fieldCode="DE" term="%22Delayed+diagnosis%22">Delayed diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Neuroleptic+malignant+syndrome%22">Neuroleptic malignant syndrome</searchLink><br /><searchLink fieldCode="DE" term="%22People+with+mental+illness%22">People with mental illness</searchLink>
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  Data: Anti‐N‐methyl‐D‐aspartate receptor (anti‐NMDAR) encephalitis presents commonly with psychiatric symptoms. One cohort of these patients reported that antipsychotic administration led to neuroleptic intolerance (NI) in 19% of them, which was preventable by a prompt encephalitis diagnosis. To date, there is no clear description of the "neuroleptic intolerance" spectrum in general or during anti‐NMDAR encephalitis. We aimed to synthesize epidemiological and clinical characteristics of patients with NI and confirmed anti‐NMDAR encephalitis, the time to the encephalitis diagnosis, the disease course, outcomes at discharge, and associated factors. We systematically searched three databases, to include clinical cases, case series, and observational studies. Additionally, we reported one clinical case. Results were summarized using narrative synthesis and the quality of the included studies was assessed. We included 22 records representing 40 patients (28 females; mean age, 24.6). Overall, the evidence quality was low. Initially, most cases were admitted in psychiatric wards (70%) with purely psychiatric symptoms (37.5%). However, most of them developed subtle concomitant neurological symptoms. The mean time to anti‐NMDAR encephalitis diagnosis was 26.7 days, which was triggered by the NI in six patients. We found no association between clinical variables as delayed diagnosis, admission to psychiatric wards or the presence of malignancy with outcome variables as unfavorable outcomes at discharge, ICU, or mechanical ventilation requirement. A thorough neurological examination in young patients with new‐onset psychiatric symptoms could help emergency physicians, neurologists, and psychiatrists suspect anti‐NMDAR encephalitis earlier. Awareness of NI as a potential side effect during suspected or confirmed anti‐NMDAR encephalitis is encouraged. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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              Text: Nov2022
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