Suicidality is a common and serious feature of anti-N-methyl-D-aspartate receptor encephalitis

Abstract

We aimed to assess suicidality risk amongst people who had had anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. All people with a definitive diagnosis of anti-NMDAR encephalitis in West China Hospital between June 2012 and February 2017 were identified and their notes were retrospectively reviewed. Demographic and clinical characteristics and risk predictors for suicidality were summarized; those with suicidality were compared to those without. 17 of 133 people (13%) presented with suicidality symptoms: 7 (5%) with suicidal ideation; 8 (6%) who attempted suicide; and 2 (1.5%) who completed suicide. Median age was 27 (16–78) years, most were female [13 (76%)]. Compared with those with no suicidality, psychiatric symptoms as the initial symptoms were more frequent in those who reported suicidality (p = 0.039); insomnia, aggression, mania, depression and delusion were also more common (p < 0.05). The use of antidepressants (p < 0.001) and recurrence of encephalitis (p = 0.020) were higher in people with suicidality than in those without. Other characteristics were not significantly different in those who had suicidality and those who did not. Suicidality is a common and potentially lethal risk for people with anti-NMDAR encephalitis. Those presenting with psychiatric symptoms as the initial symptom and with insomnia, aggression, mania, depression and delusion should be carefully screened for suicidality. Closely monitoring people who have been treated with antidepressants is necessary.

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Acknowledgements

We are grateful to Dr. Hai-tao Ren from the Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, China, for testing for anti-NMDAR antibodies and for technical support. We also grateful to Dr. Gail S Bell for reviewing the manuscript. JWS is based at UCLH/UCL Comprehensive Biomedical Research Centre, which receives a proportion of funding from the UK Department of Health’s National Institute for Health Research Biomedical Research Centres funding scheme. He receives support from the Dr. Marvin Weil Epilepsy Research Fund and the UK Epilepsy Society endows his current position. We thank all the subjects who participated in this study.

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Correspondence to Jin-Mei Li or Dong Zhou.

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No author has any conflict of interest in respect to this work. LZ, LZ, XYJ, WW, KS, ATA, MQW, XSC, DZ, and JML have no disclosures to make. JWS has received research grants and honoraria from UCB, Eisai, and Janssen.

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Zhang, L., Sander, J.W., Zhang, L. et al. Suicidality is a common and serious feature of anti-N-methyl-D-aspartate receptor encephalitis. J Neurol 264, 2378–2386 (2017). https://doi.org/10.1007/s00415-017-8626-5

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Keywords

  • Anti-NMDAR encephalitis
  • Suicidal rate
  • Psychiatric symptom
  • Predictors