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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

SO216

Collaboration between pediatricians and child psychiatrists in establishing an early, accurate diagnosis and initiating treatment in an adolescent patient with anti-NMDAR encephalitis: a case report

COOPERATION BETWEEN PEDIATRICIANS AND CHILD PSYCHIATRISTS IN THE EARLY ESTABLISHMENT OF THE RIGHT DIAGNOSIS AND TREATMENT IN AN ADOLESCENT PATIENT WITH ANTI-NMDAR ENCEPHALITIS: CASE REPORT

First-episode psychosis in adolescence may be the initial manifestation of anti-NMDAR encephalitis, and early diagnosis depends on close collaboration between pediatrics and child psychiatry.

The aim is to highlight that first-onset psychotic symptoms in adolescence may be the initial manifestation of anti-NMDAR encephalitis and to emphasize the importance of close collaboration between pediatricians and child psychiatrists for an early, accurate diagnosis; the method is a case report. A 15-year-old girl with no neurological risk factors developed disorientation and headache on day one and underwent emergency pediatric assessment following a second episode on day four (disorientation, incoherent speech, disorganized behavior, affective lability, and headache; no history of fever or head trauma, and normal laboratory and toxicology results). On day five, upon admission to pediatric neurology, an EEG was normal, brain magnetic resonance imaging (MRI) revealed a mild signal abnormality in the right hippocampus, and cerebrospinal fluid analysis showed 100 leukocytes and a normal protein level; empirical antimicrobial treatment was initiated. Four hours after admission, she developed an acute psychotic episode with psychomotor agitation, paranoid thoughts, and visual hallucinations and received 5 mg of intramuscular haloperidol; paranoid thoughts, dystonic movements, and periods of mutism subsequently persisted. On day six, she was transferred to intensive care because of mutism, tetraparesis, and worsening psychiatric symptoms (the meningoencephalitis panel was negative). She received 2 g/kg of intravenous immunoglobulin over five days and intravenous corticosteroids for five days, and anti-NMDAR encephalitis was confirmed on day eight. During tumor screening on day eight, pelvic MRI revealed a left ovarian mass suspicious for a cystic teratoma; tumor markers and 24-hour urinary catecholamines were normal. On day ten, the left ovary containing the cystic lesion, the left fallopian tube, and a smaller cystic lesion in the right ovary were surgically removed; histopathology was reported as a hemorrhagic corpus luteum cyst. Following 12 cycles of plasma exchange initiated on day twelve, her neurological and psychiatric condition improved, and she was discharged on day forty with recommendations for neurological and psychiatric follow-up. In conclusion, anti-NMDAR encephalitis may be mistaken for a primary psychiatric disorder, leading to delays in diagnosis and treatment and poorer outcomes; awareness of the clinical and demographic characteristics of new-onset psychosis, together with close collaboration between pediatrics and child psychiatry, is crucial for timely diagnosis and treatment.

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