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A 25-year-old man developed subacute psychotic symptoms with fluctuating neuropsychiatric manifestations, including cognitive impairment, disorientation, confusion, movement disorders, decreased consciousness, catatonia complicated by malignant neuroleptic syndrome, and seizures. EEG showed an extreme delta brush pattern and CSF revealed elevated IgG index, with antibody confirmation after initial treatment. Early immunosuppression using corticosteroids followed by plasmapheresis led to significant clinical improvement before confirmation at discharge.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/autoimmune-psychosis-exists-early-diagnosis-of-an-anti-nmda-receptor-autoimmune-encephalitis-presenting-as-first-episode-psychosis-in-a-25-year-old-male-a-case-report/407827/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/autoimmune-psychosis-exists-early-diagnosis-of-an-anti-nmda-receptor-autoimmune-encephalitis-presenting-as-first-episode-psychosis-in-a-25-year-old-male-a-case-report/407827.png","ImageObject",300,407,{"name":92,"@type":93},"Cart","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical features did the 25-year-old male present with?","Question",{"text":113,"@type":114},"He presented with first-episode psychosis and developed severe cognitive deficits, disorientation and confusion, movement disorders with perioral dyskinesia, decreased consciousness, and catatonia. He also had epileptic seizures, unstable vital signs, and malignant neuroleptic syndrome complicating the course.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How was anti-NMDA receptor autoimmune encephalitis diagnosed?",{"text":118,"@type":114},"An EEG showed an extreme delta brush pattern, and CSF analysis demonstrated an elevated IgG index, leading clinicians to suspect anti-NMDAR encephalitis. Anti-NMDAR IgG antibodies in CSF were detected after discharge, confirming the diagnosis.",{"name":120,"@type":111,"acceptedAnswer":121},"What treatment resulted in improvement?",{"text":122,"@type":114},"He was treated with oral corticosteroids followed by plasmapheresis. By discharge, he was alert and oriented, cooperative, and not psychotic, with only mild cognitive defects.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},407827,1790719106,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},18829141979164,"https://eur-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Wiley  \nCase Reports in Psychiatry  \nVolume 2025, Article ID 3931587, 6 pages [https://doi.org/10.1155/crps/3931587](https://doi.org/10.1155/crps/3931587)  \nCase Report  \nAutoimmune Psychosis Exists: Early Diagnosis of an  \nAnti-NMDA Receptor Autoimmune Encephalitis Presenting as First-Episode Psychosis in a 25-Year-Old Male—A Case Report  \nMarc Mourad , 1 Caroline Hallal,2 Juliana Sargi,3 Elie Atallah,4 Anthony Kassab,2 Sajida Sabsaby,5 Christian Matta ,5 Karine Abou Khaled ,5 and Sami Richa2  \n1Department of Psychiatry, Psychiatric Hospital of The Cross, Jal El Dib, Maten, Lebanon  \n2Department of Psychiatry, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon  \n3Department of Psychiatry, University of Tours, Tours, France  \n4Department of Psychology and Social Sciences/School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon  \n5Department of Neurology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon  \nCorrespondence should be addressed to Marc Mourad; [marcmourad299@gmail.com](marcmourad299@gmail.com)  \nReceived 26 July 2025; Revised 20 November 2025; Accepted 1 December 2025  \nAcademic Editor: Toshiya Inada  \nCopyright © 2025 Marc Mourad et al. Case Reports in Psychiatry published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nBackground: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder marked by prominent neuropsychiatric symptoms. It is typically first encountered by psychiatrists because psychotic symptoms can be early signs of the condition. In recent years, this form of encephalitis has been established as a distinct diagnostic entity in neurology and psychiatry. Furthermore, as an organic and autoimmune psychosis, it is considered a differential diagnosis of schizophrenia and schizoaffective disorders.  \nClinical Presentation: We report the case of a 25-year-old male who presented with a first episode of psychosis. During his stay, the patient exhibited severe cognitive deficits (disorientation, confusion, memory issues), movement disorders (dysarthria, perioral dyskinesia leading to speech difficulties), a decreased level of consciousness, and a catatonic state complicated by a malignant neuroleptic syndrome. The patient also experienced epileptic seizures and had unstable vital signs. An electroencephalogram (EEG) revealed an extreme delta brush pattern (specific for anti-NMDAR encephalitis), and CSF analysis showed an elevated immunoglobulin G (IgG) index. Based on these findings, anti-NMDAR autoimmune encephalitis was suspected 17 days after admission but not yet confirmed. The patient was treated with oral corticosteroids followed by plasmapheresis and showed significant improvement. At discharge, he was alert, oriented, cooperative, and not psychotic, with only mild cognitive defects. Days after discharge, anti-NMDAR IgG antibodies were detected in his CSF, confirming the diagnosis.  \nClinical Presentation: This case underscores the importance of considering anti-NMDAR autoimmune encephalitis as a differential diagnosis in patients with no personal or family psychiatric history who develop subacute psychotic symptoms (lasting less than 3 months) along with fluctuating neuropsychiatric signs. Conducting an EEG, cerebral MRI, and CSF analysis to confirm or exclude the condition, followed by early immunosuppressive treatment, is crucial for improving prognosis.  \nKeywords: autoimmune diseases; early diagnosis; encephalitis; extreme delta brush EEG aspect; first episode of psychosis;  \nimmunotherapies; psychosis  \n2 Case Reports in Psychiatry  \n1. Introduction to the psychiatric ward without further investigation other thana routine blood test, including CBC, which showed normal  \nSince the exact pathophysiology of schizophrenia spectrum","cbCaianHV01rx6dd","https://ap.wps.com/l/cbCaianHV01rx6dd","pdf",410050,"English","# Case Report\n## Clinical Presentation\n## Diagnosis and Treatment\n## Clinical Significance","[{\"question\":\"What clinical features did the 25-year-old male present with?\",\"answer\":\"He presented with first-episode psychosis and developed severe cognitive deficits, disorientation and confusion, movement disorders with perioral dyskinesia, decreased consciousness, and catatonia. He also had epileptic seizures, unstable vital signs, and malignant neuroleptic syndrome complicating the course.\"},{\"question\":\"How was anti-NMDA receptor autoimmune encephalitis diagnosed?\",\"answer\":\"An EEG showed an extreme delta brush pattern, and CSF analysis demonstrated an elevated IgG index, leading clinicians to suspect anti-NMDAR encephalitis. Anti-NMDAR IgG antibodies in CSF were detected after discharge, confirming the diagnosis.\"},{\"question\":\"What treatment resulted in improvement?\",\"answer\":\"He was treated with oral corticosteroids followed by plasmapheresis. By discharge, he was alert and oriented, cooperative, and not psychotic, with only mild cognitive defects.\"}]","Autoimmune Psychosis Exists - Early Diagnosis of an Anti-NMDA Receptor Autoimmune Encephalitis Presenting as First-Episode Psychosis in a 25-Year-Old Male - A Case Report | PDF",1790576336,15]