title: Anti-NMDA Encephalitis in the Acute Setting.
abstract: BACKGROUND
  Encephalitis associated with antibodies targeted against the N-methyl-D-aspartate (NMDA) receptor is increasingly recognised as a major cause of an acute presentation of organic psychosis. Misdiagnosis and subsequent inappropriate referral to psychiatric services is common and avoidable. This review focuses on addressing this issue in the acute setting.
  
  
  METHODS
  The authors present a review of existing literature relating to the pathophysiology and presentation of anti-NMDA receptor encephalitis, prior to proposing a management pathway avoiding delays to treatment incurred through misdiagnosis or inappropriate referral.
  
  
  CONCLUSIONS
  Acute care physicians should have a low threshold for suspecting anti-NMDA receptor encephalitis in any patient presenting with acute psychosis in the context of non-specific coryzal and constitutional symptoms in whom infective causes have been excluded. The presence of pleocytosis and reduced protein in routine CSF analysis should further raise suspicion, and samples should be sent for immunohistochemical testing. Availability and efficiency of this testing is currently suboptimal.
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, UK, jl507@cam.ac.uk.
authors.forename: John E
authors.initials: JE
authors.lastname: Lawrence
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Fountain
authors.forename: Mark
authors.initials: M
authors.lastname: Agius