13 percent of patients with anti-NMDA receptor encephalitis have suicidal thoughts

Thirteen percent of patients with definite anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) have suicidal thoughts and behaviors during the acute phase of the disease, according to a study published online Feb. 22 in the Journal of Neuropsychiatry and Clinical Neurosciences.

Alberto Tellez-Martinez, M.D., from the National Institute of Neurology and Neurosurgery of Mexico in Mexico City, and colleagues describe suicidal thoughts and behaviors in a cohort of Mexican patients diagnosed with definite ANMDARE. Suicidal thoughts and behaviors were examined before and after treatment with a clinical interview conducted with relatives and a direct clinical assessment with each patient.

The researchers found that 15 of 120 patients (13 percent) with definite ANMDARE had suicidal thoughts and behaviors during the acute phase of the disease; all suffered from psychosis. The 15 patients had suicidal ideation with intention. Three and seven had preparatory behaviors and carried out suicidal self-directed violence, respectively. Patients with suicidal thoughts and behaviors more often had psychotic depression and impulsivity than those without any form of suicidality. Self-directed violence during the hospitalization occurred in four patients. In 14 patients, a sustained remission was observed, with only one patient demonstrating persistent suicidal ideation and self-directed violence during follow-up.

"Clinicians must be aware of this potentially lethal risk, particularly in those presenting with symptoms of psychotic depression," the authors write. "Although the persistence of suicidal thoughts and behaviors after immunotherapy is rare, we encourage a long-term risk assessment for suicidal and no suicidal self-directed violence throughout the different stages of the disease."

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