Psychiatric Emergencies for Clinicians: Detection and Management of Anti-N-Methyl-D-Asparate Receptor Encephalitis.

A 19-year-old female college freshman presented to the emergency department (ED) for exhibiting bizarre behavior. She presented with her roommate after complaining that her boyfriend was poisoning her food. Before this episode, she was a healthy woman with no medical or psychiatric history. She denied any history of drug use, alcohol use, and she had been on no medications in the past. Collateral history provided by her roommate revealed that she was normal when they started college, but had since become ‘‘really weird’’ over the past 2 weeks. On examination, her vital signs were a temperature of 37.3 C (99.1 F), heart rate of 87 beats/min, respiratory rate of 18 breaths/ min, blood pressure of 125/85 mm Hg, and oxygen saturation of 100% on room air. She repeatedly stated that her food was poisoned and was making her sick. She was slightly disheveled, had pressured speech, and she appeared to be delusional with regard to being poisoned. The remainder of the physical and neurologic examination was normal. She had no nuchal rigidity, nystagmus, tremor, ataxia, rashes, or petechiae. Her gait was normal. Shortly after finishing the physical examination, she had a witnessed tonicclonic seizure.