Overview
Clinical Frame
Psychosis can be the first visible sign of a neurological emergency.
Psychosis can be the first visible sign of a neurological emergency. A young person who develops new paranoia, hallucinations, insomnia or disorganised behaviour and then develops seizures, abnormal movements, reduced consciousness, blood-pressure swings or hypoventilation does not fit comfortably within a primary psychiatric diagnosis. Anti-NMDA receptor encephalitis is an antibody-mediated encephalitis with a potentially severe but often reversible course. The practical nursing model is to connect the psychiatric presentation to the later neurological deterioration, protect breathing and circulation while the diagnosis is being established, look for an underlying tumour, and support prompt immunotherapy. Canadian adult guidance published in February 2024 is the principal national reference; moderate-to-severe illness should be managed with an experienced autoimmune encephalitis team and access to plasma exchange.