Anti-NMDA Encephalitis with Malignant Catatonia in an Adolescent: Differential Diagnosis and Response to Electroconvulsive Therapy

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2026-04-17

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Boria Buisac, L., Sánchez Moreno, M., Polo Sojo, M. P., & Zapata Usabel, M. A. (2026). Anti-NMDA Encephalitis with Malignant Catatonia in an Adolescent: Differential Diagnosis and Response to Electroconvulsive Therapy. Revista De Psiquiatría Infanto-Juvenil, 43(1). https://doi.org/10.31766/revpsij.v43n1a4

Issue

Vol. 43 No. 1 (2026): January-March

Section

Case reports

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Copyright (c) 2026 Revista de Psiquiatría Infanto-Juvenil

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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DOI:

https://doi.org/10.31766/revpsij.v43n1a4

Keywords:

anti-NMDA encephalitis, malignant catatonia, differential diagnosis, psychosis, electroconvulsive therapy

Abstract

Introduction: Anti-NMDA encephalitis is an autoimmune disease associated with the presence of anti-NMDA antibodies. Its clinical presentation and findings in complementary tests are nonspecific, which often delays diagnosis and treatment initiation. Malignant catatonia is a severe and potentially life-threatening mental state associated with autoimmune encephalitis. Case presentation: We present a case of anti-NMDA encephalitis in a 16-year-old female patient, who was admitted to a Child and Adolescent Psychiatry Unit after experiencing severe neurological and psychiatric symptoms. The condition was complicated by malignant catatonia and autonomic instability, with poor response to benzodiazepine treatment. The patient showed clinical improvement after the initiation of immunotherapy and electroconvulsive therapy. Conclusions: Electroconvulsive therapy is an effective treatment option for patients with this profile and should be considered for the treatment of anti-NMDA encephalitis with catatonia refractory to benzodiazepines.

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Author Biographies

Lucas Boria Buisac, Hospital Clínico Universitario Lozano Blesa

Salud Mental, Hospital Clínico Universitario Lozano Blesa, Servicio Aragonés de Salud, Zaragoza.

Marta Sánchez Moreno, Hospital Clínico Universitario Lozano Blesa

Salud Mental, Hospital Clínico Universitario Lozano Blesa, Servicio Aragonés de Salud, Zaragoza.

María Pilar Polo Sojo, Hospital Clínico Universitario Lozano Blesa

Salud Mental, Hospital Clínico Universitario Lozano Blesa, Servicio Aragonés de Salud, Zaragoza.

Maite Aranzazu Zapata Usabel, Hospital Clínico Universitario Lozano Blesa

Salud Mental, Hospital Clínico Universitario Lozano Blesa, Servicio Aragonés de Salud, Zaragoza.

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