It’s All in Your Head

By Patricia Kane

It’s a phrase you’ve likely told yourself, and if you were ever a teenage girl, a phrase you have definitely heard. While usually intended to dismiss something (a problem, an emotion, a situation), there are times where it is exactly the case. And more so than that, something you don’t necessarily have control over.

Julia’s* parents were concerned about her. She was 15 and clearly underweight; she had lost over 15 pounds in seven weeks and had a BMI of 15.7. Julia had been exhibiting extremely selective eating habits, lowered food intake and a marked increase in exercise.

*Name created for the purposes of this narrative, which recounts the case of an anonymous patient.

Sounds like a pretty cut and dry instance of anorexia, right?

So, like any good parents they took her to see the doctor, and that was the diagnosis. At her two week follow-up, everything seemed to be improving. She had gained back almost nine pounds, and her parents happily noted that her eating habits had returned to normal.

Julia’s situation took a turn for the worse, however, when four days later she was rushed to the emergency room. She’d had a seizure. Her cranial MRI and angiography, which looks at the inside of blood vessels, however, showed no abnormalities. There was also no indication that it was epileptic. Julia was placed in the adolescent psychiatric inpatient unit for supervision and further testing.

A few days later, she began experiencing auditory hallucinations, she couldn’t sleep, and her spatial, temporal and personal orientation was diminished. Doctors tried to treat her with antipsychotics, but Julia showed little improvement. She then began having difficulty controlling the muscles in her face. They tested her for a whole host of diseases, and it wasn’t until Julia had been there for 17 days that doctors were able to provide a definitive diagnosis of anti-NMDA receptor encephalitis.

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Photo Credit: Daisuke Murase, Flickr

 

It’s All in Your Head

No, really. It is. The interchange of electrical and chemical impulses managing the system that is “you” is all up there. Or begins up there.

So what happens, then, when management begins dispersing incorrect directions?

It’s like the game “Telephone,” except mistakes don’t elicit giggles. They can, and a lot of the time do, have catastrophic consequences.

The brain is an intricately designed communication device. There is a specific distribution of agents which send and receive very specific messages. Brain cells have receptors, which are on the lookout to receive these specific messages. But what happens when these receptors are damaged and can’t function properly?

Well, simply put, your brain can’t function properly.

Anti-NMDA receptor encephalitis, along with being a foreboding phrase in and of itself, is a rare and recently specified disease in which, for one reason or another, the immune system produces antibodies that target and attack these NMDA receptors. These receptors play a crucial role in not only memory and perception, but also the rhythms of breathing and locomotion.

In Julia’s case, the presence of anorectic symptoms in conjunction with anti-NMDA receptor encephalitis was a first. Identifying indicators like this are vital in improving diagnosis time and accuracy.

Furthermore, Julia’s experience illustrates the importance of multi-disciplinary teams in patient care. Because patients suffering from anti-NMDA receptor encephalitis are typically referred to psychiatric care, it is important that physicians in these departments are aware of and educated on diseases such as this.

 

Sources:

Blanke ML, VanDongen AMJ. Activation Mechanisms of the NMDA Receptor. In: Van Dongen AM, editor. Biology of the NMDA Receptor. Boca Raton (FL): CRC Press; 2009. Chapter 13. Available from: http://www.ncbi.nlm.nih.gov/books/NBK5274/

Mechelhoff, D., van Noort, B. M., Weschke, B., Bachmann, C. J., Wagner, C., Pfeiffer, E., & Winter, S. (2015). Anti-nmda receptor encephalitis presenting as atypical anorexia nervosa: An adolescent case report. European Child & Adolescent Psychiatry, doi:10.1007/s00787-015-0682-8

 

Update 9/18/2015 – Edited by Paige Jarreau

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