抗N-甲基-D-天冬氨酸受体脑炎精神症状特征及照料者负担

Neuropsychiatric symptoms and caregivers′distress in anti-N-methyl-D-aspartate receptor encephalitis

目的评估并分析抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎精神症状特征及照料者负担。方法将2011—2018年北京协和医院诊治的72例抗NMDAR脑炎患者作为研究对象,采用神经精神科问卷-知情者版(NPI-Q)评估治疗前、治疗后的精神症状和照料者负担。结果(1)抗NMDAR脑炎患者神经精神症状严重程度总分与苦恼程度总分相关系数在治疗前与治疗后分别为0.872与0.947,呈高度正相关(均P<0.001)。(2)免疫治疗前NPI-Q的12条精神症状出现频率均高于45%,免疫治疗后精神症状频率显著下降至45%以下,易激惹/情绪不稳、激越/攻击是最常见的精神症状,易激惹/情绪不稳、激越/攻击、睡眠/夜间行为通常同时存在。(3)精神症状严重的患者更倾向使用抗精神病药(Z=-2.581,P=0.01);免疫治疗后精神症状显著改善(Z=-6.611,P<0.001)。(4)首发与复发患者治疗前后精神症状的严重程度及苦恼程度差异均无统计学意义(均P>0.05)。结论抗NMDAR脑炎患者经常出现严重的精神症状,并导致照料者负担加重,免疫治疗可显著改善精神症状从而减轻照料者的负担。

Objective To explore the characteristics of psychiatric symptoms and caregivers’distress in anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis.Methods Seventy-two patients with anti-NMDAR encephalitis were investigated in Peking Union Medical College Hospital from 2011 to 2018.The Chinese version of the Neuropsychiatric Inventory-Questionnaire(NPI-Q)was used to assess the severity of neuropsychiatric symptoms and caregivers’distress around the treatment.Results A highly positive correlation existed between severity scores of neuropsychiatric symptoms and caregiver distress,and pre-and post-treatment correlation coefficients was 0.872 and 0.947,respectively(all P<0.001).The frequency of 12 symptom domains was higher than 45%before treatment,however,it significantly reduced to below 45%after treatment.Irritability/lability,agitation/aggression were the most common neuropsychiatric symptoms.Irritability/lability,agitation/aggression,and nighttime behavioral disturbances occurred concurrently.Patients with severe symptoms tended to be administrated antipsychotics(Z=-2.581,P=0.01).Neuropsychiatric symptoms significantly improved after immunotherapy(Z=-6.611,P<0.001).There was no significant difference in the symptom severity and distress subscale scores between the first episode and relapse around the therapy(P>0.05).Conclusion Patients with anti NMDAR encephalitis often present severe neuropsychiatric symptoms,which aggravate the burden on caregivers.Immunotherapy significantly improves neuropsychiatric symptoms,and thus reduces the distress of caregivers.