Catherine Fuchs

Anti-NMDA Receptor Encephalitis in a 14-Year-Old Female Presenting as Malignant Catatonia: Medical and Psychiatric Approach to Treatment

Received October 22, 2012; revised March 5, 2013; accepted March 6, 2013. FromVanderbilt UniversityMedical Center, Nashville, TN; Alive Hospice, Nashville, TN. Send correspondence and reprint requests to Jo Ellen Wilson, M.D., Vanderbilt University Medical Center, South Nashville, TN; e-mail: jo.e.wilson@vanderbilt.edu & 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved. Anti-N-methyl-D-aspartate (NMDA) receptor (antiNMDAR) encephalitis has only recently been described. Acute psychiatric symptoms, seizures, memory deficits, decreased level of consciousness, and central hypoventilation associated with ovarian teratoma and cerebrospinal fluid inflammatory abnormalities, developed in four young women. Anti-NMDAR encephalitis is increasingly recognized in children and adolescents. In one recent study, patients whowere 18 years old or younger comprised 40%of all cases of anti-NMDAR encephalitis studied. Algorithms for the treatment of anti-NMDAR encephalitis have been suggested; however, they focus mostly on immunotherapy and tumor resection and do not address the importance of targeting persistent signs of catatonia related to the physiologicmechanisms of anti-NMDARantibodies on the brain. Anti-NMDAR antibodies can persist in the cerebrospinal fluid (CSF) long after targeted immunotherapy, underscoring the importance of not only recognizing but also treating the downstream neuropsychiatric effects of these antibodies on the central nervous system. Malignant catatonia is an important neuropsychiatric phenomenon associated with significant morbidity and mortality. It consists of behavioral and motoric signs and is characterized by autonomic instability and death in about 10% of cases. The incidence rate of catatonia in the pediatric age group (18 years of age or younger) has been estimated to be 0.16 per million per year. The incidence of malignant catatonia is even rarer. Electroconvulsive therapy (ECT) is generally safe and, at times, lifesaving for pediatric patients with malignant catatonia. In its most severe forms, anti-NMDAR encephalitis is a model for malignant catatonia. We describe a case of an adolescent with antiNMDAR encephalitis associated with ovarian teratoma

Development of the Vanderbilt Assessment for Delirium in Infants and Children to Standardize Pediatric Delirium Assessment By Psychiatrists

BACKGROUND Pediatric delirium assessment is complicated by variations in baseline language and cognitive skills, impairment during illness, and absence of pediatric-specific modifiers within the Diagnostic and Statistical Manual of Mental Disorders delirium criterion. OBJECTIVE To develop a standardized approach to pediatric delirium assessment by psychiatrists. METHODS A multidisciplinary group of clinicians used Diagnostic and Statistical Manual criterion as the foundation for the Vanderbilt Assessment for Delirium in Infants and Children (VADIC). Pediatric-specific modifiers were integrated into the delirium criterion, including key developmental and assessment variations for children. The VADIC was used in clinical practice to prospectively assess critically ill infants and children. The VADIC was assessed for content validity by the American Academy of Child and Adolescent Psychiatry Delirium Special Interest Group. RESULTS The American Academy of Child and Adolescent Psychiatry-Delirium Special Interest Group determined that the VADIC demonstrated high content validity. The VADIC (1) preserved the core Diagnostic and Statistical Manual delirium criterion, (2) appropriately paired interactive assessments with key criterion based on development, and (3) addressed confounders for delirium. A cohort of 300 patients with a median age of 20 months was assessed for delirium using the VADIC. Delirium prevalence was 47%. CONCLUSION The VADIC provides a comprehensive framework to standardize pediatric delirium assessment by psychiatrists. The need for consistency in both delirium education and diagnosis is highlighted given the high prevalence of pediatric delirium.

Evaluating the Consistency of Scales Used in Adult Attention Deficit Hyperactivity Disorder Assessment of College-Aged Adults.

ABSTRACT Objective: Neurocognitive evaluations are commonly integrated with clinical assessment to evaluate adult Attention Deficit Hyperactivity Disorder (ADHD). Study goal is to identify measures most strongly related to ADHD diagnosis and to determine their utility in screening processes. Participants: 230 students who were evaluated at the Vanderbilt University Psychological and Counseling Center between July 2013 and October 2015. Methods: We retrospectively examined charts, including clinical diagnosis, family history, childhood parental reported and current self-reported ADHD symptoms, psychiatric comorbidities, and continuous performance test (CPT). Result: Positive report of childhood and current ADHD symptoms, and lack of comorbid psychiatric symptoms were strongly associated with clinical diagnosis. CPT results were not associated with an ADHD diagnosis. The absence of reported childhood and current ADHD symptoms may serve as a contradictory marker for ADHD diagnosis. Conclusion: Clinical assessment of ADHD symptoms and ADHD childhood history, but not CPT, contributes to an accurate diagnosis of ADHD in college-aged adults.

128: PEDIATRIC DELIRIUM PREVALENCE AND MOTORIC SUBTYPES IN CRITICALLY ILL INFANTS AND YOUNG CHILDREN

IN-HOSPITAL ARRESTS, ANOXIC/HYPOXIC ISCHEMIC ENCEPHALOPATHY, AND G TUBE/TRACHEOSTOMY ESTIMATES. Veerajalandhar Allareddy1, Sankeerth Rampa2, Romesh Nalliah3, Karen Lidsky4, Veerasathpurush Allareddy5, Alexandre Rotta1; 1Rainbow Babies & Children’s Hospital, Cleveland, OH, 2University of Nebraska Medical University, College of Public Health, Omaha, NE, 3Dental Medicine, Harvard University, Boston, MA, 4Rainbow Babies & Children’s Hosp., Cleveland, OH, 5College of Dentistry, University of Iowa, Iowa City, IA