“Post encephalitic psychiatric sequelae”

Clinical LaisonPsychiatry, 11/09/2010

• Encephalitis refers to an inflammation of the brain tissues.

• It can involve different regions of the brain and can be caused by different etiological agents. Whether directly or through immunological reaction not clear. ( more of viral cause in this context)

• In many cases it is followed by complete remission, but can also infrequently result in transient or persisting post encephalitis sequalae.

• These sequalae can manifest as a wide variety of clinical presentations, which pose challenges to clinicians in the realms of diagnosis and management.

• 3.5 to 7.4 per 100,000 patient years.

• HSV most common sporadic cause in western world.

• Epidemic of viral encephalitis is increasing. (HIV)

• Clinical presentation.

• Encephatitis lethargica.

ICD –F 07

• Personality and behavioural disorders due to brain disease, damage and disfunction.

• F 07.0 organic personality disorder

• F 07.1 post encephalitic syndrome

• F 07.2 post concussional syndrome.

• F07.8 other

• F07.9 unspecified

POSTENCEPHALITIC SYNDROME ( ICD)

• A syndrome which includes residual behavioral change that follows recovery from viral or bacterial encephalitis.

• The symptoms are nonspecific and depend on the individual, the infectious agent, and the age of the individual at the time of the infection.

• The disorder is often reversible, in contrast to the organic personality disorders.

• The symptoms of the disorder include general malaise, apathy or irritability, learning difficulties, altered sleep and eating patterns, and changes in sexuality and in social judgment.

• There may be a variety of residual neurological dysfunctions such as paralysis, deafness, aphasia, constructional apraxia and acalculia.

• JE associated with psychiatric presentations like social inappropriteness, aggression , emotional lability, affective and paranoid symptoms ( monnet 2003)

• HSV , EBV acute presentations with psychiatric syndromes.

• Fatigue syndrome after 6 months of glandular fever.• Kluver-Bucy syndrome after herpes encephalitis, tick-

borne encephalitis lead to fatigue, memory problems• Mood changes at recovery.• Influenza epidemic, sydenhams chorea SSPE, PANDAS

Encephalitis lethargica

• Von Economo. 1917• Influenza like prodrome with variety of

nervous manifestations like distuburbed sleep, lethargy, disturbance of ocular movements.

• Psychiatric symptoms + • Post encephalitic psychosis depression,

hypomania, catatonic symptoms, ocd mutism.

Present day Encephalitis lethargica

• Sporadic cases.• Dale et al 2004 report 20 cases with

classic neuropsychiatric manifestations.• Immune mediated like in PANDAS.• Clinical relevance is to keep a high index

of suspicion and psychiatric symptoms may be the predominant manifestation.

• Whether catatonia related to encephalitic processes?