自體免疫腦炎併發癲癇及精神疾病個案之認知功能及臨床表現探討：個案報告

Cognitive Functions and Clinical Features in a Patient With Autoimmune Encephalitis Combined With Epilepsy and Psychiatric Symptoms

10.6550/ACP.202312_17(1_2).0001

蔡宜芬(Yi-Fen Tsai)；李泳萱(Yung-Hsuan Lee)；吳明恭(Ming-Kung Wu)

自體免疫腦炎 ； 癲癇 ； 器質性精神病 ； autoimmune encephalitis ； epilepsy ； organic mental disorders

臨床心理學刊

17卷1/2期（2023 / 12 / 01）

1 - 12

繁體中文;英文

目的：過去研究指出自體免疫腦炎容易併發癲癇及精神病，且會造成認知功能損害，本個案報告以標準化測驗工具及量表搜集資料，探討自體免疫腦炎個案發病及治療後之認知功能及臨床病症變化。方法：個案為一位26歲二專畢業男性，過去無精神病史，在2020年11月30日全身型僵直—陣攣性癲癇初發後，出現妄想、幻聽、怪異行為等精神病症狀，經神經內科檢查後診斷為自體免疫腦炎。本個案報告透過心理衡鑑瞭解個案的精神症狀及認知功能表現，所使用的測驗工具包括魏氏成人智力測驗第三版（Wechsler Adult Intelligence Scale-Third Edition, WAIS-III）、威斯康辛卡片分類測驗（Wisconsin Card Sorting Test, WCST）、加州語文學習測驗（California Verbal Learning Test, CVLT）、米蘭臨床多向度人格量表（Millon Clinical Multiaxial Inventory-Third Edition, MCMI-III）、身心症狀量表（Symptom Checklist-90-Revised, SCL-90R）。結果：個案在自體免疫腦炎併發癲癇及精神病發病後，認知功能有下降現象，包括整體智能減退、較差的工作記憶、處理速度緩慢，以及概念形成與思考彈性有顯著缺損，且其精神症狀在經藥物治療後及癲癇停止發作5個月內皆持續存在。結論：自體免疫腦炎患者有高度可能併發癲癇及精神病，且即使在治療後仍可能存有認知後遺症及精神症狀，因此需持續追蹤其相關認知功能及精神症狀，以降低發展成重症或嚴重認知後遺症而損害日常生活功能之可能性。

Objectives: Previous studies have indicated that patients with autoimmune encephalitis are not easily diagnosed since they have a variety of clinical symptoms. It is worth noting that autoimmune encephalitis is likely to combine with epilepsy and psychiatric symptoms and can cause cognitive dysfunction, including memory decline, attention deficit, executive function impairment, and so on. Thus, this case report used standardized psychological tests and questionnaires to investigate the cognitive function and clinical symptoms of the patient with autoimmune encephalitis. Methods: This case is a 26-year-old male with no prior history of mental illness and epilepsy before, and he has neither a family history of mental illness nor epilepsy. He developed delusions, auditory hallucinations, disorganized behavior, and other psychiatric symptoms after the first onset of generalized tonic-clonic epilepsy on November 30, 2020, and then he was diagnosed with autoimmune encephalitis after the medical examination in the Neurology Department. We investigated the psychiatric symptoms and cognitive function performance of the patient through behavior observation and psychological assessment, and the psychological instruments we used include Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), Wisconsin Card Sorting Test (WCST), California Verbal Learning Test (CVLT), Millon Clinical Multiaxial Inventory-Third Edition (MCMI-III) and Symptom Checklist-90-Revised (SCL-90R). Results: The results revealed that the cognitive function of this case was impaired, including overall intelligence decline, poor working memory, slow processing speed, and significant deficits in concept formation and thinking flexibility. Furthermore, we observed that the psychiatric symptoms persisted even after treatment and epilepsy cessation for five months. Conclusions: Overall, autoimmune encephalitis is usually associated with epilepsy and psychosis, and it may have lasting cognitive sequelae and psychiatric symptoms even after treatment and epilepsy cessation. Therefore, it is necessary to follow up the cognitive function and psychiatric symptoms of autoimmune encephalitis patients to reduce the likelihood of developing severe cases or severe cognitive sequelae that impair the functioning of daily living.

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