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Neuropsychiatric outcomes of patients with encephalitis: A case series with long-term follow-up
1Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul, Turkiye
2Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkiye
3Korkuteli State Hospital, Department of Psychiatry, Antalya, Turkiye
4Ataturk State Hospital, Center of Alcohol and Substance Addiction Treatment, Antalya, Turkiye
Dusunen Adam Journal of Psychiatry and Neurological Sciences 2023; 36(1): 50-60 DOI: 10.14744/DAJPNS.2022.00206
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Objective: The long-term course of neuropsychiatric, cognitive, and behavioral symptoms that develop after encephalitis has not been studied adequately. We aimed to investigate the progression of these symptoms in a case series of patients followed up after encephalitis.
Method: Patients were evaluated through neurological and psychiatric assessments, as well as cranial magnetic resonance imaging and electroencephalography recordings at the baseline. Neuropsychiatric outcomes were assessed using the Mini-Mental State Examination (MMSE), Frontal Behavior Inventory (FBI), Hamilton Depression Rating Scale (HDRS), Neuropsychiatric Inventory (NPI), Katz Activities of Daily Living (Katz ADL) Index Scale, and Lawton Instrumental Activities of Daily Living (IADL) Scale.
Results: A total of 15 patients were evaluated at the baseline and 10 of them had a follow-up assessment after a median of 60 months. The patients with active epilepsy had worse Katz ADL scores than those with complete seizure control. MMSE scores were negatively correlated with FBI and ADL + IADL scores. While MMSE scores did not change significantly in the follow-up assessment, there was a decrease in FBI, HDRS, and NPI scores, as well as an improvement in ADL + IADL scores.
Conclusion: Our case series suggest that complete seizure control, high MMSE scores, and absence of frontal behavioral symptoms are associated with less dependence on others in activities of daily living after encephalitis. The overall cognitive status of patients who recovered from encephalitis was unchanged in the long term. However, patients demonstrated improvements in neuropsychiatric and behavioral symptoms, such as disinhibition, and better daily functioning with time.