ABSTRACT
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an immune-mediated disorder that typically presents with rapid development of neuropsychiatric symptoms. As a potentially reversible cause of psychosis, there have been calls internationally for routine serological screening for anti-NMDAR antibodies in patients presenting with first-episode psychosis (FEP). Increased serological testing has, however, exposed several limitations of universal screening and rekindled debate as to which patients should be tested. Screening criteria have been proposed for high-risk clinical features in FEP in which antineuronal antibody testing is indicated. The authors present a clinical vignette and a service audit as well as discuss the limitations of universal screening advocating instead for targeted testing for antineuronal antibodies in patients diagnosed as having FEP.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Psychotic Disorders , Humans , Receptors, N-Methyl-D-Aspartate , Psychotic Disorders/etiology , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications , Diagnosis, DifferentialABSTRACT
OBJECTIVE: To identify barriers to compliance with paediatric clinical practice guidelines (CPGs) in emergency departments in rural and regional New South Wales (NSW), Australia, and to propose strategies to increase their use. DESIGN: Cross-sectional survey. SETTING: Ten emergency departments in rural and regional NSW. PARTICIPANTS: Fifty medical officers. MAIN OUTCOME MEASURES: Use of clinical practice guidelines and perceived barriers to their usage. RESULTS: Only 22% of medical officers reported that they used the CPGs frequently when managing sick children. Major barriers to the use of CPGs were a lack of awareness of their existence, a lack of training in their use and poor access to the guidelines in printed or electronic format. CONCLUSION: In order to increase compliance with the paediatric CPGs, medical officers in rural and regional NSW require further training and education. The CPGs need to be readily available in either printed or electronic format.
