Between being healthy and becoming comatose: the neuropsychiatric landscape of critical illness with a focus on delirium, DSM-5 and ICD-11.

BACKGROUND: One of the most important questions remaining in matters of critical illness in the year 2019 is arguably how to address the diverse neuropsychiatric complications of critical illness. MAIN TEXT: The ICD-11 and DSM-5, two of the world's leading classification systems, disagree regarding important aspects of delirium; moreover, they do not mention critical illness and its neuropsychiatric complications at all. CONCLUSIONS: It would have been desirable for the committees revising the DSM-IV-TR and ICD-10 to have joined forces in order to generate classification systems that complement each other and, moreover, that address the "The Neuro-Psychiatry of Critical Illness".

The forthcoming DSM-5, critical care medicine, and pediatric neuropsychiatry: which new concepts do we need?

Examination and comparison of the current DSM-IV-TR and the proposed revisions for the forthcoming DSM-5, with regard to neuropsychiatric aspects of critical illness, identified five important issues. These remain to be addressed in order to improve the care of critically ill patients. These are 1) sickness behavior, as part of the organic reaction types of the brain; 2) delirium in children and the "Differential Diagnosis of Mental Disorders Due to a General Medical Condition" in children; 3) catatonia; 4) regressive disorders in childhood in relation to somatic disorders (e.g., anti-NMDAR encephalitis); 5) age-related diagnostic criteria in relation to neuro-psychiatric disorders.

First-onset psychosis, anti-NMDAR encephalitis, schizophrenia and Consultation-Liaison psychiatry.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a new, severe and possibly life-threatening disorder as illustrated by a 25% mortality or severe disability rate. Its neuropsychiatric presentation closely resembles schizophrenia. In this paper, the relationship of anti-NMDAR encephalitis to schizophrenia and its consequences in Consultation-Liaison service for diagnostic workup in patients with first-episode psychosis are addressed.

Anti-NMDAR encephalitis: a new, severe and challenging enduring entity.

Two girls, 15- and 17-year-old, were consecutively and involuntarily admitted to the local child and adolescent psychiatric hospital with severe first onset psychosis. Due to refractory agitation, ongoing psychosis and insomnia, catatonic features, autonomic instability and the need for one-on-one guidance, the first girl was transferred to the PICU of an academic tertiary hospital and anti-NMDA receptor encephalitis was diagnosed. Given this experience nursing staff suspected, due to similarities in the clinical presentation and course, anti-NMDA receptor encephalitis in the second girl also and this proved to be true. The main clinical features, pharmacological and non-pharmacological treatment strategies and outcomes are presented and discussed. Perhaps, one ought to suspect anti-NMDA receptor encephalitis in every case of severe first onset psychosis with catatonic features.