Author Credentials


Author ORCID Identifier

Adam M. Franks, MD ORCID# 0000-0002-3710-6138

William Rollyson, MD ORCID# 0000-0002-5493-2423


NMDA receptors, Autoimmune encephalitis, Drug use, Physician bias


Family Medicine | Medicine and Health Sciences | Neoplasms | Nervous System Diseases | Neurology


Anti-NMDA receptor encephalitis (aNMDAre) is a relatively newly discovered autoimmune and inflammatory disorder affecting the limbic system. It has a clinical course that includes Prodromal, Psychiatric, Unresponsive and Hyperkinetic stages. These stages are often confused with mental health issues in the medical literature, but they also share symptoms of various drug intoxication and withdrawal states. Implicit bias in physicians regarding substance use disorder and patient demographics can impair delivery of care and outcomes in patients with aNMDAre, especially in an environment of recreational drug use. When clinical presentation aligns, this diagnosis should be investigated as soon as possible, even in the case of atypical presentations or those with past or current substance use disorder. Early identification and treatment are essential to good outcomes and minimal sequalae at two years. Therefore, it is essential to consider aNMDAre with the symptom profile regardless of patient age, sex, race, or clinical disorder. Below is detailed the difficulty in diagnosing aNMDAre in a 32-year-old white male with a history of methamphetamine, opioid, benzodiazepine, and marijuana use.