Who Ya Gonna Call? A Multidisciplinary Review of Pediatric Neuropsychiatric Cases

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When patients are admitted due to altered mental status or behavioral changes, both Neurology and Psychiatry are consulted. The presentations sometimes do not clearly fit into Neurological or Psychiatric diagnoses while Pediatric teams are requesting the start of medication or treatment for resolution of the symptoms. The presenters will discuss a series of cases which have a strong psychiatric presentation and will discuss if the diagnoses are ultimately psychiatric, neurologic, or a bit of both. While the cases we are discussing will be adolescent and young adult cases, these cases will be applicable to the general Consultation-Liaison Psychiatrist. Timely diagnosis of these neurological conditions is important; delays in diagnosis can potentially misattribute the patient’s conditions to a psychiatric etiology, which may delay definitive treatment. Also, these diagnoses can present differently in pediatric cases than in adult cases. Thus, it will be important for psychiatrists to be able to recognize these conditions.

Dr. Nanda will present the case of a teenage boy who became confused, paranoid, agitated, hypersexual, and hypersomnolent. He will discuss the boy’s disease course and discuss his neurological diagnosis, Kleine Levin Syndrome, and its management.

Dr. Charoensook will discuss the case of a young woman who presented with anxiety and possible Avoidant Restrictive Food Intake Disorder (ARFID) before she received her definite neurological diagnosis. Dr. Charoensook will lead the participants through a discussion of whether her psychiatric symptoms are potentially related to her neurological diagnosis or if they occurred in parallel.

Dr. Jacobson will describe a challenging pediatric patient who was ultimately diagnosed with Anti-NMDAR encephalitis. She will discuss the presentation of Anti-NMDAR encephalitis in children and adolescents, the key clinical features psychiatrists should be aware of, and psychiatric management.

Dr. Santoro, a pediatric neurologist who specializes in neuroimmunology, will discuss neurocognitive regression in persons with Trisomy 21 and the neuroimmunologic component of this clinical entity. Down Syndrome Disintegrative Disorder is a relatively new condition characterized by developmental regression and subacute psychiatric symptoms, which may possibly be due to autoimmunity.