Schizophrenia vs. encephalitis: A neuropsychological case study

From presenting with flu-like symptoms, seizures, and erratic behaviour including hallucinations, to being dismissed as “partying too much” and misdiagnosed with schizophrenia before the ultimate provision of a neurological explanation encephalitis; this was a true sequence of events for the 24 year old female, Susannah Cahalan, who suddenly became ill with a mysterious illness that was misdiagnosed even after extensive evaluation until a neurologist was able to diagnose and effectively treat her (Cahalan, 2012; Barrett, 2016). Susannah's case bemused the medical field and became the plot of a book that subsequently garnered attention, large enough to be adapted into a movie, titled “Brain on Fire” (Barrett, 2016). Her case illustrated the exquisite interplay of neurology, physiology, and neuropsychology, complicated by personality traits and stereotypical behaviours observed in young adulthood, the period in which psychiatric illnesses also often begin to manifest. Unfortunately, while Susannah's case is rare, it is not unique. The following illustrates a case, similar to Susannah's, in which fluorodeoxyglucose-positron emission tomography (FDG-PET) scans, chronological history, and neuropsychological test results supported a diagnosis of encephalitis, while symptom presentation, response to treatment, and neurological consultation, suggested a diagnosis of schizophrenia, demonstrating a significant overlap in presentation of these two disorders and the importance of a multidisciplinary approach to diagnosis and treatment (APA, 2013; Lancaster, 2016). This case illustrates the complexity of the art and science of diagnostics during the developmental period, reminding us as professionals of the importance of thoroughly reviewing a patient's medical history and of the vital contributions each discipline can make when attempting to diagnose and treat complex presentations. From presenting with flu-like symptoms, seizures, and erratic behaviour including hallucinations, to being dismissed as “partying too much” and misdiagnosed with schizophrenia before the ultimate provision of a neurological explanation encephalitis; this was a true sequence of events for the 24 year old female, Susannah Cahalan, who suddenly became ill with a mysterious illness that was misdiagnosed even after extensive evaluation until a neurologist was able to diagnose and effectively treat her (Cahalan, 2012; Barrett, 2016). Susannah's case bemused the medical field and became the plot of a book that subsequently garnered attention, large enough to be adapted into a movie, titled “Brain on Fire” (Barrett, 2016). Her case illustrated the exquisite interplay of neurology, physiology, and neuropsychology, complicated by personality traits and stereotypical behaviours observed in young adulthood, the period in which psychiatric illnesses also often begin to manifest. Unfortunately, while Susannah's case is rare, it is not unique. The following illustrates a case, in many ways similar to Susannah's, in which fluorodeoxyglucose-positron emission tomography (FDG-PET) scans, chronological history, and neuropsychological test results indicating wide-spread brain dysfunction supported a diagnosis of encephalitis, while symptom presentation, response to treatment, and neurological consultation, suggested a diagnosis of schizophrenia, demonstrating a significant overlap in presentation of these two disorders and the importance of a multidisciplinary approach to diagnosis and treatment (American Psychiatric Association, 2013; Lancaster, 2016). This case illustrates the complexity of the art and science of diagnostics during the developmental period, reminding us as ☆ We have no known conflict of interest to disclose. We would like to thank Covenant Health, the patient, psychiatry program manager Suzanne Cardinal, and psychiatrist Dr. Darrin Bailey, for their support in undertaking this case study. * Corresponding author at: Pachet Assessment and Rehabilitation Services, 326 11245 Valley Ridge Dr NW, Calgary, AB T3B 5V4, Canada. E-mail addresses: Nicole.Kostiuk@albertahealthservices.ca (N. Kostiuk), dr.pachet@pachetservices.com (A. Pachet). 1 Covenant Health Mental Health Program at the Grey Nuns Community Hospital, Edmonton, AB. 2 Pachet Assessment and Rehabilitation Services, Calgary, AB.