Lorazepam-Resistant Catatonia in an Antipsychotic-Naïve 24-Year-Old with Psychotic Symptoms

Preventing catatonia is not likely to be a realistic goal given that it has many potential causes. Perhaps, in most cases, catatonia, such as fever, should be regarded as an ally that leads the clinician investigate and identify the underlying cause. find a halfway house – forexdata Can also help elucidate the pathophysiology and also detect changes resulting from various treatments. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations.

Hawkins, J. M., Archer, K. J., Strakowski, S. M. Somatic treatment of catatonia. J. Psychiatry Med. 25, 345–369 .

Medications that can induce catatonia include antipsychotics, corticosteroids, and disulfiram at therapeutic doses. Drug abuse , use of the general relationship between bone mineral density and alcohol intake anesthetic ketamine, and benzodiazepine withdrawal may also lead to catatonia. Periodic catatonia is an inconsistently defined entity.

Catatonia Medication

Clinically, these conditions resemble severe regressive forms of autism. The presentation of a patient with catatonia varies greatly depending on the subtype, underlying cause and it can be acute or subtle. An individual with catatonic schizophrenia may remain in a motionless, rigid state for extended periods ranging from hours to even days. Find out how medical professionals are learning about the effects of cocaine on the brain after a man was hospitalized for a year due to cocaine use. Rhoads JC, Votolato NA, Young JL, Gilchrist RH. The successful use of right unilateral ultra-brief pulse electroconvulsive therapy in an adolescent with catatonia.

Legal issues due to impaired judgment or risk-taking behavior, or due to the purchase or use of illicit substances. Turning down social gatherings because it will not involve the addictive substance (i.e. turning down an invite to a party or gathering because there will not be alcohol). An increase in risk-taking behavior, such as using the substance and driving.

People with severe catatonia can’t take care of themselves and need care from trained medical professionals. That’s because catatonia increases the risk of complications that happen when a person can’t move or react to the world around them. That means they can’t eat or drink, leading to problems like dehydration and malnutrition.

Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Bahro M, Kampf C, Strnad J. Catatonia under medication with risperidone in a 61-year-old patient.

History

Rigidity is a central feature, seen in ~80% of patients. These are marked by nonpurposeful hyperactivity or motor unrest. Patients experience prolonged periods of psychomotor agitation. Motor symptoms (e.g., rigidity, posturing) may occur less commonly (~50%). Overall patients generally appear obtunded, rather than completely comatose. Catatonia is predominantly an abnormality of motor regulation, which largely reflects dysfunction of the basal ganglia.

• There is no doubt that different types of interventions are needed to treat psychosis, a bipolar disorder, an autistic spectrum disorder, and an autoimmune disease.
• It happens most often with people who have mood disorders or psychotic disorders, like depression, bipolar disorder, and schizophrenia.
• & Farde, L. Antipsychotic occupancy of dopamine receptors in schizophrenia.
• Third, unlike typical antipsychotics, clozapine has minimal association with causing parkinsonism or worsening the motor symptoms of Parkinson’s disease.
• Neuroleptic malignant syndrome 📖 is important to consider, especially as many patients with psychiatric disorders may be receiving neuroleptics.

It was first described by Karl Kahlbaum in 1874, with many other researchers and clinicians coming to the same observation since then [1–3]. The most common psychiatric diagnoses that can be presented with a catatonic syndrome are bipolar disorder, unipolar depression, schizophrenia, and other psychotic disorders and autistic spectrum disorders [1–3, 6–8]. Catatonia may also be caused by a medical condition not classified under mental, behavioral, or neurodevelopmental disorders. In addition to reinstitution of clozapine, the use of adjunct benzodiazepines can be considered, but are unlikely to be effective if used as a monotherapy. Sometimes reinstitution of clozapine is not possible due to various factors including drug intolerance or clozapine-induced agranulocytosis.

diagnostic challenge of GABA-A or NMDA receptor inhibitors

Classically, catatonia is a feature of schizophrenia, but it can occur with severe depression. Gelenberg also stated that catatonia can appear with conversion hysteria, dissociative states, and with organic brain disease. Benzodiazepines are usually effective quickly.

Inadequate response to medical treatment for ~2-5 days . Avoid anti-dopaminergic agents, especially antipsychotics. Anti-NMDA receptor encephalitis is increasingly recognized as a common cause of severe catatonia. Two case studies describe ketamine as being rapidly effective in catatonia at very low doses (e.g., 10 or 12.5 mg). Catatonia can generally be described as either hypokinetic catatonia or hyperkinetic catatonia . Hypokinetic catatonia is the most common.

Both agents inhibit NMDA receptor signaling. Amantadine also augments dopamine signaling (which may be beneficial for catatonic symptoms – but could risk exacerbating psychotic features in patients with underlying psychosis). F. Martényi, S. Metcalfe, B. Schausberger, and M. R. Dossenbach, “An efficacy analysis of olanzapine treatment the truth about relapse rates and addiction recovery data in schizophrenia patients with catatonic signs and symptoms,” The Journal of clinical psychiatry, vol. Soon, he eats and drinks normally, the motor disturbances disappear, and he is able to form spontaneous phrases from start to end. After two weeks, the CGI improvement scale (CGI-I) is at two; after three weeks, it lowers to 1 .

Electroconvulsive therapy (ECT)

An evolutionary model of catatonia as a primitive response to fear that is triggered by extreme physical or psychological stress has also been proposed14. In this model, catatonia may be a form of the animal defense strategy of tonic immobility, which is the sudden onset of prolonged stillness or “freezing” when an animal is exposed to a threatening stimulus15. In the animal world, tonic immobility may increase the chances of survival by helping avoid predators that are triggered by movement. Catatonia and tonic immobility share many features including immobility, posturing, stupor, waxy flexibility, mutism, and abrupt onset16. For withdrawal catatonia to occur, several years of treatment are usually required, suggesting that receptor adaptations are an important etiological component for developing withdrawal catatonia. Long-term benzodiazepine use could result in GABAA receptor downregulation.

What You Need to Know About Catatonia

ECT is effective in ~90% of patients with catatonia. Among intubated patients, propofol may be useful in providing sedation and potentially treating the catatonia. Note that propofol’s mechanism of action is similar to benzodiazepines (with GABA-A receptor augmentation). Lorazepam is usually a cornerstone of the medical regimen, with ECT or other agents being added to it as necessary.

In contrast to catalepsy, this doesn’t involve being placed in the position by another person. This is when a person acts out motions or movements that could be normal but does them in an unusual or exaggerated way. Echopraxia (pronounced “eck-oh-prax-ee-ah”). This is when a person mimics or mirrors someone else’s movements. This means a person acts upset or irritable. It only counts as a symptom of catatonia if it happens and it isn’t a response to something around the person having it.

& Waiblinger, B. Successful treatment of catatonia in a young man with schizophrenia and progressive diffuse cerebral atrophy. Dhossche, D. M. Vagal intimations for catatonia and electroconvulsive therapy. An 84-year-old female with history of major depression and anxiety was evaluated by her psychiatrist for worsening anxiety and given a single dose of 3 mg of paliperidone. She had no prior documented episodes of catatonia. Her daughter brought her into the local emergency department .

Zolpidem increases neural hyperpolarization by enhancing the activity of the inhibitory neurotransmitter GABA through selective agonist activity at the benzodiazepine-1 receptor. Catatonia may be transitory or may persist for months or years. It appears in many guises.

CAD treatment included stent placement and nitroglycerin as needed. The diagnostic entities of obsessional slowness and psychogenic parkinsonism show overlapping features with catatonia, such as motor slowness, gegenhalten , mannerisms, and reduced or absent speech. However, psychogenic parkinsonism involves tremor which is unusual in catatonia. Obsessional slowness is a controversial diagnosis, with presentations ranging from severe but common manifestations of obsessive compulsive disorder to catatonia. Catatonia is a clinical diagnosis and there is no specific laboratory test to diagnose it. However, certain testing can help determine what is causing the catatonia.