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A case of agitated catatonia
O Cottencin1, P Thomas, G Vaiva
1Department of Psychiatry, School of Medicine, Centre Hospitalier Regional et Universitaire, University of Lille 2, France.
Pharmacopsychiatry
|March 10, 1999
Summary
Agitated catatonia, a persistent form of catatonia, may not be rare and can be exacerbated by neuroleptic treatment. Lorazepam offers a rapid and effective therapeutic trial for this condition.
Area of Science:
- Psychiatry
- Neurology
- Clinical Case Study
Background:
- Catatonia is a neuropsychiatric syndrome characterized by motor abnormalities.
- Agitation is a key diagnostic feature of catatonia according to the DSM IV classification.
- Permanent forms of agitated catatonia are infrequently described in medical literature.
Observation:
- A 43-year-old male with a 7-year history of undifferentiated schizophrenia presented with persistent agitation.
- The patient's agitation worsened despite treatment with multiple neuroleptics and benzodiazepines.
- Symptoms included purposeless agitation, echolalia, echopraxia, stereotyped movements, mannerisms, mimicking, and grimacing, leading to a diagnosis of agitated catatonia.
Findings:
- Electroconvulsive therapy (ECT) was initiated for drug-resistant schizophrenic agitation.
- After four ECT sessions, lorazepam was administered, leading to complete resolution of agitation within 24 hours.
- Neuroleptic treatment appeared to maintain or worsen the patient's symptomatology.
Implications:
- Permanent agitated catatonia may be more common than previously thought.
- Lorazepam can serve as a valuable therapeutic trial for agitated catatonia, particularly when resistant to neuroleptics.
- Prompt and effective sedation with lorazepam can prevent self-harm in patients with agitated catatonia.