Refractory catatonia in old age: a case report.

Area of Science:

• Geriatric Psychiatry
• Neuroscience
• Clinical Psychology

Background:

• Catatonia, a syndrome of psychomotor disruption, is frequently underdiagnosed in older adults.
• Existing research on catatonia primarily focuses on younger populations and schizophrenia, leaving a knowledge gap regarding elderly patients.
• The clinical presentation and progression of catatonia in old age remain poorly understood.

Observation:

• A 73-year-old male with a history of autistic spectrum disorder presented with depressive symptoms.
• Initial treatment with antidepressants was ineffective, but a lorazepam challenge resulted in temporary improvement.
• The patient experienced a 16-month hospital admission with extensive treatment including lorazepam, zolpidem, and electroconvulsive therapy, yet remained refractory to treatment.

Findings:

• Catatonia requires prompt consideration in older individuals presenting with atypical psychiatric symptoms.
• While benzodiazepines and electroconvulsive therapy offered partial, unsustained improvement, the patient's catatonia was ultimately refractory.
• Comorbid autistic spectrum disorder, prolonged catatonia duration, and benzodiazepine sensitivity were identified as key prognostic factors in this elderly patient.

Implications:

• Catatonia should be a key differential diagnosis for older patients with unusual functional mental illness symptoms.
• Understanding prognostic factors like autistic spectrum disorder and benzodiazepine sensitivity is crucial for managing catatonia in the elderly.
• This case underscores the need for further research into effective, sustained treatments for catatonia in geriatric populations.