Catatonia and Opioid Withdrawal: A Case Report

Area of Science:

• Psychiatry
• Toxicology
• Neurology

Background:

• Catatonia is a neuropsychiatric syndrome characterized by motor abnormalities, mutism, and withdrawal.
• The opioid epidemic has increased the prevalence of substance use, posing new challenges to mental healthcare.
• Non-prescription pills are frequently adulterated with potent synthetic opioids like fentanyl.

Observation:

• An 82-year-old female presented with catatonia, including immobility, mutism, and stereotypy, during hospitalization for altered mental status.
• Urine toxicology confirmed fentanyl use, traced to non-prescription pills obtained from Mexico.
• The patient's catatonic symptoms resolved rapidly following benzodiazepine administration.

Findings:

• Fentanyl exposure, even from non-prescription sources, can precipitate catatonia in susceptible individuals.
• Benzodiazepines are an effective treatment for substance-induced catatonia.
• This case highlights a previously unrecognized complication of illicit substance use.

Implications:

• Healthcare providers must consider fentanyl and other illicit drug exposure in patients presenting with catatonia.
• Increased awareness and education are crucial for both clinicians and patients regarding the risks of non-prescription medications.
• Further research is warranted to understand the pathophysiology and prevalence of opioid withdrawal-induced catatonia.