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Generalized Periodic Discharges Associated With Catatonia and Delirium: A Case Series
James Luccarelli1, Joshua R Smith1, Gregory Fricchione1
1Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover).
Objective:
Generalized periodic discharges are a repeated and generalized electroencephalography (EEG) pattern that can be seen in the context of altered mental status. This article describes a series of five individuals with generalized periodic discharges who demonstrated signs and symptoms of catatonia, a treatable neuropsychiatric condition.
Methods:
Inpatients with a clinical diagnosis of catatonia, determined with the Bush-Francis Catatonia Rating Scale (BFCRS), and EEG recordings with generalized periodic discharges were analyzed in a retrospective case series.
Results:
Five patients with catatonia and generalized periodic discharges on EEG were evaluated from among 106 patients with catatonia and contemporaneous EEG measurements. Four of these patients showed an improvement in catatonia severity when treated with benzodiazepines, with an average reduction of 6.75 points on the BFCRS.
Conclusions:
Among patients with generalized periodic discharges, catatonia should be considered, in the appropriate clinical context. Patients with generalized periodic discharges and catatonia may benefit from treatment with empiric trials of benzodiazepines.
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