[Treating treatment resistant catatonia with amantadine]

Catatonia is one of the most severe psychiatric syndromes, and clinical symptoms and etiology are very heterogeneous. When accompanied by autonomic instability and hyperthermia it’s termed malignant catatonia, which left untreated is associated with significant morbidity and mortality. First-line treatment is high dose benzodiazepines, followed by electroconvulsive therapy (ECT), in case of non-response. Certain patients don’t respond to either mode of treatment. Scant evidence is available for treatment options in this group. We present a case of a patient suffering from schizophrenia and episodes of catatonia treatment-resistant to both lorazepam and ECT. We performed an experimental treatment with the NMDA-receptor antagonist amantadine. This treatment-strategy seemed promising, but remission was short lived. Recovery occurred with high-dose clozapine.