Treatment-refractory Psychosis With Catatonia and Persistent Generalized Retrograde Amnesia: A Case Report of a...

In this report, we describe an unknown patient who presented to the emergency department with severe catatonia and a constellation of symptoms indicative of a primary psychotic disorder. Simultaneously, the patient exhibited severe autobiographical memory impairment suggestive of a comorbid dissociative disorder. Our report offers insight into a rare instance in which catatonia, a primary psychotic disorder, and dissociative disorder may have intersected in a clinical case. While the patient was successfully treated with lorazepam for his catatonia, his psychotic symptoms responded only minimally to several antipsychotic trials. Ultimately, his psychotic symptoms, disorganized speech and behavior, and autobiographical memory impairment were refractory to treatment, including dual clozapine-risperidone therapy. Remarkably, the patient scored an 8/30 on the Montreal Cognitive Assessment with multidomain deficits in executive function, naming, delayed recall, language, and abstraction. Finally, the patient demonstrated limited vocabulary in his native language, consistent with low educational attainment. Based on his presentation and hospital course, a differential diagnosis, which included unspecified primary psychotic disorder with catatonia, dissociative amnesia, neurodevelopmental disorder, and cognitive malingering, was proposed. The findings from this case highlight the occurrence of co-existing psychotic and dissociative disorders with multidomain neurocognitive deficits and clinical challenges in treating these cases.