Paliperidone-Induced Catatonia: Case Series and Review of Literature

Paliperidone, a second-generation antipsychotic commonly used to treat schizophrenia and schizoaffective disorder, has been rarely associated with inducing catatonia, a severe neuropsychiatric syndrome characterized by motor disturbances and altered mental status. We present two cases demonstrating variable onset of paliperidone-induced catatonia: a 20-year-old male with acute symptoms following intramuscular loading doses and a 24-year-old female with a delayed presentation. Both cases highlight the clinical challenge of timely recognition, which is critical to prevent serious complications such as dehydration and respiratory failure. Assessment using the Bush-Francis Catatonia Rating Scale (BFCRS) guided treatment with benzodiazepines and antipsychotic adjustments, resulting in significant symptom improvement. This case series underscores the need for heightened awareness of this rare adverse effect to facilitate early diagnosis and optimize outcomes in patients receiving paliperidone.