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Published on: November 21, 2013
Non-Catatonic Mutism as a Presentation of Psychosis: A Case Study
Mridul Sarangal1, Michael P Greenage2
1Sarangal, MBBS, Third-year psychiatry resident, Department of Psychiatry and Behavioral Medicine, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
Objective:
To describe a rare case of non-catatonic mutism as the primary presentation of psychosis in a patient with complex comorbidities, highlighting diagnostic differentiation and antipsychotic response.
Methods:
Case report of a 47-year-old female with bipolar II disorder, post-traumatic stress disorder, polysubstance use, and homelessness presenting with intermittent mutism. Diagnostic evaluation included clinical history, Bush-Francis Catatonia Rating Scale (BFCRS), and exclusion of alternative etiologies. Treatment involved antipsychotics with legal authorization.
Results:
BFCRS score of 3 ruled out catatonia. Mutism resolved with haloperidol 4 mg daily after initial olanzapine failure, with no overt psychotic symptoms. Integrated care addressed social determinants.
Conclusions:
Non-catatonic mutism may represent isolated psychosis, responsive to antipsychotics. Systematic evaluation is crucial in atypical presentations with psychosocial complexity.
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