A case report of malignant catatonia in a patient with apparent intoxication

Catatonia is a neuropsychiatric syndrome characterized by motor and behavioral abnormalities, such as mutism and stupor. Delay in recognition and treatment can lead to progression of a life-threatening condition, malignant catatonia. Benzodiazepines are typically used as first-line treatment, but electroconvulsive therapy (ECT) may be required in cases refractory to benzodiazepines. We present a 24-year-old male presented to the emergency department (ED) with altered mental status and demonstrated several features of catatonia, including immobility, staring, posturing, grimacing, verbigeration, rigidity, negativism, and impulsivity. Despite multiple doses of lorazepam, the patient deteriorated, developing autonomic instability and requiring intubation. He was admitted to the intensive care unit and underwent two sessions of electroconvulsive therapy. Mental status improved on hospital day seven and he was discharged in stable condition on hospital day 8. Catatonia can mimic other conditions such as psychosis, intoxication, or delirium, making diagnosis challenging in the ED. Failure to recognize malignant catatonia can lead to rapid deterioration and even death. Emergency physicians should consider catatonia in patients with altered mental status with motor and behavioral abnormalities. Early recognition and initiation of treatment is crucial to good outcomes.