Periodic Catatonia in a Veteran With Post-traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI)

Periodic catatonia is a rare subtype of catatonia characterized by a variety of neuropsychiatric symptoms that follow a cyclical pattern. These episodes typically involve alternating phases of catatonic symptoms separated by periods of remission. Despite this condition being rare, it is still considered a medical emergency and usually requires inpatient care for assessment and treatment. Unfortunately, managing periodic catatonia can be challenging, largely because its underlying biological causes are not well understood and appear to be less clearly defined as compared to other forms of catatonia. This case report features a 54-year-old male U.S. veteran diagnosed with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) after military service who has suffered multiple episodes of catatonia symptoms since being diagnosed with PTSD 21 years before presentation. He presented to the hospital for catatonic symptoms, where the patient was treated with IV lorazepam. Despite early clinical improvement after 24 hours, the patient became highly sedated. Chart review revealed similarities to prior catatonic episodes requiring hospitalization, including normal medical workups. This report is the first to describe a case of periodic catatonia in a patient with PTSD and TBI. Further, the ideological complexity of periodic catatonia is elucidated in order to provide clinical insights into its management.