Title: Catatonia and Neuroleptic Malignant Syndrome
Abstract: Abstract This case report aims to illustrate the similarity between the clinical pictures of catatonia and neuroleptic malignant syndrome. The supporting evidence for the hypotheses that catatonia and neuroleptic malignant syndrome are variants of the same disorder and that neuroleptic malignant syndrome is a neuroleptic-intensified form of an antecedent catatonic state is discussed. Keywords: Antipsychotic drugs, Catatonia, Neuroleptic malignant syndrome Introduction There has been a recent revival of interest in the diagnosis and treatment of catatonia. In recent studies, between 7% and 9% of patients admitted to acute psychiatric units were found to have catatonic syndrome. (1-3) In the literature, catatonia is described as a syndrome associated with a host of neurological, metabolic, and psychiatric disorders. (4) Prompt recognition and treatment of catatonia is important, as prolonged catatonia has potentially life-threatening somatic complications. Neuroleptic malignant syndrome (NMS) bears a close resemblance to catatonia in its clinical picture and its potential for leading to serious morbidity and mortality. It has been suggested that catatonia and NMS are variants of the same disorder. (5,6) The following case history illustrates the relationship between catatonia and NMS. Salient points concerning the management of these syndromes will be briefly discussed. Case Report A 34-year-old woman with a 6-year history of schizophrenia was admitted to a psychiatric hospital because of an acutely deteriorating mental condition. She became dull and inactive and expressed persecutory ideas toward her brother. She also refused food, drink, and maintenance antipsychotic medication (thioridazine). On examination, she was mute, displayed a rigid and awkward posture with staring eyes, and was alternatively resistive and ambivalent on approach. She was mildly dehydrated and afebrile. Her blood pressure was 130/80 mm Hg and pulse rate was 80 beats per minute. Investigations showed mildly elevated white blood cell count of 11.2 x 109 U/L (normal range, 4.5 to 11.0 x 109 U/L) and creatine phosphokinase (CPK) level of 490 U/L (normal range, 34 to 38U/L). Electroencephalogram was normal. Psychiatric History A review of the patient's past psychiatric history revealed that she had presented to a psychiatric outpatient clinic 6 years previously with a 1-week history of muttering to herself, auditory hallucinations, and irrelevant speech. The patient harboured persecutory ideas, stating that ghosts wanted to kill her. The diagnosis of schizophreniform psychosis was made and the patient was prescribed an intramuscular dose of 50 mg of zuclopenthixol acetate, followed by chlorpromazine 50 mg nocte and trifluoperazine 3 mg twice daily and 5 mg nocte. Two days later, the patient was admitted to a medical ward in a stuporous state. She was afebrile at the time, with normal white blood cell count. Following an inconclusive medical assessment, she was referred to the outpatient psychiatric clinic for further assessment 3 days later, when she was found to be muttering with her eyes shut. Mannerism, negativism, and waxy flexibility were also noted. A subsequent diagnosis of catatonic schizophrenia was made and the patient was admitted to a psychiatric hospital. During hospitalisation, she was treated with repeated intramuscular injections of zuclopenthixol acetate and oral antipsychotic medication (trifluoperazine), but the catatonic features persisted. In addition, the patient exhibited signs suggestive of autonomic abnormality, namely fluctuating blood pressure and tachycardia, which were becoming more prominent. Intermittent low-grade fever also developed. Her CPK level was 236 U/L. Two weeks postadmission, she was transferred back to the medical ward due to swelling in her right leg and suspected deep vein thrombosis. …
Publication Year: 2001
Publication Date: 2001-12-01
Language: en
Type: article
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Cited By Count: 1
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