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Challenges of first episode catatonia in a geriatric case of treatment resistant depression
26 April 2024
Read this case report on diagnosing and treating catatonia in an older patient with complex medical conditions, including delirium and treatment-resistant depression.
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Case report: Diagnostic and therapeutic challenges of first-episode catatonia in a geriatric case of treatment-resistant depression. Psychiatry Research Case Reports
Yanhui Li, Nisha Chandwani
Multiple authors have discussed challenges in diagnosis and management of catatonia (opens in new tab), but there are limited case studies highlighting multiple issues in both domains concurrently. We present a case of first-episode akinetic catatonia (opens in new tab) in a 63-year-old male with a history of treatment-resistant depression, to highlight multiple diagnostic and therapeutic challenges in catatonia (opens in new tab) and discuss learning points. The patient had a likely episode of transient ischemic attack (opens in new tab) (TIA) which precipitated delirium, and subsequently developed catatonia and severe hyponatremia (opens in new tab). The cause behind his acute catatonia was unclear. Catatonic symptoms did not improve with benzodiazepines (opens in new tab), while side effects (opens in new tab) of oversedation and ongoing delirium limited further uptitration of benzodiazepines (opens in new tab). Electroconvulsive therapy (opens in new tab)was also not initiated in view of vascular risks with the recent TIA. The patient's catatonia subsequently resolved spontaneously with treatment of his medical conditions. This case highlights the complexity behind identifying etiologies of catatonia with the interplay of multiple medical conditions on the background of an affective disorder and ongoing delirium. It also illustrates therapeutic challenges in the context of unresponsiveness to benzodiazepines (opens in new tab), presence of concomitant delirium and contraindications to initiating electroconvulsive therapy. We discuss learning points in reference to latest guidelines in management of catatonia by the British Association of Psychopharmacology (opens in new tab) (BAP), and review related literature. We discuss etiologies of catatonia, the relationship between catatonia and delirium, and offer recommendations in the face of therapeutic challenges discussed. There is a need for further research and clarification of guidelines in regard to contraindications to ECT and management of catatonia with ongoing delirium.
doi: https://doi.org/10.1016/j.psycr.2024.100226 (opens in new tab)