Periodic catatonia with long-term treatment: a case report

Abstract

BackgroundPeriodic catatonia has long been a challenging diagnosis and there are no absolute guidelines for treatment when precipitating factors are also unclear. We report a schizophrenia patient with periodic catatonia with a 15-year treatment course. A possible correlation between decreased daylight exposure and periodic attacks has been observed.Case presentationWe describe a 49-year-old woman with periodic catatonia associated with schizophrenia with 15 years of follow-up. The patient was treated with the antipsychotics risperidone, haloperidol, loxapine and quetiapine, but catatonia still relapsed once per year during the first few years of her disease course. The treatment was consequently been switched to clozapine due to fluctuated psychotic illness, and a longer duration of remittance was achieved. Lorazepam-diazepam protocol was used for rapid relief of catatonic symptoms, and was able to significantly shorten the duration of the symptoms. In addition, we observed a possible correlation between catatonic episodes and decreased daylight exposure during the 15-year duration.ConclusionsSuccessful treatment of acute periodic catatonia was achieved with a lorazepam-diazepam protocol, and the patient remained in remission for a longer duration under clozapine treatment. Besides, the possibility of decreased daylight exposure acting as a precipitating factor was observed during our 15 years of follow-up.

Periodic Catatonia: Long-term Treatment With Lamotrigine: A Case Report

“…Older published studies have reported cyclic shifts in nitrogen balance or thyroid dysfunction in association with periodic catatonia 2. Finally, in another case report, Chen and Huang17 noted a correlation between decreased daylight exposure and catatonia attacks, despite the patient’s good adherence to medication.…”

“…22 There are also reports on the benefit of clozapine for patients with catatonia, with an increase in the duration of the catatonia-free period reported. 17,23 However, atypical antipsychotics should be used with caution as catatonia is a risk factor for the development of neuroleptic malignant syndrome. 4,7 Other reports have suggested using N-methyl-D-aspartate receptor antagonists, such as amantadine and memantine.…”

“…Several studies have also indicated the efficacy of second-generation antipsychotics such as olanzapine,19,20 risperidone,21 and quetiapine 22. There are also reports on the benefit of clozapine for patients with catatonia, with an increase in the duration of the catatonia-free period reported 17,23. However, atypical antipsychotics should be used with caution as catatonia is a risk factor for the development of neuroleptic malignant syndrome 4,7.…”

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

“…There is great uncertainty in the treatment of periodic catatonia, though several sources advise treatment in acute catatonic episodes along the lines of other cases of catatonia with benzodiazepines and ECT ( Fink and Taylor, 2001 ; Ghaffarinejad et al, 2012 ; Hervey et al, 2013 ), and several reports support this ( Chen and Huang, 2017 ; Hervey et al, 2013 ; Saddichha et al, 2007 ). However, some cases do not respond to these treatments.…”

The syndrome of catatonia

“…S obzirom na multifaktorijelnu etiologiju katatonije, kod naše pacijentkinje (biološki faktori, psihološki faktori i psihosocijalni stres) neophodan je integrativni pristup dijagnostici i terapiji prema redu hitnosti i težini kliničke slike, a nakon produženog stacionarnog lečenja smatramo indikovanim redovne kontrole psihijatra, uz medikamentoznu terapiju i psihoterapijsku podršku jednom nedeljno (suport i kognitivnobihejvioralna terapija -KBT), kao i terapiju zbog politoksikomanije [19][20][21].…”