Associate Professor, Department of Psychiatry and Behavior Science, Eastern Virginia Medical School

Elionora Katz MD

Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School

Purnima Gorrepati MD

Eastern Virginia Medical School, Department of Psychiatry and Behavioral Sciences

Paul A. Sayegh, MD

Vice-Chair, Eastern Virginia Medical School, Department of Psychiatry and Behavioral Sciences

First published in Psychiatry Weekly, Volume 6, Issue 24, October 31, 2011

Introduction

Periodic catatonic schizophrenia is a form of thought disorder with prominent motor symptoms.¹ It is a recognized subtype of schizophrenia and is characterized not only by periodically reappearing phases of catatonic excitement or stupor separated by regular intervals, but also by its hereditary pattern in families.² The interval of resolution can last from weeks to years.³

The following case report presents a patient whose medical history and pattern of hospital admissions suggest a possible diagnosis of periodic catatonia.

Case Report

Ms. S. is a 43-year-old military veteran with a history of schizophrenia who was brought to the emergency room by her husband after one week of self-neglect. The patient did not respond to any commands, had a lengthy period of mutism and immobility, and refused food and fluids. On admission, the patient was mute, unresponsive to all form of stimuli, and was curled up in a fetal position with her eyes closed. She was resistant to any in changes in her body position.

The patient had an extensive psychiatric history that included 14 prior admissions for self-neglect during the previous 5 years. All previous admissions ran a similar course, as the patient would not communicate verbally, refused to eat, and was immobile. Of note in her history were bilateral transmetatarsal amputations secondary to frost bite. The patient had been left in an apartment without heat during winter 2008, and during that catatonic phase of her illness did not take her psychiatric medications, did not eat or drink, and developed frostbite. Treatment with amantadine, bromocriptine, and lorazepam had been unsuccessful in the past for a catatonic phase. The patient had never received ECT treatments. On this admission, the patient received ECT using a MECTA spectrum 5000Q device with bitemporal electrode placement. The patient was also placed on olanzapine 10 mg daily and fluoxetine 40 mg daily. During the first 3 ECT treatments, the patient remained non-responsive. After the fourth ECT treatment, however, the patient showed some improvements, responding to auditory stimuli with rapid bilateral eye movements. She began to ambulate to the restroom, showed increased appetite, and communicated with hospital staff. The patient had mild psychomotor retardation; she moved slowly and spent most of her day in bed. Her speech remained monotone. After further ECT treatments, and with additional pharmacologic treatment, the patient showed robust improvements in mood, facial expression, behavior, and thought process and was considered to be ready for discharge.

Ms. S. had a total of 7 inpatient ECT treatments. At the time of discharge, she was drinking and eating adequately, was engaging in daily physical therapy, and was communicating appropriately with the treatment team. Mental status exam revealed no mood symptoms or thought disorder, delusional thinking or hallucinations. She was fully oriented in all spheres, and the plan was to maintain her on olanzapine, fluoxetine, and maintenance outpatient ECT.

Disclosure: The authors report no affiliation with, or financial interest in, any organization that might pose a conflict of interest.

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References:

1. Miller MC. What is catatonia? You hardly hear about it anymore. Has it been cured? Harv Ment Health Lett. 2010 Sep; 27(3):8.

2. Weder ND, Muralee S, Penland H, Tampi RR. Catatonia: a review. Ann Clin Psychiatry. 2008 Apr-Jun;20(2):97-107

3. Kleinhaus K, Harlap S, Perrin MC, et al. Catatonic Schizophrenia: A Cohort Prospective Study. Schizophr Bull. 2010 Aug 6

 

Please direct all correspondence to:
Elionora Katz, MD
Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School,
825 Fairfax Ave, Ste 710,
Norfolk, Virginia 23507.
Tel:(757) 274-5639 or katzey [at] evms.edu