Neuroleptic-Induced Catatonia in First-Episode Psychosis: A Case Report
Justin Palanci1, Mina Boazak1, Robert Cotes1; 1Emory University Department of Psychiatry and Behavioral Sciences
Catatonia is an underreported and under-recognized neuromotor disorder defined by three or more of the following symptoms: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, and echopraxia. It has various etiologies including psychiatric and medical illness, and pharmaceuticals. We describe a case of neuroleptic-induced catatonia (NIC) in a patient with first-episode psychosis (FEP). The patient is a 22 year old male who presented with auditory hallucinations, paranoid delusions, and disorganized thoughts. Treatment was initiated with Risperidone 2 mg nightly. On hospital day four, he received Haloperidol 5 mg and Lorazepam 2 mg after reporting auditory hallucinations and anxiety. On hospital day five, he received an additional dose of Haloperidol 5 mg after reporting auditory hallucinations. On hospital day six, he presented with worsening thought blocking, mutism, and staring concerning for catatonia. Neurological exam and laboratory evaluations were unremarkable. A Bush-Francis Catatonia Rating Scale was eight. A Lorazepam challenge of 2 mg was administered with rapid improvement in his thought blocking and speech latency. He was initiated on scheduled Lorazepam 1 mg, which was tapered and discontinued over the next three days. Risperidone was discontinued and Aripiprazole 5 mg daily was initiated on hospital day seven and titrated to 10 mg daily. At discharge, his psychotic symptoms improved and a Bush-Francis Catatonia Rating Scale was zero. This is the first report to describe a treatment approach to NIC in a patient with FEP. We demonstrate successful re-initiation of an antipsychotic shortly after catatonic symptom remission.
Topic Area: First Episode Psychosis