Refractory catatonia in old age: a case report
Abstract Background Catatonia is a clinical syndrome characterized by psychomotor disruption, which often goes undiagnosed. Most reports have focused on interventions and outcomes for catatonia in younger people and those with schizophrenia. The clinical characteristics and course of catatonia in ol...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-021-03000-3 |
| _version_ | 1818363401105047552 |
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| author | Emma Bean Callum Findlay Claire Gee Jay Amin |
| author_facet | Emma Bean Callum Findlay Claire Gee Jay Amin |
| author_sort | Emma Bean |
| collection | DOAJ |
| description | Abstract Background Catatonia is a clinical syndrome characterized by psychomotor disruption, which often goes undiagnosed. Most reports have focused on interventions and outcomes for catatonia in younger people and those with schizophrenia. The clinical characteristics and course of catatonia in old age are poorly understood. We present a report of an older person whose catatonia was refractory to extensive treatment, and we identify important implications for the management of catatonia in old age. Case presentation We describe a 73-year-old white man with longstanding autistic spectrum disorder who presented with symptoms of depression. Following a period of diagnostic uncertainty and failure to improve with antidepressant medication, a lorazepam challenge yielded an abrupt improvement in presentation. The patient was treated extensively with lorazepam, zolpidem, and electroconvulsive therapy during his 16-month hospital admission, but his catatonia ultimately proved refractory to treatment. Conclusions Catatonia should be considered promptly as a differential diagnosis in older people presenting with atypical features of functional mental illness. Although partial improvement of catatonic features was achieved using benzodiazepines and electroconvulsive therapy, these were not sustained in our patient. We identified comorbid autistic spectrum disorder, prolonged duration of catatonia, and sensitivity to benzodiazepines as important factors in prognostication in old age. |
| first_indexed | 2024-12-13T21:47:53Z |
| format | Article |
| id | doaj.art-b5a40d6502fd4605bdc4885a817344bf |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-13T21:47:53Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-b5a40d6502fd4605bdc4885a817344bf2022-12-21T23:30:22ZengBMCJournal of Medical Case Reports1752-19472021-08-011511610.1186/s13256-021-03000-3Refractory catatonia in old age: a case reportEmma Bean0Callum Findlay1Claire Gee2Jay Amin3University Hospitals Southampton NHS Foundation TrustUniversity Hospitals Southampton NHS Foundation TrustMemory Assessment and Research Centre, Southern Health NHS Foundation TrustMemory Assessment and Research Centre, Southern Health NHS Foundation TrustAbstract Background Catatonia is a clinical syndrome characterized by psychomotor disruption, which often goes undiagnosed. Most reports have focused on interventions and outcomes for catatonia in younger people and those with schizophrenia. The clinical characteristics and course of catatonia in old age are poorly understood. We present a report of an older person whose catatonia was refractory to extensive treatment, and we identify important implications for the management of catatonia in old age. Case presentation We describe a 73-year-old white man with longstanding autistic spectrum disorder who presented with symptoms of depression. Following a period of diagnostic uncertainty and failure to improve with antidepressant medication, a lorazepam challenge yielded an abrupt improvement in presentation. The patient was treated extensively with lorazepam, zolpidem, and electroconvulsive therapy during his 16-month hospital admission, but his catatonia ultimately proved refractory to treatment. Conclusions Catatonia should be considered promptly as a differential diagnosis in older people presenting with atypical features of functional mental illness. Although partial improvement of catatonic features was achieved using benzodiazepines and electroconvulsive therapy, these were not sustained in our patient. We identified comorbid autistic spectrum disorder, prolonged duration of catatonia, and sensitivity to benzodiazepines as important factors in prognostication in old age.https://doi.org/10.1186/s13256-021-03000-3CatatoniaElectroconvulsive therapyBenzodiazepinesOld ageAutistic spectrum disorderCase report |
| spellingShingle | Emma Bean Callum Findlay Claire Gee Jay Amin Refractory catatonia in old age: a case report Journal of Medical Case Reports Catatonia Electroconvulsive therapy Benzodiazepines Old age Autistic spectrum disorder Case report |
| title | Refractory catatonia in old age: a case report |
| title_full | Refractory catatonia in old age: a case report |
| title_fullStr | Refractory catatonia in old age: a case report |
| title_full_unstemmed | Refractory catatonia in old age: a case report |
| title_short | Refractory catatonia in old age: a case report |
| title_sort | refractory catatonia in old age a case report |
| topic | Catatonia Electroconvulsive therapy Benzodiazepines Old age Autistic spectrum disorder Case report |
| url | https://doi.org/10.1186/s13256-021-03000-3 |
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