Refractory catatonia in old age: a case report
Refractory catatonia in old age: a case report
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 representation: 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.
Benzodiazepines, Catatonia,, autistic spectrum disorder, case report, electroconvulsive therapy, old age
Bean, Emma
e5c08353-605e-4ea6-af2f-51f0e384553b
Findlay, Callum
16e75504-207b-425c-8728-aead3a419bb9
Gee, Claire
462553b8-9db8-48c6-b946-336a0663be67
Amin, Jay
692a8880-70ff-4b64-a7e9-7d0d53449a30
14 August 2021
Bean, Emma
e5c08353-605e-4ea6-af2f-51f0e384553b
Findlay, Callum
16e75504-207b-425c-8728-aead3a419bb9
Gee, Claire
462553b8-9db8-48c6-b946-336a0663be67
Amin, Jay
692a8880-70ff-4b64-a7e9-7d0d53449a30
Bean, Emma, Findlay, Callum, Gee, Claire and Amin, Jay
(2021)
Refractory catatonia in old age: a case report.
Journal of Medical Case Reports, 15 (1), [406].
(doi:10.1186/s13256-021-03000-3).
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 representation: 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.
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Case Report manuscript - revised
- Accepted Manuscript
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s13256-021-03000-3
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e-pub ahead of print date: 21 July 2021
Published date: 14 August 2021
Additional Information:
Funding Information:
We would like to thank the family of this patient for their permission to publish this article.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords:
Benzodiazepines, Catatonia,, autistic spectrum disorder, case report, electroconvulsive therapy, old age
Identifiers
Local EPrints ID: 450994
URI: http://eprints.soton.ac.uk/id/eprint/450994
ISSN: 1752-1947
PURE UUID: c4c974c5-91fc-4989-b007-e151e8e1ef63
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Date deposited: 01 Sep 2021 16:30
Last modified: 24 Jul 2024 01:47
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Author:
Emma Bean
Author:
Callum Findlay
Author:
Claire Gee
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