Overlooking catatonia: Can't see the forest for the trees

Abstract

Catatonia is a psychomotor syndrome with poorly understood pathophysiology that frequently occurs concurrently with acute psychiatric and medical illnesses. Its prevalence among psychiatric inpatients has been reported to be as high as 38% and is primarily observed in those with mood disorders. Diagnosis requires the presence of at least three of the following signs: mutism, negativism, immobility, agitation, waxy flexibility, catalepsy, posturing, grimacing, stereotypies, mannerisms, echopraxia, and echolalia. Although the most commonly observed signs are immobility and mutism, the presentation of catatonia is often highly variable and shares significant overlap with other neurological conditions. Consequently, diagnosing this complex clinical syndrome remains a challenge. Here, we present a case of catatonia initially unrecognized in a patient with major depressive disorder with psychotic features. The patient's catatonia was perceived incidentally after administration of a one-time dose of a benzodiazepine while on the inpatient psychiatry ward. Subsequent daily treatment with a benzodiazepine resulted in a drastic improvement in the patient's functioning over the following week. This case underscores the importance of performing a detailed psychiatric examination to avoid missing the diagnosis of catatonia, especially for patients with affective and psychotic disorders as more subtle catatonic signs may be masked. Therefore, being proficient at recognizing all the features and patterns of catatonia is essential for early detection and treatment.

Keywords

• catatonia
• misdiagnosed catatonia
• subclinical catatonia