Psychiatry and Clinical Psychopharmacology

A case report: catatonia due to hyperthyroidism

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S152-S152
Read: 1022 Published: 18 February 2021

Catatonia is a neuropsychiatric disease, characterized by symptoms including mutism, psychomotor retardation, catalepsy, echolalia and echopraxia. Although catatonia has historically been associated with schizophrenia and listed as a subtype of the disorder, it can occur in patients with a primary mood disorder and in association with neurological diseases and other general medical conditions. In this report, 24 year-old woman patient is presented. Patient was brought to the emergency clinic with catatonia symptoms. Symptoms were firstly noticed by her mother three days ago. There was no history of psychiatric admission before. In her psychiatric examination, self-care was impaired. Due to negativism, mutism and psychomotor retardation, she was uncooperative and her orientation could not be evaluated. Bilateral upper extremity rigidity was examined. In her family history, her father had thyroid disease, and died due to thyrotoxicosis; her mother was diagnosed with intellectual developmental disorder. In physical examination, except sinus tachycardia, her electrocardiogram was normal. Serum free T3 and free T4 levels were high (13.9 pmol/L, 66.4 pmol/L respectively), TSH level was suppressed (0.009 mIU/L). She was diagnosed with Catatonia Due to A Medical Condition. We did not prefer electroconvulsive therapy because of thyrotoxicosis risk. Lorazepam 5 mg per day (5x1 mg) was started. Using ultrasonography and scintigraphy, thyrotoxicosis was found to be associated with diffuse thyroiditis. Antithyroid medication (metimazole) was added. Within one month, patient started to communicate with treatment members and catatonia disappeared. She was planned to be followed at outpatient clinic. Catatonia due to a medical condition is separated into three groups: neurologic, substance induced and metabolic. In the literature, neurological diseases are mostly accused. To our knowledge, thyroid diseases are rarely seen with catatonia, and a few cases have been presented. The presented free T3 and free T4 levels were lower than that of our patients. Patients diagnosed with catatonia due to hyperthyroidism should be treated with benzodiazepines. Electroconvulsive therapy has the risk of thyrotoxicosis and should be avoided.

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