A catatonic depression case; remitted depression and recurrent catatonia: a case report

In the current edition of Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (DSM-5) catatonia is not recognized as a separate disorder, but is associated with psychiatric conditions such as schizophrenia (catatonic type), bipolar disorder, post-traumatic stress disorder, depression and other mental disorders, as well as drug abuse or overdose (or both). It may also be seen in many medical disorders including infections (such as encephalitis), autoimmune disorders, focal neurologic lesions (including strokes), metabolic disturbances, alcohol withdrawal and abrupt or overly rapid benzodiazepine withdrawal. Lorazepam and electroconvulsive therapy have been well established as the first-line choices for treating catatonia, and a related treatment algorithm has been suggested. However, the real mechanism of catatonia was still unknown. Although the diagnosis of catatonia remains dependent upon the recognition of cardinal motor and behavioral signs and symptoms, a thorough psychiatric and medical evaluation and history is necessary to identify and treat the underlying cause. In our report, a 75-year-old male has had symptoms, which were lack of appetite, alogia, anhedonia, decreased self-care for two months and urinary incontinence for a week. After medical assessment, it had been said that there was no organic illness and he had been referred to psychiatry. In his psychiatric examination, self-care was decreased, psychomotor activity was decreased, he was alogic, only his eye movements were observed communicative. Affect and mood were depressed. After citalopram and lorazepam treatment was started, clinical improvement achieved. However, catatonia was recurred three weeks after discontinuation of lorazepam. He has had symptoms appetite, alogia, anhedonia, decreased self-care again. Catatonia was then relieved with two days lorazepam administration; and there were no complaints regarding depression. With this report, we will discuss the concept of catatonia accompanied by example of cases.