Bipolar disorder first presented with catatonia: a case report

atatonia is first described by Kahlbaum in 1874 as a syndrome of abnormal movement and emotion. Catatonia is defined as a separate diagnostic entity in DSM-5. According to DSM-5, catatonia is dominated by least three of these symptoms: stupor, catalepsy, waxy şexibility, mutism, negativism, posturing, mannerism, stereotype, agitation, grimacing, echolalia and echopraxia. Its incidence differs ranging from 0.6 to 1.7%. It can occur within patients associated psychiatric (e.g. bipolar disorder, psychotic disorder, autism spectrum disorder), medical or neurologic conditions. Prevalence studies showed that it was frequently seen together with depressive or bipolar disorders. In this case, we report an adolescent, who first presented with catatonia and after diagnosed with bipolar disorders and discuss the clinical characteristics of catatonia in this population. A 17-year-old male patient, who was admitted to our department with catatonic presentation that includes complaints of refusal of eating, mutism, directing the gaze at a certain point, fearfulness after a stressor. On psychiatric assessment, he was conscious, but not cooperating and orientation is not evaluated. Mood was depressive, affection was limited. Patient had an apathic appearance. His psychomotor activity was severely decreased. He was hospitalized for a month in the child and adolescent inpatient clinic. He was initially tried on a low dose of lorazepam (up to 1 mg twice daily), which was switched to olanzapine (15 mg once daily)The patient improved on these medications and was discharged in a stable state on olanzapine (15 mg once daily) He was diagnosed with psychotic disorder. After discharge, he did well for 4 to 5 months. The patient had been treated with olanzapine and low dose sertraline for depression. The medication was discontinued by the patient following successful treatment. He was brought to our clinic due to complaints of aggression, rapid speech, reduced sleep, talking too much, increasing energy, motor hyperactivity, leaving home without notice. On psychiatric assessment, patient was conscious, cooperating and oriented. Mood was irritable. Affection was appropriate to his mood. Rate of speech was increased and associations were loosened. Thought content indicated persecutory delusions. Visual and auditory hallucinations were noted. His psychomotor activity was increased. He had no insight. According to clinical evaluation of the patient based on DSM V diagnostic criteria, he was diagnosed as having bipolar disorder with psychotic features. Catatonia is not rare and must be kept in mind in the differential diagnosis in children and adolescents with affective, psychotic, autistic, developmental, and medical conditions. Our case is considerable because evolution of catatonia in adolescents is important to diagnose the underlying cause and to follow up probably the associated mood disorders.