Clozapine for the management of persistent catatonia

• Published in: Journal of psychiatry & neuroscience Vol. 41; no. 6; pp. E81 - E82
• Main Authors: Tabbane, Karim, MD, Halayem, Soumeyya, MD, Joober, Ridha, MD, PhD
• Format: Journal Article
• Language: English
• Published: Canada Joule Inc 01.11.2016; CMA Impact, Inc
• Subjects: Case studies; Catatonia; Clozapine; Dopamine; Dosage and administration; Drug therapy; Electroconvulsive therapy; Medical Education; Neurobiology; Neurosciences; Patient outcomes; Psychiatry; Psychopharmacology for the Clinician; Schizophrenia
• ISSN: 1180-4882; 1488-2434
• DOI: 10.1503/jpn.150352

42-year-old man with a diagnosis of undifferentiated schizophrenia has been hospitalized several times since age 23 for psychotic relapses, usually in the context of nonadherence to medication. During the last relapse, he was concerned about many plots being planned against him for vague reasons. He experienced catatonic symptoms, including rigid postures, resistance to eating and drinking, immobility, mutism and staring, and displayed periods of unexplained aggressiveness. Physical examination revealed waxy flexibility with no extrapyramidal symptoms or fever. He had a score of 24 on the Bush-Francis Catatonia Rating Scale (BFCRS), which is compatible with a severe form of catatonia. Even in a patient with psychiatric illness, a plethora of medical conditions can be associated with catatonia. The patient was assessed by an internist and a neurologist, and no clinical abnormalities were identified. Laboratory results, including MRIs and electroencephalography (EEG) scans were unremarkable. Alternatively, but not exclusively, the effect of clozapine could derive from its enhanced antipsychotic properties.