Лоразепамовый тест

Case material and retrospective studies support the use of both lorazepam and ECT in treating catatonia, but few prospective investigations exist and none employ quantitative monitoring of response. In this study we test their efficacy in an open, prospective protocol, and define a "lorazepam test' with predictive value for treatment. Twenty-eight patients with catatonia were treated systematically with parenteral and/or oral lorazepam for up to 5 days, and with ECT if lorazepam failed. Outcome was monitored quantitatively during the treatment phase with the Bush-Francis Catatonia Rating Scale (BFCRS). In 16 of 21 patients (76%) who received a complete trial of lorazepam (11 with initial intravenous challenge), catatonic signs resolved. A positive response to an initial parenteral challenge predicted final lorazepam response, as did length of catatonic symptoms prior to treatment. Neither demographic variables nor severity of catatonia predicted response to lorazepam. Four patients failing lorazepam responded promptly to ECT. It is concluded that lorazepam and ECT are effective treatments for catatonia. The rating scale has predictive value and displays sensitivity to change in clinical status.

Catatonia. II. Treatment with lorazepam and electroconvulsive therapy.

Пернициозная анемия в форме кататонии без признаков анемии и макроцитоза

Pernicious anaemia can present with psychiatric symptoms before haematological or neurological manifestations appear. We describe a young woman who presented with insidious onset catatonia without evidence of psychosis or depression. Blood count and mean cell volume were normal and neurological findings were equivocal. Low B12 levels and intrinsic factor antibodies were found only by chance when they were included in a battery of further investigations. B12 replacement was followed by prompt improvement. This case provides an argument for wider screening for B12 deficiency in certain individuals with psychiatric disorders.

Pernicious anaemia presenting as catatonia without signs of anaemia or macrocytosis

Treatment of Catatonia With Methylphenidate in an Elderly Patient With Depression

Matthew L. Prowler, M.D., David Weiss, M.D., and Stanley N. Caroff, M.D.

Received June 2, 2008; revised July 1, 2008; accepted July 2, 2008. From the Dept. of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA; and the Philadelphia Veterans Affairs Medical Center. Send correspondence and reprint requests to Matthew L. Prowler, M.D., Dept. of Psychiatry, University of Pennsylvania School of Medicine, 3535 Market St., 2nd Fl., Philadelphia, PA 19104. e-mail: matthew.prowler@uphs.upenn.edu
© 2010 The Academy of Psychosomatic Medicine

BACKGROUND: Catatonia is especially common among patients with mood disorders. OBJECTIVE: The authors evaluated the effects of methylphenidate as an augmentation strategy in an elderly patient with catatonia and depression. METHOD: Methylphenidate was administered to a catatonic patient who had not responded to lorazepam. RESULTS: The patient showed an acute and marked response to methylphenidate. DISCUSSION: Methylphenidate may be effective as an adjunct in elderly depression patients with catatonia, as well as in medically ill, apathetic patients. However, there have been few attempts to study the role of psychostimulants in alleviating catatonia in general, or catatonia associated specifically with an underlying depressive disorder, even though catatonia is frequently associated with mood disorders.

Treatment of Catatonia With Methylphenidate in an Elderly Patient With Depression

Кататония - обзор

http://www.psyobsor.org/1998/35/3-4.html

Кататония в психиатрической классификации

Catatonia in Psychiatric Classification: A Home of Its Own

нейропсихиатрическая симптоматика СКВ в виде клиники БАР с кататоническими включениями

BACKGROUND: The American College of Rheumatology has defined 19 neuropsychiatric syndromes associated with systemic lupus erythematosus (SLE) involving the central, peripheral, and autonomic nervous systems. Neuropsychiatric manifestations of lupus (NPSLE) have been shown to occur in up to 95% of pediatric patients with SLE. OBJECTIVE: The authors describe a 15-year-old African American young woman with a family history positive for bipolar I disorder and schizophrenia, who presented with symptoms consistent with an affective disorder. METHOD: The patient was diagnosed with Bipolar I disorder with catatonic features and required multiple hospitalizations for mood disturbance. Two years after her initial presentation, the patient was noted to have a malar rash and subsequently underwent a full rheumatologic work-up, which revealed cerebral vasculitis. RESULTS: NPSLE was diagnosed and, after treatment with steroids, the patient improved substantially and no longer required further psychiatric medication or therapy. CONCLUSION: Given the especially high prevalence of NPSLE in pediatric patients with lupus, it is important for clinicians to recognize that neuropsychiatric symptoms in an adolescent patient may indeed be the initial manifestations of SLE, as opposed to a primary affective disorder.


Neuropsychiatric Systemic Lupus Erythematosus Presenting as Bipolar I Disorder With Catatonic Features

Кататония при отмене клоназепама

BACKGROUND: Catatonia is a often a complex syndrome. It has been divided into categories of simple and malignant, with the latter being a more severe form involving autonomic instability and/or fever and having a higher mortality rate. OBJECTIVE: There have been only two cases presented in the literature postulating benzodiazepine-withdrawal as a possible trigger for malignant catatonia. Here, the authors present a case of catatonia likely caused by abrupt benzodiazepine discontinuation; they also discuss neurobiological mechanisms relating to catatonia. METHOD: The authors report on a 60-year-old man with a history of depression and posttraumatic stress disorder who was brought to the emergency department with acute confusion, grimacing, stereotypy, refusal of food and water, muscle rigidity, mutism, and extreme negativism. He had recently and abruptly discontinued all psychotropic medication. RESULTS: After administration of lorazapam, the patient was re-started on clonazepam, after which there was a complete and sustained resolution of catatonic symptoms and autonomic instability. CONCLUSION: Catatonia may result from a wide variety of etiologies. Catatonia due to benzodiazepine-withdrawal is a rare but serious condition that may be difficult to distinguish from other causes of catatonia. The mechanism by which catatonia may be precipitated by benzodiazepine-withdrawal is unknown, but likely involves a rapid decrease in GABA transmission in the central nervous system.

Case Report