Page 101 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Recurrent catatonia in a complex patient

Figure 1. Timeline of inpatient clinical course

used in catatonia owing to the highest levels of efficiency as narcolepsy, dementia, depression, and psychosis.
3
and efficacy demonstrated in previous research. 14-17 Autoimmune disorders such as anti-N-methyl-D-aspartate
Coupling of the increased dopamine release in the striatum (NMDA) receptor encephalitis and hyponatremia with
through 5-HT receptor stimulation and low D2 receptor subsequent extrapontine myelinosis secondary to Addison’s
1A
3
occupancy may produce a net effect on overall dopamine disease have been cited as triggers of catatonia. In some
neurotransmission, which is potentially responsible for cases, autoimmune disorders appeared to be the proximate
the anticatatonic effects of clozapine. Despite advantages cause of catatonia (NMDA receptor encephalitis); in other
14
in treating catatonia, the use of clozapine requires a cases, the autoimmune disorder was a more distal cause
baseline evaluation, slow titration, and close monitoring. (Addison’s disease). 3
14
Lurasidone and cariprazine may be useful for mood The major limitations of the current case were patient’s
disorder-related catatonia, which justifies its use in our loss to follow-up and non-attendance at scheduled mental
18
patient. health, rheumatology, and hematology outpatient visits.
Hypoxia, induced by obstructive sleep apnea, may In addition, there is limited literature on catatonia with
exacerbate catatonia. One case in the literature involved comorbid polycythemia and hematological-immunological
a 20-year-old male patient with central hypoventilation disorders. More case reports and studies are needed to
presenting with resistant catatonia. He had a history enhance our understanding of these associations.
19
of hypoventilation at birth and was supported by 24-h 4. Conclusion
mechanical ventilation for the first 5 years of his life.
19
During hospitalization, laboratory result indexes, including Managing recurrent catatonia in a patient with BD1,
complete blood count, of this patient were normal, as polycythemia, and a positive ANA titer presents complex
opposed to polycythemia accompanied by an increased challenges. The presence of hemato-immunological
hemoglobin and hematocrit identified in our patient. abnormalities adds a layer of complexity to the detection
A fluorodeoxyglucose positron emission tomography and management of catatonic symptoms, underscoring the
scan during hospitalization showed a hypometabolic need for comprehensive exploration of the neuropsychiatric
distribution, which is characteristically consistent with and systemic factors of catatonia to help strengthen our
hypoperfusion. 19 Increased mechanical ventilation understanding of the neuropsychiatric condition.
19
successfully resolved his psychiatric symptoms. Despite Acknowledgments
the rarity, hypoxia from (central or obstructive) apnea is
possibly linked to catatonic symptoms in our patient. This None.
association may imply that increased PCO and decreased
2
PO (the latter of which was seen in our patient) may have Funding
2
pathophysiological implications for catatonic symptoms. None.
Phlebotomy can increase oxygenation and thus serve as a
treatment for polycythemia, which holds the potential, in Conflict of interest
addition to lorazepam, to resolve catatonia symptoms. The authors declare that they have no competing interests.
In patients with positive ANA value of 1:160,
autoimmune causes and/or comorbidities should be Author contributions
explored. Immune dysregulation is the mechanistic Conceptualization: All authors
driver for a variety of neuropsychiatric disorders, such Investigation: All authors

Volume 2 Issue 4 (2024) 3 doi: 10.36922/jcbp.4140