Page 99 - JCBP-2-4

Journal of Clinical and

Basic Psychosomatics

CASE REPORT
Recurrent catatonia in a patient with bipolar

disorder and polycythemia: A case report

Tiffany Eatz * , Jessica Mikolowsky , and Lisa Oliveri-Naidu 1,2
1
1
1 Department of Psychiatry, University of Miami Miller, School of Medicine, Miami, Florida, United
States of America
2 Department of Psychiatry, Miami VA Healthcare System, Miami, Florida, United States of America

Abstract

We report the diagnostic and management challenges encountered in a case of
a 57-year-old male patient with bipolar I disorder and comorbid polycythemia
secondary to obstructive sleep apnea, who was treated in our inpatient psychiatric
unit for suicidal ideation and recurrent catatonia. He was found to have catatonia
with a Bush–Francis Catatonia Rating Scale score of 18. He subsequently exhibited
a positive response to the lorazepam challenge test. Before discharge, his
daily lorazepam dose was titrated to 6 mg, which led to resolution of catatonic
symptoms, and was tapered to discontinuation. During the second hospitalization,
the patient’s catatonia returned, but due to lorazepam-induced bradycardia,
he refrained from taking more than 1 mg of the medication. Divalproex sodium
and memantine were initiated as off-label catatonic treatment plus lurasidone
for bipolar depression. The patient was also found to have a positive antinuclear
antibody titer (1:160). The hemato-immunological abnormalities present in our
*Corresponding author: patient complicated his catatonic condition, underscoring the need to explore
Tiffany Eatz medical and neuropsychiatric catatonic factors for accurate diagnosis of this
(t.eatz@med.miami.edu) neuropsychiatric syndrome.
Citation: Eatz T, Mikolowsky J,
Oliveri-Naidu L. Recurrent catatonia
in a patient with bipolar disorder and Keywords: Catatonia; Bipolar disorder; Polycythemia; Neuropsychiatry; Antinuclear
polycythemia: A case report. J Clin antibody
Basic Psychosom. 2024;2(4):4140.
doi: 10.36922/jcbp.4140
Received: July 4, 2024
Accepted: September 25, 2024 1. Introduction
Published Online: November 4, 2024 Catatonia is a neuropsychiatric condition characterized by various motor and behavioral
abnormalities, such as immobility, reduced verbal communication, unusual actions,
Copyright: © 2024 Author(s).
1,2
This is an Open-Access article and impaired volition. It is crucial to differentiate catatonia from other psychiatric
distributed under the terms of the disorders, including different types of mood disorders, psychotic conditions with
Creative Commons Attribution significant negative symptoms, and selective mutism. Catatonia presents in different
3,4
License, permitting distribution,
3,5
and reproduction in any medium, forms, including stuporous, excited, malignant, and neuroleptic-induced types.
provided the original work is Originally classified under schizophrenia, catatonia is now recognized in association
properly cited. with various medical and psychiatric conditions. Initially, in the 1800s, Kahlbaum
Publisher’s Note: AccScience described catatonia as a psychomotor syndrome associated with different underlying
Publishing remains neutral with disorders. Shortly thereafter, Kraepelin instead defined catatonia as a manifestation of
6
regard to jurisdictional claims in 7
published maps and institutional dementia praecox (an obsolete term for schizophrenia) rather than a separate illness.
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affiliations. Approximately one century later, this erroneous classification was rectified. Today,
Volume 2 Issue 4 (2024) 1 doi: 10.36922/jcbp.4140