The article reviewed here is ‘Catatonia. Treatment and Recognition’ by Cottencin and colleagues. This is a paper consisting of a case report with discussion. The authors describe the case of a 54-year old lady with a history of hypomania (later revised to Bipolar Disorder) who was initially admitted to hospital for an alcohol detoxification. After being noted to have depression with anxiety she was then discharged on an antidepressant as well as an antipsychotic with sedative properties – Cyamemazine which acts at D2 and serotonin 2c receptors. She was readmitted 2 days later with a number of symptoms including mutism, disorientation, flight of ideas, wandering, rigidity and oppositionalism. The authors included Neuroleptic Malignant Syndrome as a differential but there is no mention that I could find of the CK’s or autonomic features. The authors focus on their main differential that of catatonia. They found that she scored highly on the Catatonia Rating Scale (although commenting on the reliability and sensitivity of catatonia scales) and then proceeded to initiate a Zolpidem challenge. She responded well to this and there was a marked improvement on the Rating scale scores which peaked at 45 minutes before returning to (roughly) baseline levels after 3 hours. The authors conclude that a Zolpidem challenge is a useful confirmation test for catatonia before speculating that the withdrawal from a number of GABAergic medications prior to the episode may be related to the onset of the catatonia. The difficulty in interpreting a case-report is that it is difficult to control for a number of potentially important factors – medications, mood, alcohol withdrawal, abrupt withdrawal of multiple medications to name but a few. The opportunistic case-report also differs from the more ‘controlled’ settings of the clinical trial where subjects with certain characteristics are selected for inclusion. Nevertheless they offer initial evidence and the speculation here has led to a useful hypothesis which can be further assessed.
Cottencin O, Danel T, Goudemand M, Thomas P and Consoli S. Catatonia recognition and treatment. Med Sci Monit. 15(8). CS 129-131. 2009.
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