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Cureus Aug 2023Catatonia is a behavioral syndrome characterized by a variety of symptoms such as mutism, stupor, rigidity, negativism, and verbigeration. It can be caused by various...
Catatonia is a behavioral syndrome characterized by a variety of symptoms such as mutism, stupor, rigidity, negativism, and verbigeration. It can be caused by various psychiatric and general medical conditions. While the diagnosis in the pediatric population is relatively uncommon, emerging literature supports a higher prevalence of catatonia in children. We present a 12-year-old girl with a complex medical and psychosocial history, including a functional neurological disorder and concerns for child abuse and Munchausen syndrome by proxy imposed by her mother. The patient was initially admitted for medical management of vomiting and refusal to eat. Child psychiatry was consulted for further assessment and noted multiple catatonic symptoms with a Busch-Francis catatonia rating scale (BFCRS) score of 22. A subsequent 1 mg IV lorazepam challenge test showed improvement in the patient's symptoms with a repeat BFCRS score of 10. This case supports emerging literature suggesting a higher prevalence of catatonia in children and the importance of recognizing this syndrome and its wide array of underlying causes.
PubMed: 37680395
DOI: 10.7759/cureus.43082 -
Medicine Aug 2023Necrotizing fasciitis is rapidly progressive infection with high mortality rate. This study aimed to summarize the clinical and pathological presentation of this case.
RATIONALE
Necrotizing fasciitis is rapidly progressive infection with high mortality rate. This study aimed to summarize the clinical and pathological presentation of this case.
PATIENT CONCERNS
A 46-year-old woman patient presented to our emergency department of an obstetric and gynecology clinic on the 8th day after total abdominal hysterectomy. The abdominal wall showed pronounced signs of inflammation. Abundant purulent content was oozing from the abdominal wound.
DIAGNOSES
The patient underwent surgery. Areas of necrosis were observed on the skin around the wound, the subcutaneous fatty tissue was necrotic around the incision site, and the fascia was completely dehisced.
INTERVENTIONS
Wound debridement and flap cutting of the anterior abdominal wall were performed. Metronidazole, ceftriaxone, and vancomycin were administered intravenously. A plastic surgeon suggested daily debridement and toileting of the wound in the operating room. Swabs of the abdominal cavity, abscess cavity, and abdominal wound were obtained, and Enterococcus faecalis was isolated. After the negativism of microbiological swabs, excochleation of granulation tissue was performed by a plastic surgeon.
OUTCOMES
Nineteen days after the relaparotomy, the patient was discharged in good general condition with advice for further monitoring and therapy.
LESSONS
Successful treatment of necrotizing fasciitis can be achieved through an initial diagnosis, adequate debridement, empirical broad-spectrum antibiotic coverage, and multidisciplinary treatment.
Topics: Pregnancy; Female; Humans; Middle Aged; Fasciitis, Necrotizing; Skin; Vancomycin; Hysterectomy; Inflammation; Debridement
PubMed: 37543829
DOI: 10.1097/MD.0000000000034451 -
The South African Journal of Psychiatry... 2023The successful use of ECT as treatment for catatonia, in the context of HIV (human immunodeficiency virus) infection, has been described previously. Ketamine has been...
INTRODUCTION
The successful use of ECT as treatment for catatonia, in the context of HIV (human immunodeficiency virus) infection, has been described previously. Ketamine has been used as an anaesthetic induction agent for ECT, although not considered the induction agent of choice. There are also case reports suggesting that ketamine may be an alternative treatment specifically for catatonia.
PATIENT PRESENTATION
This case report describes the management of a female patient who presented with catatonia, evidenced by stupor, waxy flexibility, mutism, negativism, and stereotypy, as well as stage four HIV infection, with poor response to previous psychotherapeutic interventions.
MANAGEMENT AND OUTCOME
We describe the course of management of this patient with ECT, following poor initial clinical response to ECT with propofol induction, the subsequent use of ketamine as an anaesthetic induction agent for ECT, with associated improvement in seizure quality, and good overall clinical response to ECT demonstrated thereafter.
CONCLUSION AND CONTRIBUTIONS
This case report suggests that ketamine may be a viable induction agent for ECT in this clinical setting.
PubMed: 36756540
DOI: 10.4102/sajpsychiatry.v29i0.1944 -
Neuropsychopharmacology Reports Mar 2023Neuroleptic malignant syndrome (NMS) is a rare and life-threatening reaction. The incidence rate of NMS has dropped because of the higher use of atypical antipsychotics,...
BACKGROUND
Neuroleptic malignant syndrome (NMS) is a rare and life-threatening reaction. The incidence rate of NMS has dropped because of the higher use of atypical antipsychotics, compared with the typical ones. The mortality rate in patients taking injectable antipsychotics has been also by 38%.
AIM
Here, a case developing the NMS symptoms following Flupentixol (FPX) use was reported.
CASE PRESENTATION
The patient was a 46-year-old man with the history of schizoaffective disorder (SAD) and recently on six-weekly doses of long-acting (LA) typical antipsychotic drugs. He was referred with a fever, sweating, a food intolerance, mutism, and disorientation in 2019. He was presented with generalized rigidity, negativism, and neck stiffness. The patient's initial creatine phosphokinase (CPK) level was 1476 IU/L, which gradually elevated to 3997 IU/L on Day 26. NMS was further diagnosed, in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, and the score 9+ in the Naranjo Algorithm as the adverse drug reaction probability scale. Afterward, the patient was treated with bromocriptine at a dose of 5 mg 3 times a day, which progressively reached a maximum of 50 mg. He experienced sepsis and resistant respiratory infection several times. The case was finally discharged after 66 days of hospitalization, with a high level of consciousness, but limited verbal communication, in a fever-free condition with the oral administration of bromocriptine and lorazepam.
CONCLUSION
In conclusion, there were suggestions for the management challenges of NMS in patients receiving LA injectable antipsychotic agents.
Topics: Male; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Flupenthixol; Bromocriptine; Antipsychotic Agents; Psychotic Disorders
PubMed: 36585735
DOI: 10.1002/npr2.12315 -
Case Reports in Psychiatry 2022Catatonia is regarded as a diverse type of motor dysregulation syndrome that includes mutism, immobility, catalepsy, negativism, stereotypies, and echo phenomena....
BACKGROUND
Catatonia is regarded as a diverse type of motor dysregulation syndrome that includes mutism, immobility, catalepsy, negativism, stereotypies, and echo phenomena. Catatonia is known to coexist with a wide range of physical and mental health conditions, including mood disorders, schizophrenia, autoimmune disorders, and metabolic abnormalities. Albeit, the association between obsessive-compulsive disorder (OCD) and catatonia is underreported, and mechanisms are not well elucidated. . In this study, we present a case of a 36-year-old woman who developed episodes of catatonia during the course of her obsessive-compulsive disorder (OCD). Success rates have been recorded with both benzodiazepines and electroconvulsive therapy (ECT). Gauging the severity of her symptoms and poor drug compliance, the patient was opted for and successfully treated with ECT. She was also educated about OCD through a series of therapy sessions and exposure and response prevention (ERP) principles. She was maintained on ERP and adjunctive clonazepam upon discharge. On subsequent follow-ups, the patient seemed to be doing well and was eager to begin her job again.
CONCLUSION
Our study shows a possible link between OCD and catatonia. Additionally, robust studies are needed in order to determine the pathophysiology of catatonia and the mechanism of ECT so that more beneficial therapeutics can be developed. A combination of ECT and antidepressants with ERP therapy for recurrent catatonia with OCD could be effective as a therapeutic modality.
PubMed: 36425076
DOI: 10.1155/2022/2022474 -
Heliyon Aug 2022The relationship between corpus callosum and schizophrenia is elusive. Neuropsychiatric symptoms in Mild encephalitis with reversible splenial lesion (MERS) such as...
The relationship between corpus callosum and schizophrenia is elusive. Neuropsychiatric symptoms in Mild encephalitis with reversible splenial lesion (MERS) such as delirium, and negativism, suggest a link between corpus callosum and psychiatric disturbances. Here in, we report catatonia as an initial symptom of MERS in a schizophrenic patient. The aim of this study is to discuss the likely causal relationship between catatonic syndrome and MERS. To the best of our knowledge, the catatonia was not reported before as a prodromal symptom of MERS. We therefore report this case in order to enlarge the spectrum of MERS symptoms in psychiatric patients and discuss the relationship between catatonia and splenium lesions.
PubMed: 36072258
DOI: 10.1016/j.heliyon.2022.e10257 -
Cureus Jun 2022Herein, we report the case of a 20-year-old Caucasian male with a previous psychiatric history of schizophreniform, autism, unspecified intellectual disorder, and past...
Herein, we report the case of a 20-year-old Caucasian male with a previous psychiatric history of schizophreniform, autism, unspecified intellectual disorder, and past medical history of hypertension, who presented after a suicidal attempt. One month prior to admission for the suicidal attempt, the patient had mutism. While admitted, the patient showed signs of mutism, posturing, negativism, and waxy flexibility. Treatment with both aripiprazole and lorazepam was effective and reversed the patient's catatonia after low-dose titration. This case highlights the importance of reviewing patient history and presenting symptoms in the management of catatonia. Additionally, this case provides an opportunity to review the diagnostic approach and treatment type used for patients presenting with catatonia.
PubMed: 35911277
DOI: 10.7759/cureus.26328 -
Frontiers in Psychiatry 2022Catatonia is an underdiagnosed and undertreated neuropsychiatric syndrome characterized by catalepsy, negativism, mutism, muscular rigidity, and mannerism, often...
BACKGROUND
Catatonia is an underdiagnosed and undertreated neuropsychiatric syndrome characterized by catalepsy, negativism, mutism, muscular rigidity, and mannerism, often accompanied by autonomic instability and fever. Although there is growing interest in studying cognitive impairments before and after catatonia, little is known about the cognitive features of the syndrome.
METHODS
This systematic review was registered at PROSPERO (CRD42022299091). Using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, we searched PubMed, ScienceDirect, and PsycArticles using a combination of the terms "Catatonia" and "Cognitive impairment" and "Executive function" and "Frontal lobe" and "Parietal lobe." Studies included original research articles enrolling patients with catatonic syndrome according to specified criteria. Fourteen studies were deemed relevant for inclusion. The abstraction form included age, assessment during acute episode, associated diagnosis, assessment procedure, and cognitive domains. Outcome measures were extracted.
RESULTS
Executive functions and visuospatial abilities proved to be the most investigated domains. A great heterogeneity has been observed in the assessment tools used among the 14 evaluated studies. Findings showed that catatonic patients had worse performance than healthy and non-catatonic psychiatric patients in frontal and parietal cortical functions.
CONCLUSION
Because of the small number of studies in such heterogeneous areas and significant methodological limitations, the results should be regarded with caution. Future research assessing cognitive impairments on catatonic patients is needed.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299091], identifier [CRD42022299091].
PubMed: 35845445
DOI: 10.3389/fpsyt.2022.877566 -
Ciencia & Saude Coletiva Jul 2022The text addresses the sociability circuits of 'men who have sex with men' in the Metropolitan Region of Recife during the first year of the COVID-19 pandemic. In March...
The text addresses the sociability circuits of 'men who have sex with men' in the Metropolitan Region of Recife during the first year of the COVID-19 pandemic. In March 2020, with the arrival of the epidemic in Brazil, a first movement was characterized by the shift of interactions to the online dimension. From June onwards, after stricter social distancing, offline sexual interactions, social interactions at friends' houses, the return to bars and sociability on the street were resumed in that order, in the wake of what was happening in the broader society. In the mismatch between the negationist speech of the President of the Republic and the role of the state government in implementing measures of social distancing; in the contradictions generated by the leniency regarding crowding in public transport on the way to and from work and the attempts to contain the crowds seeking leisure activities, a 'new normal' emerged and was marked by negativism, omnipotence and fatalism. Between September 2020 and February 2021, what were most evident were parties, ostensive circulation of people and the lack of mask use, boosting the numbers of the infected and the dead, in the normalization of an unprecedented health crisis in Brazil.
Topics: Brazil; COVID-19; Homosexuality, Male; Humans; Male; Pandemics; Sexual and Gender Minorities
PubMed: 35730840
DOI: 10.1590/1413-81232022277.04512022