olanzapine and Catatonia

Topics: Antipsychotic Agents; Benzodiazepines; Cardiomyopathies; Catatonia; Clozapine; Heart Failure; Humans; Olanzapine; Rhabdomyolysis

Catatonia can be associated with multiple physical and mental illnesses, and idiopathic catatonia is a well-recognized clinical entity. Here we report a case of recurrent idiopathic catatonia with underlying immunologic abnormalities, with an emphasis on etiological hypotheses. An 18-year-old female with mild learning disability, dyspraxia, autoimmune hypothyroidism, and nonceliac gluten intolerance was referred to mental health services after developing an episode of catatonia following tonsillitis. She had experienced 2 previous episodes suggestive of catatonia, one of which developed after a snakebite and the other after a viral infection. Samples of cerebrospinal fluid and whole blood tested positive for human herpesvirus (HHV) on DNA-polymerase chain reaction testing during her third episode, but the patient had no signs of encephalitis. She responded well to lorazepam but developed significant side effects with low-dose olanzapine and aripiprazole. She returned to her usual baseline with medical management. Very little is known about possible etiologies of recurrent idiopathic catatonia. An atypical response to an HHV infection is a likely cause of one of the episodes in this case. There is substantial evidence connecting immune dysregulation to mental illnesses. Proinflammatory effects of latent HHV, proinflammatory genetic polymorphisms related to learning disability, and autoimmune dysfunction are likely factors that may have contributed to the development of recurrent catatonia following external antigen exposure in this case. Future research should focus on immune-mediated etiologies of catatonia, the role of immunotherapy in the treatment of idiopathic catatonia, and systems research to improve multidisciplinary management of neuropsychiatric disorders.

Topics: Adolescent; Catatonia; Encephalitis; Female; Humans; Lorazepam; Mental Disorders; Olanzapine

Topics: Adolescent; Antipsychotic Agents; Aripiprazole; Catatonia; Humans; Male; Olanzapine; Schizophrenia

Topics: Adolescent; Antipsychotic Agents; Catatonia; Clozapine; Delusions; Feeding and Eating Disorders of Childhood; Haiti; Humans; Male; Marijuana Abuse; Olanzapine; Schizophrenia; Weight Loss

Topics: Adult; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Antipsychotic Agents; Catatonia; Diagnosis, Differential; Female; Humans; Methylprednisolone; Olanzapine; Plasmapheresis; Psychotic Disorders

A 79-year-old Japanese woman with schizophrenia was hospitalized because of idiopathic duodenal stenosis. Three days after discontinuing ingestion, including the administration of psychotropic drugs, the patient demonstrated incoherent behaviour and strong general muscle tension, and was unable to engage in conversation. Computed tomography indicated bilateral regions of low density in the frontal lobes, subsequent to which she was diagnosed with post-lobotomy catatonia. Administration of olanzapine (10 mg/day) improved the patient's condition within a short period. Previous studies have demonstrated an association between the dysfunction of frontal circuits and catatonia; therefore, the observed catatonic episode might relate to the disconnection of nerve fibres in the prefrontal lobes induced by her lobotomy. Olanzapine was likely effective in treating catatonia because of its reported efficacy in improving frontal lobe function.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Catatonia; Female; Humans; Olanzapine; Postoperative Complications; Psychosurgery; Schizophrenia; Treatment Outcome

A 19-year-old male came to the Emergency Room of our hospital due to an episode of dystonic movements and disorientation 4 days after consuming methamphetamine, which evolved to a catatonic frank syndrome and eventually to status epilepticus. Definitive diagnosis was anti-NMDA receptor encephalitis, an acute inflammation of the limbic area of autoimmune origin in which early diagnosis and treatment are key elements for the final outcome. In this case, initial normal tests and previous methamphetamine poisoning delayed diagnosis, because inhaled-methamphetamine poisoning causes similar clinical symptoms to anti-NMDA receptor encephalitis. Methamphetamine poisoning may have caused an immune response in the patient, bringing on the progress of the pathology.

Topics: Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Anticonvulsants; Autoantibodies; Benzodiazepines; Catatonia; Delayed Diagnosis; Diagnosis, Differential; Diagnostic Errors; Diazepam; Electroconvulsive Therapy; Emergencies; Epilepsies, Partial; Hallucinations; Humans; Infectious Encephalitis; Male; Methamphetamine; Olanzapine; Poisoning; Receptors, N-Methyl-D-Aspartate; Status Epilepticus; Young Adult

We present the case of an elderly woman with hypothyroidism and no psychiatric history who presented with new onset of psychosis, paranoia, catatonic features and Capgras syndrome (CS). This case illustrates the spectrum of neuropsychiatric symptoms that may accompany hypothyroidism and the importance of considering thyroid dysfunction as a primary contributor to severe psychiatric symptoms, especially in previously stable patients. We demonstrate the effectiveness of combination levothyroxine and olanzapine, with its favourable cardiac profile, in the treatment of myxoedema madness. Antipsychotics can be weaned once psychiatric symptoms resolve and hormone levels are stabilised.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Capgras Syndrome; Catatonia; Female; Humans; Hypothyroidism; Myxedema; Olanzapine; Thyroxine

Obsessive slowness is described to be a syndrome of extreme slowness in ways various tasks are performed. Its existence as an independent syndrome is challenged by authors, who regard it to be a part of obsessive compulsive disorder. We describe here a case of a 24-year-old male patient who presented with catatonic symptoms. Diagnostic difficulties and management issues are highlighted.

Topics: Behavioral Symptoms; Benzodiazepines; Catatonia; Diagnosis, Differential; Fluoxetine; Humans; Intellectual Disability; Intelligence Tests; Male; Obsessive Behavior; Olanzapine; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Young Adult

Topics: Adult; Aggression; Antipsychotic Agents; Autopsy; Benzodiazepines; Bipolar Disorder; Catatonia; Death, Sudden; Female; Humans; Hypothyroidism; Incidence; Lorazepam; Obesity; Olanzapine; Ovarian Neoplasms; Patient Admission; Patient Transfer; Pulmonary Embolism; Restraint, Physical; Risk; Valproic Acid; Venous Thrombosis

Although neurological manifestations of typhoid fever was thought to be obsolete from modern world, emergence of multidrug resistant typhoid bacilli and reporting of outbreak of typhoid fever with a range of early neuropsychiatric manifestations from various parts of world has led clinicians and investigators to re-evaluate the clinical spectrum of this endemic sinister disease. An 18-year-old male student was admitted in psychiatry ward with mutism, staring look, posturing and rigidity. There was history of typhoid fever 1 week before for which he was prescribed cefuroxime. Although investigations fail to provide any clue, his catatonic symptoms disappeared 2 weeks later giving way to resting tremor, bradykinesia, cog-wheel rigidity but without gait abnormality. He was successfully treated with lorazepam, amantidine, olanzapine and pramiprexole. The patient was asymptomatic within a month. He had no recurrence of symptoms till last follow-up, 6 months from the illness.

Topics: Adolescent; Amantadine; Antiparkinson Agents; Antipsychotic Agents; Benzodiazepines; Benzothiazoles; Catatonia; Humans; Hypnotics and Sedatives; Lorazepam; Male; Olanzapine; Parkinsonian Disorders; Pramipexole; Typhoid Fever

Acute catatonia is a non-specific, relatively frequent syndrome, which manifests itself through characteristic motor signs that enables its diagnosis. It occurs in association with mood disorders, psychotic disorders and several somatic or toxic diseases. Its short-term prognosis is of paramount importance. Without effective treatment, it is associated with high mortality. Despite the vital risk inherent in this disorder, it is not recognized as an independent diagnostic category by international rankings, which makes its diagnostic detection difficult and consequently does not allow adequate therapeutic care. However, if benzodiazepines and electroconvulsive therapy have proved effective in the treatment of acute catatonia, the role of atypical antipsychotics remains controversial. In fact, despite the progress made by the DSM-IV-TR and CIM 10 by the recognition of the etiologic diversity of catatonia, we deplore the absence to date of a consensus on clinical management and therapy of catatonia, which constitutes a source of confusion for practitioners in their approach to catatonic patients. To illustrate the difficulty in supporting these patients, we report here a clinical vignette.. Mr. M. aged 21, without psychiatric history, has shown a functional acute psychotic episode involving a delirious and hallucinatory syndrome associated with a marked catatonic dimension. Olanzapine was initiated at a dose of 10mg/d on the nineth day of hospitalization; the clinical picture was complicated by a malignant catatonia justifying the halt of olanzapine and the institution, in intensive units, of 15mg per day of lorazepam. After 72hours, the patient has not responded to this treatment. ECT was expected, but the patient died on the 12th day.. This case raises a threefold question: the crucial issue of immediate vital prognosis, that of the truthfulness of the positive diagnosis of this psychotic table and finally the issue of therapeutic care, primarily the well-founded or otherwise use of an atypical antipsychotic for the treatment of this type of psychotic disorder. For Mr. M., the clinical diagnosis that he has shown, according to the DSM IV-TR, is brief psychotic disorder "temporary diagnosis". This diagnosis - brief psychotic disorder - does not actually allow for a specific clinical approach to this type of psychotic table. The immediate vital prognosis inherent in the catatonic dimension may not be properly evaluated and the therapeutic conduct may miss the application of the specific treatment of the catatonic syndrome. The proper diagnosis for this type of psychotic disorder would be "catatonia" as proposed by Taylor and Fink, instead of "brief psychotic disorder" if the international rankings have included this disorder as a separate and independent diagnosis. The identification by international rankings of the catatonic syndrome as an independent diagnostic category seems essential for clinicians to allow: its clinical detection, the establishment of a syndromic diagnosis of catatonic disorder, appropriate prognostic evaluation and finally, the application of a suitable therapeutic strategy. Conventional treatment, benzodiazepine- and/or ECT-based, can solve the catatonic episode in a few days, irrespective of its etiology and its severity. Moreover, while all authors agree that conventional antipsychotics may induce a catatonic state or worsen a preexisting catatonia into a malignant catatonia and should thus be avoided for catatonic patients or with prior catatonic episodes, recent data from the literature emphasize the frequent and successful use of atypical antipsychotics, including olanzapine, in various clinical forms of benign catatonia. However, our patient did not respond to treatment with olanzapine and got even more complicated. Was the malignant catatonia that this patient has shown induced by olanzapine ? The answer to this question seems difficult since some authors report the efficacy of olanzapine in malignant catatonia. We wonder if we should have kept olanzapine and strengthen its dosage like Cassidy et al. in 2001 and Suzuki et al. in 2010 for the treatment of the malignant form constituted in this patient rather than having stopped it and used lorazepam as indica. The non-recognition of catatonia as an independent entity, the lack of a therapeutic consensus and the pending issue on the safety and efficacy of atypical antipsychotics in the treatment of catatonia are at the origin of the difficulties of therapeutic support of catatonic patients.

Topics: Acute Disease; Antipsychotic Agents; Benzodiazepines; Catatonia; Fatal Outcome; Hospitalization; Humans; Male; Olanzapine; Prognosis; Psychotic Disorders; Treatment Failure; Young Adult

This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

Topics: Adolescent; Amantadine; Antiparkinson Agents; Antipsychotic Agents; Benzodiazepines; Catatonia; Combined Modality Therapy; Creatine Kinase; Dibenzothiazepines; Diseases in Twins; Drug Substitution; Drug Therapy, Combination; Electroconvulsive Therapy; Female; Humans; Neurologic Examination; Olanzapine; Piperazines; Quetiapine Fumarate; Recurrence; Schizophrenia; Thiazoles

Topics: Aged; Antineoplastic Agents, Hormonal; Antipsychotic Agents; Benzodiazepines; Catatonia; Delirium; Humans; Male; Olanzapine; Prednisolone

We report the case of a 29-year-old man, who could not remember some words of Kanji and showed emotional instability. Magnetic resonance imaging (MRI) scan of his brain appeared normal. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis. An electroencephalogram (EEG) showed slow activities in both frontal regions of the brain. He was diagnosed as acute encephalitis. On his fourth hospital day, he was found to be catatonic and showed mutism, akinetism, and catalepsy. On the ninth day, he showed hyperpyrexia, muscle rigidity, difficulty in swallowing, respiratory insufficiency, and rhabdomyolysis (creatine phosphokinase (CK), 3038 IU/l). He was diagnosed as malignant catatonia. Intravenous administration of acyclovir, high-dose methylprednisolone, antibiotics, diazepam, and dantrolene sodium was not effective. After initiating oral administration of olanzapine, his condition improved.

Topics: Acute Disease; Administration, Oral; Adult; Antipsychotic Agents; Benzodiazepines; Catatonia; Electroencephalography; Encephalitis; Humans; Male; Olanzapine; Treatment Outcome

Topics: Antipsychotic Agents; Benzodiazepines; Catatonia; Child; Depressive Disorder, Major; Female; Follow-Up Studies; Humans; Olanzapine; Remission Induction

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 B(12) levels and intrinsic factor antibodies were found only by chance when they were included in a battery of further investigations. B(12) replacement was followed by prompt improvement. This case provides an argument for wider screening for B(12) deficiency in certain individuals with psychiatric disorders.

Topics: Adult; Anemia, Pernicious; Antipsychotic Agents; Benzodiazepines; Brain; Catatonia; Delayed Diagnosis; Diagnosis, Differential; Female; Humans; Hydroxocobalamin; Injections, Intramuscular; Magnetic Resonance Imaging; Neuropsychological Tests; Olanzapine; Recurrence; Tomography, X-Ray Computed; Vitamin B 12 Deficiency

Catatonia is a rare complication of multiple sclerosis (MS). We present a case of a 28-year-old inpatient with MS successfully treated with electroconvulsive therapy (ECT) after developing a catatonic syndrome. A subsequent relapse also responded to ECT, after which the patient received maintenance ECT for 13 months without complications. Follow-up 18 months later did not reveal any evidence of neurological deterioration. We conclude that ECT was a safe and effective treatment in this MS patient.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Catatonia; Disease Progression; Electroconvulsive Therapy; Humans; Male; Mood Disorders; Multiple Sclerosis; Olanzapine; Recurrence

Topics: Antipsychotic Agents; Benzodiazepines; Catatonia; Humans; Olanzapine; Taiwan; Young Adult

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Catatonia; Female; Humans; Olanzapine; Recurrence

To report the case of an 11-year-old girl who presented with acute onset of psychotic symptoms with catatonic features treated with electroconvulsive therapy (ECT).. Described herein is the case of an 11-year-old, prepubertal girl who represented with catatonic symptoms unresponsive to conventional medical treatment. After thorough clinical investigation and obtaining a second opinion we gained consent from her parents to perform ECT as a life saving procedure.. Six ECT treatments were administered with clinical improvement, the patient did develop hypomanic symptoms as a side-affect of ECT.. The patient exhibited potentially life-threatening self-harming behaviour secondary to catatonic and psychotic symptoms. Her behaviour and symptoms responded to ECT. The patient developed hypomania that responded to mood stabilization. ECT was a safe and effective treatment for catatonia in this prepubescent girl.

Topics: Acute Disease; Antipsychotic Agents; Benzodiazepines; Catatonia; Child; Electroconvulsive Therapy; Female; Hallucinations; Humans; Olanzapine

Topics: Aged; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Catatonia; Chlorpromazine; Cholinesterase Inhibitors; Cognition Disorders; Creatine Kinase; Dementia; Disease Progression; Donepezil; Female; Humans; Indans; Lorazepam; Muscle Rigidity; Neuroleptic Malignant Syndrome; Olanzapine; Piperidines; Recurrence; Risperidone

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Catatonia; Female; Humans; Male; Olanzapine

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Catatonia; Humans; Male; Muscle Rigidity; Olanzapine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Catatonia; Diagnosis, Differential; Electroconvulsive Therapy; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Treatment Outcome

A 17-year-old adolescent female presented to a psychiatric emergency room with excitement, confusion, and psychotic symptoms. After brief exposure to haloperidol and olanzapine, she developed fever, rigidity, waxy flexibility, autonomic instability, and elevated creatinine phosphokinase enzyme. Approximately 6 weeks after the onset of the illness, multiple laboratory tests, and evaluation at three different hospitals, the condition was effectively treated with electroconvulsive therapy (ECT). This case is a lesson in delayed recognition and the delayed use of ECT for the malignant catatonia/neuroleptic malignant syndrome.

Topics: Adolescent; Benzodiazepines; Brain; Catatonia; Diagnosis, Differential; Diagnostic Imaging; Electroconvulsive Therapy; Electroencephalography; Female; Haloperidol; Humans; Neuroleptic Malignant Syndrome; Neurologic Examination; Neuropsychological Tests; Olanzapine; Pirenzepine; Treatment Outcome

We present the case of a 31-year-old woman with recent refractory bipolar disorder who developed a malignant syndrome preceded by catatonic motor features. This resistant case of lethal catatonia responded selectively to high-dose olanzapine treatment. The case illustrates the need to consider lethal catatonia in apparent cases of neuroleptic malignant syndrome that do not respond to conventional treatment with dantrolene and bromocriptine.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Catatonia; Electroconvulsive Therapy; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Psychomotor Agitation

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Catatonia; Dose-Response Relationship, Drug; Follow-Up Studies; Humans; Male; Olanzapine; Pirenzepine; Severity of Illness Index; Treatment Outcome