quetiapine-fumarate and Catatonia

We describe a case with complicated clinical presentations who was difficult to treat. We described the possible etiologies and differential diagnosis of neuroleptic malignant syndrome (NMS), catatonia, and infection, in details. This patient was also referred to neuro-intensive care unit for extensive workup and treatments by neurologist guidelines. In addition, we also used lorazepam-diazepam protocol and antipsychotics, but both failed to completely relieve her symptoms. She eventually responded to electroconvulsive therapy (ECT).A 60-year-old female patient with schizophrenia was diagnosed to suspected pneumonia, urinary tract infection, and retarded catatonia at first. The brain computed tomography revealed no significant finding. She developed NMS caused by the administration of low-dose quetiapine (200 mg) after carbamazepine was discontinued. The Francis-Yacoub NMS rating scale (F-Y scale) total score was 90. We utilized lorazepam-diazepam protocol and prescribed bromocriptine and amantadine, but NMS was not improved. Meanwhile, we arranged the brain magnetic resonance imaging to survey the physical problem, which revealed agenesis of septum pellucidum and dilated lateral ventricles. She was then transferred to the neuro-intensive care unit on the 15th hospital day for complete study. The results of cerebrospinal fluid study and electroencephalography were unremarkable. She was transferred back to psychiatric ward on the 21st hospital day with residual catatonic and parkinsonian symptoms of NMS, and the F-Y scale total score was 63. Finally, her residual catatonic condition that followed NMS got improved after 11 sessions of ECT. On the 47th hospital day, the F-Y scale total score was 9.This report underscores that the ECT is an effective treatment for a patient of NMS when other treatments have failed.

Topics: Antipsychotic Agents; Carbamazepine; Catatonia; Electroconvulsive Therapy; Female; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Quetiapine Fumarate

Topics: Antipsychotic Agents; Catatonia; Humans; Quetiapine Fumarate

Topics: Benzodiazepines; Catatonia; Humans; Quetiapine Fumarate; Substance Withdrawal Syndrome

Topics: Antipsychotic Agents; Catatonia; Clozapine; Humans; Psychotic Disorders; Quetiapine Fumarate

Malignant catatonia (MC) is a movement disorder syndrome characterized by immobility, rigidity, and consciousness disorders that develops in association with mental and physical diseases. It is often fatal due to hyperthermia, rhabdomyolysis, and acute kidney injury. Its clinical symptoms are similar to those of another disorder, neuroleptic malignant syndrome (NMS), and it is often difficult to distinguish between the 2 disorders.. An Asian woman in her 60s with history of schizophrenia. She was admitted to our hospital because of symptoms such as fever, unconsciousness, and muscle rigidity. Blood tests showed kidney injury and high creatinine kinase levels.. At the time of admission, she had been diagnosed with NMS complicated by pulmonary aspergillosis and was undergoing treatment although there was no improvement.. Subsequently, the administration of propofol, a gamma-aminobutyric acid A agonist, markedly improved the symptoms, and the diagnosis was corrected to MC. At the beginning of her hospitalization, she received dantrolene, bromocriptine, amantadine, and L-3,4-dihydroxyphenylalanine as treatment for NMS, but her symptoms did not improve. With propofol, which is used for sedation, her catatonic symptoms improved markedly. Quetiapine administration further improved the symptoms, and it eventually resolved completely.. The patient's MC was in remission. Prolonged intensive care management resulted in a decline in activities of daily living, and she required rehabilitation at another hospital.. This is the first report of MC with suspected involvement of pulmonary aspergillosis. MC differs from NMS, in that it is treated more effectively with gamma-aminobutyric acid A agonists. Although benzodiazepines are the first choice for the diagnosis and treatment of MC, they are ineffective for majority of patients with schizophrenia. However, even in such cases, propofol and quetiapine are effective, and they facilitate diagnosis and treatment.

Topics: Catatonia; Diagnosis, Differential; Female; Humans; Hypnotics and Sedatives; Middle Aged; Neuroleptic Malignant Syndrome; Propofol; Pulmonary Aspergillosis; Quetiapine Fumarate; Renal Insufficiency; Schizophrenia

Topics: Aged; Antipsychotic Agents; Basal Ganglia; Brain; Catatonia; Cerebral Cortex; Creutzfeldt-Jakob Syndrome; Depression; Diagnosis, Differential; Electroencephalography; Humans; Magnetic Resonance Imaging; Male; Quetiapine Fumarate

Bipolar disorder (BD) has been linked with the manifestation of catatonia in subjects with autism spectrum disorders (ASD). Idiopathic basal ganglia calcification (IBGC) is characterized by movement disorders and various neuropsychiatric disturbances including mood disorder.. We present a patient with ASD and IBGC who developed catatonia presenting with prominent dystonic feature caused by comorbid BD, which was treated effectively with quetiapine.. In addition to considering the possibility of neurodegenerative disease, careful psychiatric interventions are important to avoid overlooking treatable catatonia associated with BD in cases of ASD presenting with both prominent dystonic features and apparent fluctuation of the mood state.

Topics: Adolescent; Autistic Disorder; Basal Ganglia; Bipolar Disorder; Brain Diseases; Calcinosis; Catatonia; Diagnosis, Differential; Dibenzothiazepines; Humans; Magnetic Resonance Imaging; Male; Quetiapine Fumarate; Tomography, X-Ray Computed

Neuroleptic malignant syndrome (NMS) is a rare life-threatening condition associated with the use of antipsychotics and other drugs that influence dopaminergic transmission. Although NMS is typically associated with classical antipsychotics, it can also be induced by atypical antipsychotics. In this paper, we report a case of NMS associated with clozapine use.. A 27-year-old male was diagnosed as schizophrenia in 2006 and zuclopenthixol depot was administered parenterally. Following the second injection, NMS was diagnosed and he was switched to clozapine. After 4 years of clozapine use, one day, he suddenly stopped eating, stayed in bed all day, and had incontinence. Upon examination at our hospital the patient had muscle rigidity, high fever, leukocytosis, and a high creatine phosphokinase level, and NMS was diagnosed. He was put on bromocriptine. NMS resolved, but psychotic relapse and catatonia developed. 10 sessions of electro convulsive treatment (ECT) were administered. Quetiapine 25 mg/day was introduced and titrated up to 600 mg/day afterwards. He has been using quetiapine 600 mg/day for 18 months and at the time this manuscript was written has not had any signs of psychosis or NMS.. NMS is usually induced by the use of agents with high dopaminergic affinity. Incomplete or extraordinary NMS cases have been reported due to clozapine and atypical antipsychotics. The presented case is noteworthy due to the complete and typical presentation of NMS. It should always be kept in mind that all atypical antipsychotics including clozapine have the probability to induce NMS although not common.

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Creatine Kinase; Diagnosis, Differential; Humans; Male; Neuroleptic Malignant Syndrome; Psychotic Disorders; Quetiapine Fumarate; Schizophrenia; Serotonin Antagonists

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: Catatonia; Dibenzothiazepines; Electroconvulsive Therapy; Hepatolenticular Degeneration; Humans; Male; Quetiapine Fumarate; Young Adult

Sequential therapeutic trials for catatonoid frontal signs in clinically-evident frontotemporal dementia (n = 2) revealed differential benefits for lorazepam, amantadine, memantine, pramipexole, aripiprazole, quetiapine, citalopram, and donepezil, although certain signs also worsened. Citalopram and donepezil were poorly tolerated. Ramelteon was without effect. While memantine appeared to improve cognition in case 1, this remains to be established by more reliable neuropsychological testing. Parkinsonism (case 2) responded to pramipexole, but not amantadine or levodopa. Possible relationships of catatonoid signs requiring future confirmation include insufficient GABA-A (multiple signs) and D2 (mutism) and excessive NMDA (immobility, rigidity), D2/D3 (mannerisms, verbal perseveration), and 5HT1a (staring) receptor stimulation. Low-dose lorazepam and quetiapine required close monitoring.

Topics: Aged; Amantadine; Antipsychotic Agents; Aripiprazole; Benzothiazoles; Catatonia; Citalopram; Clinical Trials as Topic; Dibenzothiazepines; Donepezil; Dopamine Agents; Excitatory Amino Acid Antagonists; Female; Frontotemporal Dementia; Humans; Hypnotics and Sedatives; Indans; Lorazepam; Memantine; Middle Aged; Nootropic Agents; Piperazines; Piperidines; Pramipexole; Quetiapine Fumarate; Quinolones; Selective Serotonin Reuptake Inhibitors

We encountered 2 patients with a psychiatric disorder (depression in one and catatonia in one) accompanied by motor inhibition that was complicated by pulmonary embolism (PE). In both cases, the psychiatric disorder was safely resolved with electroconvulsive therapy (ECT) during anticoagulant therapy. The 2 cases direct our attention to at least 3 important points regarding safe administration of ECT shortly after the occurrence of PE, that is, careful evaluation of cardiac function and residual deep vein thrombosis before the start of an ECT course, adjustment of anticoagulants, and prevention of recurrent deep vein thrombosis and PE by methods in addition to anticoagulant therapy (fluid infusion, use of support hose, and timely ECT).

Topics: Aged; Anticoagulants; Antipsychotic Agents; Catatonia; Depressive Disorder, Major; Dibenzothiazepines; Electroconvulsive Therapy; Female; Fluid Therapy; Heart Function Tests; Humans; Hypochondriasis; Lithiasis; Middle Aged; Pulmonary Embolism; Quetiapine Fumarate; Recurrence; Venous Thrombosis

A 22-year-old woman went through a period with a labile mood that first turned into psychotic hyperactivity and was then followed by hyperthermia and exhaustion. This was accompanied by diminished consciousness, sinus arrhythmia and respiratory insufficiency. With a working diagnosis of 'lethal catatonia' she was treated by electroshock and later also with the antipsychotic agent quetiapine. After a few electroshock treatments her vital functions improved and ultimately, the patient recovered. Lethal catatonia is characterised by acute excitation, catalepsy, autonomic instability and fever, which can lead to death. The syndrome often starts with mood instability, which turns into hyperactivity accompanied by hyperthermia and exhaustion. The creatine kinase, blood-sedimentation rate and leukocyte count are often raised. Lethal catatonia must be distinguished from the neuroleptic malignant syndrome, serotonin syndrome and encephalitis. The pathophysiology is unclear, but most reports suggest a hypodopaminergic state. The syndrome is associated with affective disorders and schizophrenia. Early recognition is made difficult by the low frequency of appearance, diversity in nomenclature, and strong resemblance to other syndromes.

Topics: Adult; Antipsychotic Agents; Catatonia; Diagnosis, Differential; Dibenzothiazepines; Dopamine; Electroconvulsive Therapy; Female; Humans; Quetiapine Fumarate; Treatment Outcome