Treatment of a Complex Case of Catatonia and Conversion Features With Electroconvulsive Therapy in a 14-Year-Old Male

Evaluation of Catatonia with Different Assessment Scales in Psychiatry and Neurology

OBJECTIVE

Catatonia is a syndrome that can be missed in clinical settings. Diagnosis of catatonia is important because the condition can be reversible and is associated with severe complications. This study aims to screen patients with catatonia admitted to a university hospital's psychiatry and neurology services, examine their characteristics, and compare the coverage of different catatonia scales.

METHOD

During a consecutive 20 months study period, the Turkish adaptations of the Bush-Francis Catatonia Rating and the KANNER scales were administered in psychiatry and neurology inpatient units and patients on the waiting list for psychiatric hospitalization. The participants were also evaluated with DSM-5 criteria. In addition, the sociodemographic and clinical characteristics of the patients in the psychiatric group were compared.

RESULTS

A total of 214 patients were evaluated. Twenty-eight (13.1%) screened positive for catatonia, and 23 (82.1%) were diagnosed with catatonia according to DSM-5 criteria. KANNER and Bush- Francis identified the same patients as having catatonia. In addition to schizophrenia and mood disorders; neurodevelopmental disorder, encephalitis, postpartum psychosis, obsessive-compulsive disorder, delirium, cerebrovascular disease, functional neurological symptom disorder have also been found to be associated with catatonia. The most common complication was urinary tract infection. Life-threatening complications were also observed.

CONCLUSION

Overlooking catatonia may have dire consequences. Adhering solely to the DSM-5 criteria may miss some patients with catatonia. Widely and efficiently using standardized catatonia scales can improve detection capacity and enhance the management of morbidity and mortality.

An Unusual Presentation of Catatonia-Like Behavior: Differentiating Malingering from Catatonia

Malingering involves the intentional production of physical or psychological behaviors due to motivation from external incentives, posing unique challenges to healthcare. Although malingering as an entity has been well studied, the current literature does not explore the intentional production of catatonia-like behavior or how to differentiate malingering from catatonia. Here, we describe a 45-year-old female who was admitted to an acute psychiatric hospital with a complex presentation of catatonia-like signs that was ultimately thought to be volitional behavior, resulting in a diagnosis of malingering. We highlight the important factors considered in her presentation, the differences between her behaviors and true catatonia, and other important differential diagnoses to consider. Although a diagnosis of malingering is difficult to make, we underscore the importance of reaching this conclusion in order to avoid unnecessary and potentially harmful medical interventions. We stress the importance of shifting focus from medical management to more appropriate patient goals such as providing social services and treatment of other underlying psychiatric illnesses.