Catatonic Dilemma in a 33-Year-Old Woman: A Discussion
Case. We report a case of catatonia with elevated CK, elevated temperature, and hypoferritinemia after abrupt discontinuation of clozapine in a patient with known proneness to catatonic symptoms. Reinstatement of clozapine therapy was contraindicated due to leukopenia. Neuroleptic malign syndrome co...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Case Reports in Psychiatry |
| Online Access: | http://dx.doi.org/10.1155/2013/542303 |
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| author | Alexander Koch Karin Reich Jan Wielopolski Marion Clepce Marie Fischer Johannes Kornhuber Norbert Thuerauf |
| author_facet | Alexander Koch Karin Reich Jan Wielopolski Marion Clepce Marie Fischer Johannes Kornhuber Norbert Thuerauf |
| author_sort | Alexander Koch |
| collection | DOAJ |
| description | Case. We report a case of catatonia with elevated CK, elevated temperature, and hypoferritinemia after abrupt discontinuation of clozapine in a patient with known proneness to catatonic symptoms. Reinstatement of clozapine therapy was contraindicated due to leukopenia. Neuroleptic malign syndrome could not be ruled out by the administration of quetiapine; this prevented the quick use of other potent D2 antagonists. Some improvement was achieved through supportive therapy, high dose of lorazepam, and a series of 10 ECT sessions. Returning to baseline condition was achieved by a very careful increase of olanzapine. Discussion. Catatonic symptoms in schizophrenia as well as in NMS might be caused by a lack of striatal dopamine (CS) or dopamine D2 antagonism (NMS). CS might be a “special” kind of schizophrenia featuring both hypo- and hyperactivity of dopaminergic transmission. ECT has been described as a “psychic rectifier” or a “reset for the system.” The desirable effect of ECT in cases of CS might be dopaminergic stimulation in the striatum and decrease of both the dopaminergic activity in the limbic system and the serotonergic activity on 5-HT2 receptors. The desirable effect of ECT in NMS would be explained by activation of dopaminergic transmission and/or liberation of dopaminergic receptors from the causative neuroleptics. |
| format | Article |
| id | doaj-art-46e5bec6fd684542a09f0d0abd8573d4 |
| institution | Kabale University |
| issn | 2090-682X 2090-6838 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Psychiatry |
| spelling | doaj-art-46e5bec6fd684542a09f0d0abd8573d42025-02-03T05:50:15ZengWileyCase Reports in Psychiatry2090-682X2090-68382013-01-01201310.1155/2013/542303542303Catatonic Dilemma in a 33-Year-Old Woman: A DiscussionAlexander Koch0Karin Reich1Jan Wielopolski2Marion Clepce3Marie Fischer4Johannes Kornhuber5Norbert Thuerauf6Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, GermanyDepartment of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, GermanyDepartment of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, GermanyDepartment of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, GermanyDepartment of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, GermanyDepartment of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, GermanyDepartment of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, GermanyCase. We report a case of catatonia with elevated CK, elevated temperature, and hypoferritinemia after abrupt discontinuation of clozapine in a patient with known proneness to catatonic symptoms. Reinstatement of clozapine therapy was contraindicated due to leukopenia. Neuroleptic malign syndrome could not be ruled out by the administration of quetiapine; this prevented the quick use of other potent D2 antagonists. Some improvement was achieved through supportive therapy, high dose of lorazepam, and a series of 10 ECT sessions. Returning to baseline condition was achieved by a very careful increase of olanzapine. Discussion. Catatonic symptoms in schizophrenia as well as in NMS might be caused by a lack of striatal dopamine (CS) or dopamine D2 antagonism (NMS). CS might be a “special” kind of schizophrenia featuring both hypo- and hyperactivity of dopaminergic transmission. ECT has been described as a “psychic rectifier” or a “reset for the system.” The desirable effect of ECT in cases of CS might be dopaminergic stimulation in the striatum and decrease of both the dopaminergic activity in the limbic system and the serotonergic activity on 5-HT2 receptors. The desirable effect of ECT in NMS would be explained by activation of dopaminergic transmission and/or liberation of dopaminergic receptors from the causative neuroleptics.http://dx.doi.org/10.1155/2013/542303 |
| spellingShingle | Alexander Koch Karin Reich Jan Wielopolski Marion Clepce Marie Fischer Johannes Kornhuber Norbert Thuerauf Catatonic Dilemma in a 33-Year-Old Woman: A Discussion Case Reports in Psychiatry |
| title | Catatonic Dilemma in a 33-Year-Old Woman: A Discussion |
| title_full | Catatonic Dilemma in a 33-Year-Old Woman: A Discussion |
| title_fullStr | Catatonic Dilemma in a 33-Year-Old Woman: A Discussion |
| title_full_unstemmed | Catatonic Dilemma in a 33-Year-Old Woman: A Discussion |
| title_short | Catatonic Dilemma in a 33-Year-Old Woman: A Discussion |
| title_sort | catatonic dilemma in a 33 year old woman a discussion |
| url | http://dx.doi.org/10.1155/2013/542303 |
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