["Catatonic dilemma". Therapy with lorazepam and clozapine].
We are reporting on a patient with a schizoaffective disorder (ICD 10:F25.1), whose catatonic symptoms deteriorated while receiving high-potency neuroleptic drugs in combination with anticholinergic medication. Initially there was a "catatonic dilemma", i.e. it was not possible to differentiate between the morbigenous and pharmacogenic (malignant neuroleptic syndrome) etiology of the catatonic symptoms. Catatonic symptoms were successfully treated with a combination of lorazepam and clozapine. The severe catatonic syndrome was found to be a neuroleptic-induced deterioration of a primary morbogenous catatonic syndrome. Thus, this case also suggests that the malignant neuroleptic syndrome and neuroleptic non-responsive catatonia may not be two different disease entities but that catatonia under neuroleptic medication is caused by the interaction of individual disposition, morbigenous and pharmacogenic factors.
Lausberg
H
H
Psychiatrische Klinik, Freien Universität Berlin.
Hellweg
R
R
D000328:Adult; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003024:Clozapine / Q000008:administration & dosage* / Q000009:adverse effects; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis / Q000188:drug therapy; D012560:Schizophrenia, Catatonic / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*
D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D003024:Clozapine; D008140:Lorazepam