ECT treatment of malignant catatonia/NMS in an adolescent: a useful lesson in delayed diagnosis and treatment.
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.
Division of Child and Adoloscent Psychiatry, University of Michigan, Ann Arbor, Michigan 48109-0390, USA. neerag@umich.edu
Neera
N
Ghaziuddin
Iyad
I
Alkhouri
Donna
D
Champine
Paul
P
Quinlan
Thomas
T
Fluent
Mohammad
M
Ghaziuddin
D000293:Adolescent; D001569:Benzodiazepines; D001921:Brain / Q000187:drug effects / Q000473:pathology; D002389:Catatonia / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004565:Electroconvulsive Therapy; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis / Q000628:therapy*; D009460:Neurologic Examination / Q000187:drug effects; D009483:Neuropsychological Tests; D000077152:Olanzapine; D010890:Pirenzepine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
D001569:Benzodiazepines; D010890:Pirenzepine; D006220:Haloperidol; D000077152:Olanzapine