Catatonia in obsessive-compulsive disorder: etiopathogenesis, differential diagnosis, and clinical management.
OBJECTIVE
We describe the case of a patient who developed an episode of catatonia during the course of her life-long obsessive-compulsive disorder (OCD) and discuss issues related to the etiopathogenesis, differential diagnosis, and therapeutic management of this association.


BACKGROUND
Catatonia is conventionally considered a heterogeneous syndrome of motor dysregulation characterized by mutism, immobility, negativism, posturing (catalepsy), stereotypies, and echophenomena. The relationship between OCD and catatonia is still misunderstood and poses significant challenges to the diagnosis and treatment of patients with both conditions.


METHODS
Naturalistic follow-up of a single case.


RESULTS
A patient with OCD developed catatonia in concert with deteriorating mood, thought, and behavior. This atypical clinical presentation of individuals with OCD and the list of differential diagnosis raised during the patient's clinical assessment are discussed on 3 different levels: symptomatic presentation, comorbidity pattern, and pharmacodynamic mechanisms involved.


CONCLUSIONS
The development of a systematic therapeutic plan for patients with OCD and comorbid catatonia includes: the fine-tuning of the antiobsessional treatment; management of comorbid disorders that may engender catatonia; prompt discontinuation, and subsequent slow reintroduction of drugs deemed to trigger toxic reactions or to worsen comorbid disorders and, ultimately, the catatonia; and the implementation of specific anticatatonia measures.
Fontenelle
Leonardo F
LF
Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil. ifontenelle@gmail.com
Lauterbach
Edward C
EC
Telles
Leonardo L
LL
Versiani
Marcio
M
Porto
Fábio H
FH
Mendlowicz
Mauro V
MV
D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002389:Catatonia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000188:drug therapy; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors