Introduction:
Catatonia is regarded as a diverse type of motor dysregulation syndrome
that includes mutism, immobility, catalepsy, negativism, stereotypies,
and echo phenomena (Rasmussen et al., 2016). More than 10% of patients
with acute psychiatric conditions have been found to experience this
psychomotor condition (Rasmussen et al., 2016). The syndrome has been
divided into two subtypes. Retarded-type catatonia is marked by
rigidity, immobility, staring, mutism, and a variety of other clinical
symptoms. In a less frequent condition known as excited catatonia,
patients experience protracted episodes of psychomotor agitation.
Catatonia once believed to be a subset of schizophrenia, is now known to
coexist with a wide range of physical and mental health conditions,
including affective disorders like depression, bipolar disorder, and
schizophrenia and medical conditions like encephalitis, autoimmune
disorders, strokes, intracranial mass lesions, Vitamin B12 deficiency,
Wilson disease, and as a consequence of other drugs like psychotropic
drugs, including fluphenazine, haloperidol, risperidone, and clozapine,
non-psychotropic drugs such as steroids, disulfiram, ciprofloxacin, and
several benzodiazepines (McKeown et al., 2010).
In many cases, catatonia must be treated before a precise diagnosis of
any underlying issues can be made (Gross et al., 2008). There are
however many unanswered questions regarding the connection between OCD
and catatonia, which makes it difficult to diagnose and treat patients
who suffer from both diseases (Fontenelle et al., 2007).
The fact that catatonic syndrome is linked to other illnesses highlights
the urgency of a prompt diagnosis and course of action. For instance,
the development of neuroleptic malignant syndrome, which has a mortality
rate of about 10% and may be clinically indistinguishable from
malignant catatonia, appears to be a risk factor for catatonia.
Catatonia itself can make it difficult, if not impossible, to conduct
patient interviews and physical tests, making it harder to identify
underlying diseases. These side effects of catatonia emphasize how
critical it is to identify the condition and start treatment as soon as
possible (Rasmussen et al., 2016).
The cornerstone of curing disease is proper diagnosis. Unlike medical or
surgical diseases, mental disorders are substantially symptom-based
diagnoses. According to the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) or the International Classification of Diseases, Tenth
Revision, Clinical Modification (ICD-10), in the process of evaluating,
syndromes are invariably associated with certain diagnoses. Hence,
although rare, catatonia may be associated with obsessive-compulsive
disorder (OCD) (Psychiatry.Org - DSM , n.d.; World Health
Organization, 1993).
Benzodiazepines are considered first-line treatments for catatonia.
However, only 70% and 79% of cases remit with benzodiazepines and
lorazepam respectively (Hawkins et al., 1995). In refractory cases with
medical therapy, the use and efficacy of electroconvulsive therapy (ECT)
are bolstered by limited case studies (Duarte-Batista et al., 2020;
D’Urso et al., 2012). In this paper, we present a case of 36 years old
woman who developed episodes of catatonia during the course of her
obsessive-compulsive disorder (OCD). Success rates have been recorded
with both Benzodiazepines and Electroconvulsive therapy (ECT). Gauging
the severity of her symptoms and poor drug compliance, the patient was
opted for and successfully treated with ECT. This report has been
drafted in accordance with CARE guidelines (Gagnier et al., 2013).