Abstract- Poster

Abstract

Introduction:Malignant catatonia is a life-threatening psychomotor syndrome which presents along with symptoms of catatonia like stupor, waxy flexibility, catalepsy, mutism, negativism, posturing, stereotypy, agitation, grimacing, echolalia and echopraxia, it can also include autonomic instability like fever, hypertension and tachycardia, which makes it difficult to differentiate from other disorders like delirium, neuroleptic malignant syndrome.Case Description:A 24yr old female patient who was 5weeks postpartum with no previous history of psychiatric illness and no significant family history presented with postpartum psychosis. Symptoms included over religiosity, decreased need for sleep, talking and laughing to self, anger and irritability, and not taking care of her new born baby for 1 week before presenting to the op. At the time of presentation patient was unkempt, uncooperative, agitated and non-verbal. She also developed waxy flexibility, negativism, catalepsy and grimacing, she stopped drinking water and eating for 2days. Patient showed no response to Olanzapine. With this Lorazepam challenge was done and patient showed slow response making catatonia as a differential. Later she developed fever and autonomic instability and elevated creatine kinase with her symptoms Modified ECT was initiated to treat Malignant catatonia. She responded well to 4 sessions of ECT with complete resolution of symptoms. She was maintaining well on low dose of lorazepam, mood stabilizer and antipsychotic for maintenance of her mood and psychotic symptoms.Conclusion:In severe cases of catatonia like in Malignant catatonia ECT has to be initiated as soon as possible as Malignant catatonia has higher rate of response to ECT than treatment with Lorazepam alone.