Abstract
BackgroundCatatonia is a neuropsychiatric syndrome with motor and behavioural symptoms. Though usually occuring in patients with schizophrenia and mood disorders, this syndrome may also be associated with neurological diseases or general medical conditions. Few cases of catatonia associated with autoimmune disorders have been described.Case presentationHere, we report the case of a 27-year-old woman diagnosed with Hashimoto’s encephalitis (HE) who attempted suicide and infanticide by defenestration. As she presented risk factors for postpartum psychosis, she was treated principally with antipsychotics. Despite adequate treatment for psychosis, symptoms worsened and she developed catatonia. Complementary investigations showed elevated titres of anti-thyroglobulin and anti-thyroperoxidase antibodies (200 and 10 times, respectively, as compared to normal levels) and electroencephalography were suggestive of encephalopathy. In the presence of an otherwise unexplained neuropsychiatric condition, HE was suspected and oral prednisolone was introduced. Psychiatric symptoms improved dramatically within 72 h and the patient was still free of any symptom 3 years later.ConclusionCatatonia of organic aetiology should always be considered before a psychiatric aetiology especially in case of clinical worsening in spite of adequate psychotropic treatment. To our knowledge, this is the first description of catatonia associated with HE.
Highlights
Catatonia is a neuropsychiatric syndrome with motor and behavioural symptoms
Catatonia of organic aetiology should always be considered before a psychiatric aetiology especially in case of clinical worsening in spite of adequate psychotropic treatment
This is the first description of catatonia associated with Hashimoto’s encephalitis (HE)
Summary
As psychiatric symptoms can be prominent in encephalopathy, they could potentially be misleading and point to catatonia of psychiatric origin. Hashimoto’s encephalopathy is a difficult diagnosis, especially when the thyroid hormonal status is normal. Clinicians should think about dosing thyroid antibodies when confronted with catatonia. A multidisciplinary diagnosis approach with psychiatrists, internists and neurologists is recommended in any case of catatonia [36]. Consent section Written informed consent was obtained from the patients for publication of their case reports and any accompanying images. We have no financial gain or loss from the publication of the manuscript. The article was written by LL, MEM, ER. PV, MAZ and JMD has made substantial contributions to the analysis and interpretation of data and has been involved in revising the article critically for important intellectual content. LL, MEM, ER, PV, MAZ and JMD have given final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
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