EPA-1364 – Malignant catatonia and neuroleptic malignant syndrome: two sides of the same coin?

Abstract

Catatonia is a neuropsychiatric syndrome that appears in medical, neurological and psychiatric disorders. The diversity of its presentation led to the identification of different subtypes, one of them called the’malignant catatonia’ (MC). This subtype shares many characteristics with the neuroleptic malignant syndrome (NMS), which could reflect a similar pathophysiology. It will be made a revision of malignant catatonia/NMS based on a case report. Presentation of the case report and review of the literature in PubMed and reference books. A Bipolar patient with 54 years developed a clinical picture characterized by mutism, negativism and immobility. The clinical picture rapidly worsened with the onset of great muscle rigidity, autonomic changes (hemodynamic instability, diaphoresis), leukocytosis and rhabdomyolysis. Supportive care was started, aripiprazole was suspended and the patient started electroconvulsive therapy (ECT) in combination with benzodiazepines which resolved the clinical picture. Before discharge aripiprazole was reintroduced without recurrence of the symptoms. The malignant catatonia was described before the introduction of psychotropic agents and studies suggest that it is indistinguishable from NMS, either clinically or by laboratory tests. Whether or not NMS and MC are the same syndrome with different triggers, they are life threatening. In this case ECT showed high efficacy leading us to assume catatonia as the probable syndrome. However, some studies report the efficacy of this procedure in the treatment of NMS as well.