Recurrent Catatonia Onset in an Octogenarian Woman Managed with Electroconvulsive Therapy

Abstract

<h3>Introduction</h3> Catatonia is a neuropsychiatric syndrome of motor, affective and behavioral dysregulation, accompanied by potential systemic complications with significant morbidity and mortality¹^,². Multiple disorders have been associated with catatonia; these include structural and intrinsic brain diseases, systemic disorders, and psychiatric disorders³,⁴. In the elderly, the prevalence of catatonia fluctuates between 5.5%-11.22% depending on the clinical setting⁵^,⁶. Despite the significant prevalence, there is limited literature regarding the clinical characteristics of recurrent catatonia in the elderly. <h3>Methods</h3> We hereby describe a case of a 91-year-old woman with recurrent major depressive disorder, who presented with recurrent catatonia and comorbidities of atrial fibrillation on therapeutic anticoagulation, hypertension, mild cognitive impairment, and constipation. <h3>Results</h3> The patient's initial presentation occurred at the age of 87 years when she presented with symptoms of catatonia consisting of immobility, mutism, rigidity, negativism, and severe decline in oral intake as the initial manifestation of her first non-psychotic depressive episode. During her initial presentation, catatonia was treated with lorazepam with an adequate response but was transitioned to an acute course of bilateral electroconvulsive therapy (ECT) due to side effects with lorazepam. Her symptoms rapidly resolved after three ECT treatments, and she was on maintenance antidepressant therapy with venlafaxine extended-release 75 mg daily. Catatonia symptoms recurred after two years concomitantly with a depressive episode with psychotic features. The patient responded well once again to the acute course of bilateral ECT during her second episode of depression and required a prolonged course of maintenance ECT every one to three weeks with adequate tolerance. She had a recurrence of catatonia at the age of 91 years in the context of her husband's death. She was managed with an acute course of six ECT treatments and transitioned to weekly maintenance ECT. During all presentations, extensive medical workup was unremarkable for organic causes, and there was no evidence of cognitive decline. Her symptoms of catatonia remitted completely in between depressive episodes. <h3>Conclusions</h3> Catatonia can be a life-threatening emergency. Recurrent catatonia could be a precursor of severe major depressive episodes. This case highlights the importance of identifying catatonia in the elderly, brings awareness to the multiple etiologies to be considered when catatonia arises, including affective disorders, and the potential role of ECT in the management of recurrent catatonia. Further studies are needed regarding the prognosis of recurrent catatonia in the geriatric population. <h3>This research was funded by</h3> None