Catatonia Research Articles

The classification of psychotic disorders has undergone avariety of changes. Since Karl Ludwig Kahlbaum's (Kahlbaum 1874) first descriptions of catatonic states and Emil Kraepelin's (Kraepelin 1883) nosological classification of psychotic syndromes in the second half of the nineteenth century, the diagnostic criteria for these disorders have been repeatedly modified, significantly impacting clinical practice. Eugen Bleuler (Bleuler 1911) coined the term "schizophrenia", emphasizing the disturbances in thinking, feeling and acting that he had observed. With the introduction of the 11th version of the International Classification of Diseases (ICD-11), several significant changes to the diagnostic criteria were introduced. First-line symptoms according to Schneider lost importance. The subtypes (e.g., paranoid, hebephrenic and catatonic schizophrenia) were also omitted and symptom and progression classifiers have been introduced instead. Finally, catatonia is now defined as an independent diagnostic entity, while in ICD-10 it was still assigned to schizophrenia under the code F20.2. This recognizes catatonia's independent, cross-diagnostic nature. Due to these symptom and progression classifiers, the ICD-11 now takes amore ahybrid categorical and dimensional approach to the diagnosis than the previous version.

Schizophrenia (SZ) is associated with chronic oxidative stress in the patient's body. Previous studies revealed an increased copy number of genes for 47S pre-ribosomal RNA (pre-rRNA) in SZ patients. In this study, levels of oxidative stress and factors involved in the adaptive response to chronic stress (rDNA transcription) were, for the first time, compared in blood cells of patients with catatonic SZ(C) and paranoid SZ(P), chronic forms of schizophrenia, as well as healthy controls (HC). Ribosomal DNA (rDNA) and telomere repeat (TR) were quantified in leukocyte DNA using non-radioactive quantitative hybridization. Fragments of 5' external transcribed spacer (5' ETS) and 18S rRNA were assayed in leukocyte RNA using quantitative reverse transcription PCR (RT-qPCR). Proteins γ-histone H2AX (γH2AX), NADPH-oxidase 4 (NOX4), nuclear factor erythroid 2-related factor 2 (NRF2), BCL2-like protein 4 (BAX), BCL2, and oxidation marker 8-oxo-2'-deoxyguanosine (8-oxodG) were quantified in blood lymphocytes using flow cytometry. SZ(C) cells exhibited higher levels of the oxidative stress markers than SZ(P) and HC cells. The rDNA copy numbers in SZ(C) genomes negatively correlated with the amounts of the oxidative stress markers levels. Thus, genomes of blood cells isolated from catatonic patients harbor more copies of ribosomal genes than those from paranoid schizophrenia patients, correlating with higher levels of rRNA in catatonic patients. The upregulated ribosome biogenesis appears to be required for adaptive response to the elevated levels of oxidative stress in catatonic compared to paranoid patients.

Anti NMDA receptor encephalitis manifested as acute psychosis- case report

The classification of psychotic disorders has undergone avariety of changes. Since Karl Ludwig Kahlbaum's (Kahlbaum 1874) first descriptions of catatonic states and Emil Kraepelin's (Kraepelin 1883) nosological classification of psychotic syndromes in the second half of the nineteenth century, the diagnostic criteria for these disorders have been repeatedly modified, significantly impacting clinical practice. Eugen Bleuler (Bleuler 1911) coined the term "schizophrenia", emphasizing the disturbances in thinking, feeling and acting that he had observed. With the introduction of the 11th version of the International Classification of Diseases (ICD-11), several significant changes to the diagnostic criteria were introduced. First-line symptoms according to Schneider lost importance. The subtypes (e.g., paranoid, hebephrenic and catatonic schizophrenia) were also omitted and symptom and progression classifiers have been introduced instead. Finally, catatonia is now defined as an independent diagnostic entity, while in ICD-10 it was still assigned to schizophrenia under the code F20.2. This recognizes catatonia's independent, cross-diagnostic nature. Due to these symptom and progression classifiers, the ICD-11 now takes amore ahybrid categorical and dimensional approach to the diagnosis than the previous version.

The Article Abstract is not available.

Background: Schizophrenia, a severe mental illness, is marked by disturbances in thought, cognitive impairments, negative symptoms, disorganized speech, hallucinations, catatonic behavior, psychotic symptoms, delusions, and behavioral changes. Schizophrenia has been associated with several gene polymorphisms and neurotransmitter imbalances. This study aims to analyze cognitive performance in schizophrenia patients using the Digit Span Test, with a focus on proline dehydrogenase (PRODH) gene polymorphisms. Material and Methods: This cross-sectional, observational analytic study included 99 individuals diagnosed with schizophrenia. Blood samples were collected and analyzed in the Biochemical Laboratory of the Medical Faculty of Andalas University using Polymerase Chain Reaction (PCR) to test for PRODH gene polymorphisms. The Structured Clinical Interview for DSM (SCID-1) was used to diagnose schizophrenia. Data were analyzed using the Chi-Square Test in SPSS 25.0, with statistical significance set at p = 0.05. Results: The cohort consisted of 99 patients who had been diagnosed with schizophrenia, most of whom were male (62.6%) with a median age of 37 years. A majority were unmarried (50.5%). PCR results revealed the following genotype distributions: homozygous dominant (CC) in 22 participants, heterozygous (TC) in 10, and homozygous recessive (TT) in 65. Cognitive function, as assessed by the Digit Span Test, yielded varied results in the forward span (p = 0.334) and higher deficit scores (score < 5) in the CT and TT groups than the CC group in the backward span (p = 0.314). However, these differences were not statistically significant. Conclusion: The PRODH gene polymorphism does not significantly affect cognitive function in patients with schizophrenia. Other factors may be more influential in shaping the cognitive function of individuals with schizophrenia.

&lt;b&gt;Background and Objective:&lt;/b&gt; Schizophrenia is a severe and chronic mental disorder which are characterized by delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms and cognitive symptoms. Several gene polymorphisms and neurotransmitters have been linked to schizophrenia. This study assessed the correlation between proline level, Kynurenic Acid (KYNA) and glutamate level with cognitive function among schizophrenia patients, contributing to understanding biochemical factors associated with cognitive impairments. &lt;b&gt;Materials and Methods:&lt;/b&gt; The research was a cross-sectional observational analytic study of 99 patients diagnosed with schizophrenia. Schizophrenia was diagnosed by SCID-1 questionnaire and the patient's blood was taken to be analyzed in the Biochemical Laboratory of Medical Faculty Andalas University using Enzyme-Linked Immunosorbent Assay (ELISA) to characterize kynurenic acid level, glutamate level and proline level. Data were analyzed using Spearman Correlation in SPSS 25.0, with significance at p<0.05. &lt;b&gt;Results:&lt;/b&gt; There were 99 schizophrenia patients; most of them were male (62.6%), age median 37 years old and not married (50.5%). The Microproline Level median among participants was 2.64 μg/mL, the median KYNA level was 14.6 nmol/L and the glutamate level was 10.5 μg/mL. Cognitive function was assessed by Rey Auditory Verbal Learning Test (RAVLT), Digit Span Test and Trail Making Test (TMT) with a score median of 4/5/5/5 (Trial 1/2/3/Recall), 6/2 (forward/backward), 68/37 sec (TMT A/B), respectively. Spearman Correlation showed that microproline has a negative correlation with RAVLT Trial 1 (r = -0.221, p = 0.014), Digit Span Backward (r = -0.181, p = 0.036), TMT A (r = 0.204, p = 0.021) and TMT B (r = 0.185, p = 0.034). In contrast, other neurotransmitters do not correlate with any cognitive tests. &lt;b&gt;Conclusion:&lt;/b&gt; Proline may play a role in the pathophysiology of cognitive deficits in schizophrenia, highlighting its potential as a target for therapeutic interventions.

To study the psychopathological structure of resistant schizophrenia with the distinguishing of various clinical variants. The study was conducted at emergency departments of the round-the-clock Psychiatric Clinical Hospital No.1, named after N.A. Alekseev. One hundred twelve patients with a diagnosis of schizophrenia were examined using clinical psychopathological and psychometric methods as standardized scales (PANSS and BFCRS). Three clinical variants have been identified: impaired reasoning and perception with a predominance of delusional disorders, catatonic disorders with a predominance of oneiroid confusion, and impaired behavior and affect with a predominance of aggression. The earliest onset age of 17.1±3.2 years was found in the clinical variant with behavioral impairment (p=0.022). In the clinical variant with impaired reasoning, there were statistically significant differences (p<0.05) in the sum of scores on the PANSS-P subscale - 31.7±3.1; on P1 «Delusions» - 6.5±0.6; P2 «Conceptual disorganization» - 5.9±1.6; P3 «Hallucinations» - 6±0.3; G4 «Tension» - 5.5±0.6; G9 «Unusual thought content» - 5±0.8. The study of resistant schizophrenia with the identification of disorders in various areas of mental activity and the determination of their quantitative indicators is a promising area of research, as it helps to identify risk groups for the development of resistance and develop new strategies for overcoming it.

Catatonic Stupor in Schizophrenia is a Mis-activated Death-Feigning

Abstract: Catatonia is a neuropsychiatric phenomenon characterized by severe motor and behavioural abnormalities. It can arise as a complication when the central nervous system (CNS) is affected in patients with systemic lupus erythematosus (SLE). This case report describes a rare presentation of a 16-year-old female diagnosed with SLE, who developed catatonic features as her SLE symptoms worsened. Initially, she exhibited a depressive mood with emotional lability, followed by psychotic symptoms that progressed to mutism, posturing, echopraxia, and cognitive decline. Psychiatric management with olanzapine and amisulpride was ineffective. A lorazepam challenge provided transient improvement but did not lead to complete remission of catatonic symptoms. Ultimately, the addition of amantadine and lithium as adjuncts to lorazepam proved effective in managing catatonic state. The development of catatonia in the context of steroid and immunomodulator (e.g., cyclophosphamide) use exacerbated catatonic symptoms and contributed to the worsening of preexisting CNS lupus. This case highlights the potential emergence of catatonic features with the use of steroids and immunosuppressants-agents that are central to SLE treatment. Therefore, physicians should remain vigilant for motor disturbances, as their presence can worsen the prognosis and help differentiate catatonia from CNS lupus.

Electroconvulsive therapy (ECT) is underused, logistically challenging for those who are justice-involved, and laced with ethical problems for those on death row. Herein we describe a case of a man without history of long-standing psychiatric illness who, after more than 15 years on death row, was hospitalized for altered mental status. After medical stabilization, the altered mental status persisted. On exam, he displayed signs of catatonic stupor with repetitive non-goal-directed motor activity, repetition of words, rigidity, and negativism, among others. The Bush-Francis Catatonia Rating Scale was found to be 23. Lorazepam was nontherapeutic. Hospital psychiatry considered ECT. Hospital medicine, medical prison staff, and the hospital ethics committee were consulted. Consent to treat catatonia with ECT was obtained from next of kin. Before treatment, the ECT psychiatrist spoke with prison staff regarding the presence of plastic restraints. To balance the competing demands of carceral policies and musculoskeletal protection, we implemented the practice of removing plastic restraints after the patient was sedated by anesthetic, with restraints being reapplied after the motor convulsion ended. Five days after 7 ECT treatments given thrice weekly, the catatonic symptoms remitted. Ethically, psychiatrists are not to restore competency for the purpose of execution. In this case, ECT was used by psychiatrists unaffiliated with the criminal legal system to reduce suffering and improve quality of life given the potentially fatal consequences of catatonia.

Introduction Traumatic brain injury (TBI) is considered a global health crisis. It results in injury to the brain from an external impact leading to severe disability, with higher incidence statistics recently observed in young adults and elderly individuals. Purpose The review aims to analyze current research findings explaining the prevalence, incidence, and demographics of such injuries stressing the need for enhanced prevention and management techniques. The pathophysiology involves a complex cascade of biochemical and cellular events, which results in necrotic-apoptotic neuronal cell death. Method The review synthesizes current research on TBI, highlighting epidemiological data, advanced diagnostics, and effective rehabilitation strategies like physical and cognitive therapy. Findings Traumatic Brain Injury is an important public health issue with high morbidity and mortality rates causing extreme damage to a person, such as comas, catatonic states for various years, or lifelong injury or demolition. Early diagnostic imaging techniques include CT, MRI, advanced neuroimaging methods, and blood-based biomarkers. In the acute setting, initial management is directed toward stabilizing and preventing secondary injuries and early mobilization. The goals of rehabilitation are to promote the highest level of functional independence and physical function, cognitive functions, and social integration. Conclusion This review highlights that the use of new rehabilitation technologies, such as VR-based and robot-assisted therapies, might lead to improved recovery. Long-term supportive care combined with community integration is mandatory for enhancing quality of life. A systematic multidisciplinary team approach and family support are needed for traumatic brain injury survivors.

This study aims to analyze the production of assertive speech in Indonesian in catatonic schizophrenia patients who experience symptoms of perseveration. Catatonic schizophrenia is characterized by motor and behavioral disorders, while perseveration is the continuous repetition of words or phrases that are not in accordance with the context of the conversation. This study uses a descriptive qualitative method with subjects of catatonic schizophrenia patients who show symptoms of perseveration in communication. Data were obtained through participant observation, in-depth interviews, and audio recordings of patient communication. Data analysis was carried out thematically to identify patterns of assertive speech production that emerged from patient verbal interactions. The results of this study indicate that although catatonic schizophrenia patients with symptoms of perseveration have difficulty in maintaining a logical and coherent conversation flow, there are still efforts to convey assertive speech in the form of firm statements, although often interrupted by repetition of words. These findings provide important insights into understanding the dynamics of communication in schizophrenia patients, as well as offering implications for the development of more effective communication therapy for patients with similar conditions.

Background. Currently, researchers are aiming to establish the relationship between neurocognitive disorder and other clinical manifestations of endogenous diseases and functional indicators of the patient’s adaptation to social life. According to some data, the development of cognitive disorders is associated with the severity of catatonic disorders in the clinical picture of various diseases, in particular the presence of catatonic symptoms determines the worst indicators of cognitive functioning in the case of schizophrenia.The aim. To study the clinical and psychopathological features of catatonic syndrome in connection with schizophrenia spectrum disorders, as well as its connection with neurocognitive disorder manifestations among patients with endogenous disorders.Methods. From September 2022 to March 2024, we conducted a prospective, multicenter study of patients (n = 69) suffering from paroxysmal schizophrenia with primary catatonic symptoms in the structure of attacks. Mental status, the severity of catatonic symptoms using Bush – Francis Catatonia Rating Scale, neurocognitive profile using a number of validated scales (Montreal Cognitive Scale, Brief Assessment of Cognition in Schizophrenia, Frontal Assessment Battery) were assessed.Results. Neurocognitive disorder was revealed in all cases studied. It has been noted that, depending on the presence/absence of affective symptoms, various domains of the neurocognitive profile are affected. Thus, in patients without severe affective symptoms, auditory and verbal memory, attention, processing speed, and motor skills are impaired. In patients with pronounced affective disorders, processing speed, motor skills, and problem-solving behavior are affected.Conclusion. Based on the results of processing the material, it was revealed that the most pronounced neurocognitive disorders were found in case of the manifestation of paroxysmal paranoid schizophrenia in male patients with a relatively early onset of the disease and hypokinetic catatonic disorders. In the future, we are planning to compare these results with the results of control group of patients with endogenous diseases and without catatonia.

Catatonia was first described by Kahlbaum in 1874. Subsequently, in 1908, Kraepelin delineated a cyclical pattern of catatonia in a group of patients with Schizophrenia. Further ahead, in 1938, Gjessing demonstrated the role of nitrogen phasic change in synchronous syntonic cases of periodic catatonia. However, Stokes et al., in 1941, demonstrated it to be a result of steady accumulation rather than a phasic change in nitrogen balance. There are no reliable prevalence figures for periodic catatonia. Prominent diagnostic manuals have not given this diagnostic entity a separate nosological status, despite evidence of a discrete metabolic profile. This case series elucidates periodic catatonia in different psychiatric disorders and how a separate diagnostic criterion could help in early detection and management. We narrate three case reports of catatonic manifestations in two young adolescents and one young adult male, with no underlying medical condition. The first case report highlights intermittent brief periods of catatonic excitement beginning with acute anxiety and followed by fainting spells. The second case report narrates an acute onset manic episode which alternates with the catatonic episode. The third case report shows seasonal advents of catatonia. The pharmacological intervention itself was adequate enough to resolve the catatonic symptoms. The three cases give a purview of catatonic manifestations with differential phenomenology. The treatment of catatonia bears challenges owing to a lack of awareness and differential response to available pharmacotherapy.

The use of clozapine in pregnant women with catatonic schizophrenia is still rarely reported and raises concerns regarding its safety. This study aims to describe the effectiveness and safety of using low-dose clozapine in pregnant women with catatonic schizophrenia. Case report of a 27 year old woman with catatonic schizophrenia who was given low dose clozapine therapy (6.25 mg/day) during the second trimester of pregnancy until delivery. The primary focus is on response to clozapine and pregnancy outcomes. Administration of low doses of clozapine resulted in significant improvements in patient communication without significant side effects. Although the dose is well below the common therapeutic dose, clozapine is effective in managing the symptoms of catatonia. The baby was born via caesarean section at 39 weeks 5 days of gestation with a weight of 3000 grams, a length of 48 cm, and an Apgar score of 8-9, without congenital abnormalities. Evaluation one month after delivery did not show any complications related to the use of clozapine in the mother and baby. The use of low-dose clozapine in this case represents a promising approach in managing catatonic schizophrenia during pregnancy, with good outcomes in both mother and baby. Clozapine appears to be effective even at very low doses, offering a balance between symptom management and fetal safety. However, further research is needed to confirm the long-term safety profile and effectiveness of low-dose clozapine in this population. ABSTRAKPenggunaan clozapine pada ibu hamil dengan skizofrenia katatonik masih jarang dilaporkan dan menimbulkan kekhawatiran terkait keamanannya. Studi ini bertujuan untuk menggambarkan efektivitas dan keamanan penggunaan clozapine dosis rendah pada pasien ibu hamil dengan skizofrenia katatonik. Laporan kasus seorang wanita berusia 27 tahun dengan skizofrenia katatonik yang diberikan terapi clozapine dosis rendah (6,25 mg/hari) selama kehamilan trimester kedua hingga persalinan. Fokus utama adalah pada respons terhadap clozapine dan hasil kehamilan. Pemberian clozapine dosis rendah menghasilkan perbaikan yang signifikan dalam komunikasi pasien tanpa efek samping yang berarti. Meskipun dosisnya jauh di bawah dosis terapeutik umum, clozapine efektif dalam mengelola gejala katatonia. Bayi lahir melalui sectio caesaria pada usia kehamilan 39 minggu 5 hari dengan berat 3000 gram, panjang 48 cm, dan Apgar score 8-9, tanpa kelainan kongenital. Evaluasi satu bulan pasca persalinan tidak menunjukkan adanya komplikasi terkait penggunaan clozapine pada ibu dan bayi. Penggunaan clozapine dosis rendah pada kasus ini menunjukkan pendekatan yang menjanjikan dalam mengelola skizofrenia katatonik selama kehamilan, dengan hasil yang baik pada ibu dan bayi. Clozapine tampaknya efektif bahkan pada dosis yang sangat rendah, menawarkan keseimbangan antara manajemen gejala dan keamanan janin. Namun, diperlukan penelitian lebih lanjut untuk mengonfirmasi profil keamanan jangka panjang dan efektivitas clozapine dosis rendah dalam populasi ini.

Introduction Stupor is a state of numbness of almost all personality functions, accompanied by stiffness, lethargy and abulia (lethargy). A person in a state of stupor is recognized by the fact that he is constantly silent, does not respond to stimuli at all, refuses food, has a motionless body posture, a face immobile like a mask, a gloomy and absent look. We can call a person who is in a stupor only by calling loudly, shaking hard and similar charms. Catatonic stupor is a state of complete loss of spontaneous and active movement, the patient stands stiffly for hours, sits, does not take food, does not speak but registers everything that is happening around him because his consciousness is not clouded.ObjectivesHere, we report on the case of a 32 year-old man. He was brought in the Emergency Center by his mother with the eyes shut and unresponsive to all sorts of verbal and gestural attempts to elicit any kind of response, with extreme complete body rigidity. He was sweating.Over several weaks, he developed gradually social withdrowal, motoric stereotypies, loss of apetite, body stiffness. Three days before he was admited to the hospital he stopped eating, drinking water, he was developed body rigidity.MethodsCase reportResultsHe was admitted to a Psychiatric Clinic and first days he was treated with 7,5 mg of lorazepam daily, kariprazin tbl. a 3mg in the morning and olanzapine 10 mg in the evening. Over several days symptoms has diminished.ConclusionsThe patient was reacted very well on the therapy and after several days syptoms diminished. After a month he was released from the hospital. He is in good remission for over a year. He comes regularly for outpatient check-upsDisclosure of InterestNone Declared

IntroductionSevere schizophrenia is often closely related to delinquency resulting in relative overrepresentation of these manifestations of disease in forensic institutions.ObjectivesThe aim of the present work is to report the therapeutic challenges in a case of severe schizophrenia in a forensic institution from a clinical viewpoint as a basis for discussion.MethodsThe case report is based on the available clinical documentation, exploratory interviews as well as a structured clinical interview (PANSS).ResultsPresenting a case of a 41-year-old, male Caucasian inpatient suffering from a catatonic schizophrenia, we report the challenges in treatment of chronic, major schizophrenic disease resistant to antipsychotic medication. Without any previous criminal convictions, he has been instutionalized in a forensic psychiatry after a bodily harm to a random stranger about three years ago. Regarding medical history, information is limited to a few inpatient admissions prior to detention documenting intravenous opioid and cocaine abuse. Initially, the patient presented sexual disinhibition and ongoing endangerment of others with frequent assaults to other patients and prison guards. From a psychopathological viewpoint several phenomenona such as delusional intuition, acoustic, tactile and coenaesthetic hallucinations, echolalia, mannerisms and thought diffusions reflect the severe course of the disease (PANSS: P 34/49, N 38/49, G 73/112; total 145/210). Therapeutic attempts with an antipsychotic combination of risperidone, olanzapine and quetiapine as well as valproic acid resulted in insufficient recovery with persistent physical assaults and florid psychosis. In reaction to that zuclopenthixol for impulse control was added. As from the beginning of this year a switch of medication by gradually replacing risperidone and zuclopenthixol with haloperidol and clozapine showed modest success. Under the current medication and therapeutic drug levels the patient does not pose endangerment to others. However, regular tonic-eye fits require supplementary treatment with biperiden, and the patient still presents frequent periods of self-harm punching himself, verbal lack of impulse control and the psychopathological phenomenona described before. In addition to pharmacological treatment the patient receives psychotherapeutic one-on-one conversations. Despite approaching all limits of the available antipsychotic repertoire, psychopathology is only insufficiently controlled leading considerations to electroconvulsive therapy as a treatment of last resort.ConclusionsCertainly, the present case is exemplary for a severely ill population of patients reaching – after a long and untreated course of disease - a chronic stage that does not sufficiently respond to a multitude of treatment attempts despite proper compliance raising the urgent need for further treatment options.Disclosure of InterestNone Declared

IntroductionSeveral studies have demonstrated the unfavorable and neurotoxic effects of untreated psychosis (UP) on the brain. An estimated 10 to 12 cc of brain tissue could be potentially damaged due to neuroinflammation and oxidative stress when a first episode of psychosis goes untreated. Other studies have found a correlation between the duration of untreated psychosis (DUP) and treatment resistance or nonresponse. Evidence-based schizophrenia treatment mainly relies upon the use of first and second-generation antipsychotics, without solid evidence that the former is superior to the latter regarding the treatment of negative symptoms. Both groups, however, can come with a risk of side effects. Cariprazine, a third-generation antipsychotic, represents a safe and effective treatment, targeting both the positive and negative symptoms of schizophrenia.ObjectivesTo report a clinical case of a woman with an extreme DUP with predominantly negative symptoms of schizophrenia and highlight the favorable outcome cariprazine monotherapy had on her global functioning.Methods We report a clinical case of a 58-year-old woman with a history of a 40-year UP successfully treated with 4,5mg of cariprazine. The woman was brought involuntarily for psychiatric assessment at the emergency department with a clinical image of catatonic stupor and predominantly negative symptoms of psychosis. Her total PANSS score at admission was 129. The negative subscale score was 49. She was initially treated with 3mg cariprazine and 10mg olanzapine and was gradually left on 4,5mg cariprazine monotherapy with an adjunctive 30mg mirtazapine.ResultsThe patient was dismissed after 47 days of hospitalization. Cariprazine was effective in targeting both the cognitive and affective symptoms of long-standing UP. In the long-term, cariprazine also improved remnant delusional ideas of somatic and persecutory types, enhancing the patient’s social life, ensuring her support network, and assisting her integration into the community. The patient did not report any side effects, and her blood test results were within the normal range.Conclusions Not all cases of schizophrenia are dramatic at presentation - some can have a chronic and insidious course predominated by negative symptoms. UP can lead to disastrous consequences for the patient’s biopsychosocial well-being, leading to future treatment resistance and disability. Although such cases of untreated psychosis seem to be from the past, we should be conscious of their existence and treat them with a patient-personalized and symptom-centered approach. Cariprazine was successful and effective in treating this patient with a remarkable course of UP.Disclosure of InterestNone Declared

Introduction: central pontine myelinolysis (CPM) is rare neurological condition. The severe symptoms of neurologic and psychiatric disorders accompanying this condition are not sufficiently disclosed in the literature. Most often CPM develops on infusion therapy and forced correction of hyponatremia. The complexity of diagnosis and the lack of certain algorithms for the management of this category of patients cause a high frequency of disability, persistent neurological and psychiatric symptoms, and lethal outcomes.The aim was to present and analyze clinical picture of psychosis in CPM on the example of non-Hodgkin’s lymphoma case report. Patient and method: clinical analysis of disorders in 14-years old patient with diagnosis of non-Hodgkin’s lymphoma.Results: clinical polymorphism of psychotic features, catatonic disorders, neurological symptoms at the end stage and development of psychosis associated with CPM during cytotoxic treatment. A year and a half follow-up of the first generation antipsychotics administration is presented.Conclusion: CPM may occur on cytotoxic infusion therapy in patients with non-Hodgkin’s lymphoma and be accompanied by severe psychotic disorders. Thus, practitioners should be aware of the risks of this condition, its diagnostic and therapeutic options when working with these patients.