Catatonia is a neuropsychiatric syndrome that may occur in association with mental, neurological and medical disorders. A delay in diagnosis and treatment of catatonic symptoms is related to a high risk of medical complications such as dehydration, malnutrition, pressure ulcers, thrombotic events, aspiration pneumonia and infections.
The authors present the case of a bipolar patient, admitted to the Psychiatric Clinic of the Azienda Ospedaliero-Universitaria Pisana for catatonic syndrome, complicated by weight loss, deep vein thrombosis (DVT), pressure ulcers and systemic infection.
Supportive therapy, including hydration, electrolytic restoration and antibiotics was adopted to stabilize the patient’s general conditions. Treatment with low molecular weight heparin was given for DVT and to prevent pulmonary embolism. Catatonic symptoms were initially treated with intravenous administration of delorazepam, with some improvement in catalepsy and waxy flexibility. As treatment with benzodiazepines was not completely effective, electroconvulsive therapy (ECT) was used in combination with delorazepam, which led to progressive resolution of catatonic symptoms.
The existence of medical complications requires a multidisciplinary therapeutic strategy, with the intervention of different specialists. Our experience confirms the efficacy and safety of ECT in catatonia, even in the presence of serious complications such as DVT. In these cases, combination of ECT and benzodiazepines should be considered elective treatment to achieve quick resolution of symptoms and reduce morbidity and mortality.