Catatonia is a complex syndrome of specific motor abnormalities associated with various psychiatric disorders. Historically, more than 50 clinical signs have been described in catatonia, however, it is now confined to the 23 signs mentioned in the Bush-Francis Catatonia Rating Scale. In clinical practice we are apt to recognise catatonia in its stuporous form presenting in emergency with risks due to compromised food and water intake and immobility. Excited catatonia is often missed or diagnosed in hindsight when it presents with manic excitement. In this case series we want to highlight that the presence of a few catatonic signs may often be missed as has been pointed out earlier. This under-recognition may account for the discrepancy between findings in literature. In the International Pilot Study of Schizophrenia (IPSS) though catatonic signs were noted in 96 patients only a few among them were diagnosed as catatonic schizophrenia. Conversely, most of the 55 patients diagnosed as having catatonic schizophrenia did not have catatonic symptoms.
In this case series, we would like to present three patients with persistent catatonic symptoms occurring during their psychotic illnesses. The catatonic signs were recognized on clinical evaluation. The signs specifically responded to treatment with lorazepam and in two of the cases, drug default or attempts to taper the dose; led to resurgence of catatonic symptoms.