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Catatonia

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Personally I haven't, but I'm sure a lot of people have at one time or another. Can you be a bit more specific? What advice are you looking for about it?

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has anyone presented a case on catatonia?

Like Chris said....can you be more specific on what you want?

I have seen &managed Catatonic patients and presented a case with it as diagnostic possibility.

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has anyone presented a case on catatonia?

yes

:lol: :lol: :D :D

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This is a patient with mild learning difficulties.he first presented with features of depression and some paranoia.given fluoxetine but did not take and then within 2 weeks stopped eating drinking.admitted in medical ward with catatonic features.given lorazepam .initially helped.now in LD unit still on high dose of lorazepam,amitriptaline and risperidone.still psychomotor retardation.very slow progress.ECT not considered as eating drinking.but nothing seems to be shifting.

what next?any ideas?

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i wonder what more can be done sb he is already eating and drinking and is on lorazepam which shud treat the catatonia irrespective of the cause.also whether the catatonia is caused by psychosis or depression he is on an antidepressant and antipsychotic. ::)

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Give it time. Can take weeks to shift.

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Oh, and make sure he doesn't have a brain tumour. Or anything else organic.

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This is a patient with mild learning difficulties.he first presented with features of depression and some paranoia.given fluoxetine but did not take and then within 2 weeks stopped eating drinking.admitted in medical ward with catatonic features.given lorazepam .initially helped.now in LD unit still on high dose of lorazepam,amitriptaline and risperidone.still psychomotor retardation.very slow progress.ECT not considered as eating drinking.but nothing seems to be shifting.

what next?any ideas?  

What are the catatonic symptoms???

'psychomotor retardation' is not a catatonic symptom, nor is 'not eating or drinking' alone...

Use this scale to rate his catatonia (after examining him)... this is the Bush Francis scale that is used widely... By the way, it is also a very good tool for examination and learning the definitions...

http://168.144.150.122/Catatonia%20Rating%20Scales.pdf

First of all, confirm the diagnosis.... (of catatonia)...

If he does have catatonic features.... then find out the reason for catatonic symptoms...  rule out all physical causes...

if he does have catatonic features and it is secondary to a mood or psychotic disorder, that is an indication for ECT...

How is Lor administered??? did you try IV???? what was the response???

what is high dose of Lorazepam??? upto 12 mg per day is what is recommended by Max Fink, who is supposed to be an expert on Catatonia...

But in a number of people the response is short lived...

few things to be aware of, just make sure he doesnt go into NMS on antipsychotics... and if he is extremely immobile and hardly swallowing, then watch out for aspiration and complicaitons...

in refractory cases, mood stabilisers (valproate, topiramate) and clozapine have all been suggested and found to be useful...

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well intially he was mute,there was posturing,ambitendency.now he speaks but very low in volume,soft tone difficult to comprehend.he still had posturing and ambitendency.

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well intially he was mute,there was posturing,ambitendency.now he speaks but very low in volume,soft tone difficult to comprehend.he still had posturing and ambitendency.

That means he is responding to Lorazepam... now you should treat the underlying cause... which you should be able to make out from the MSE...

eg: if he is psychotic, with antipsychotics, depressed - antidepressant etc...

you may need to increase Lorazepam... there may be reasons to go over the BNF limits... make sure you have the evidence in hand, and quote it in notes...

Max Fink in his book says you can go upto 12mg per day and the acute treatment response may take upto 10 days as Chris pointed out...

In the meantime, you should try and find out what symptoms preceeded... keep in mind that mood disorders and mania are one of the most common symptoms of Catatonia...

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