| Abstract [eng] |
Introduction: Catatonia syndrome is a complex neuropsychiatric condition. The most commonly observed symptoms include stupor, staring, mutism, negativism, withdrawal, and rigidity. The syndrome has long been associated with psychiatric disorders. However, an increasing number of cases are also being observed in the context of organic disorders. Catatonia resulting from cerebral hypoxia is a rare condition. The main treatments for catatonia are benzodiazepines and electroconvulsive therapy. The complex etiological mechanisms of catatonia and comorbid patient conditions can influence the effectiveness of treatment and overall outcomes. Aim: To review the scientific literature on the manifestation and treatment options of catatonia syndrome, present a clinical case, and provide a discussion with a literature analysis. Methods: A literature review was conducted on the Medline (PubMed) database, using the keywords: “catatonia”, “opioid intoxication”, “basal ganglia”, “hypoxia”, “electroconvulsive therapy”, “delayed post-hypoxic leukoencephalopathy”. Articles were selected based on specific criteria. A clinical case is presented along with a discussion. Clinical Case: A 44 – year – old patient was hospitalized following a suicide attempt involving opioids, which resulted in hypoxic brain damage in the basal ganglia. The patient initially recovered, but after a few weeks developed catatonic symptoms — mutism, stupor, negativism, waxy flexibility, and muscle rigidity. Treatment with lorazepam and electroconvulsive therapy was initiated, but with little effect. The patient’s history reveals that for about 2 years, there have been behavioral changes, apathy, and disturbances in thinking and perception. Still, there is insufficient information to diagnose a potential chronic psychotic disorder. Discussion: In the presented clinical case, the development of catatonia syndrome may be attributed to hypoxic changes in the basal ganglia. However, the influence of a chronic psychotic disorder cannot be ruled out. This is suggested by the fluctuating course of the patient's condition, with periods of temporary improvement followed by deterioration, as well as the insufficient effectiveness of commonly effective catatonia treatments. The response to catatonia treatment may depend on various factors, including the etiological origin of catatonia, the acuteness of the condition, and the overall physical state of the patient. Conclusion: It is important to include catatonia syndrome in the differential diagnosis, even in patients who are not of psychiatric profile. Early and prompt recognition of catatonia can help prevent serious complications. Further and more in-depth research on this syndrome is necessary in order to uncover various associations with its etiology, symptoms, and treatment effectiveness. Keywords: catatonia; hypoxia; opioid intoxication; basal ganglia; electroconvulsive therapy. |
