Abstract

HYDROCEPHALUS INDUCED CATATONIA

Objective: Psychiatrists managing catatonia often face with a dilemma in management. This case described the difficulties faced in determining the underlying aetiology and treatment of a patient presented with catatonia. Method: We reported a case of 23 years-old lady who presented with an acute onset of catatonia. Communicating hydrocephalus was noted on CT brain and was initially thought to be the cause of her catatonic presentation. However, further assessment by neuro medical team concluded that it was unlikely the cause of catatonia. Thus, a diagnosis of catatonia associated with another mental disorder was explored. It was difficult to ascertain an associated psychiatric diagnosis for catatonia at that time as comprehensive interviews were impossible due to the catatonic state. More information on mood symptoms came to light later that supported the diagnosis of catatonia with associated Major Depressive Disorder. She was started on a trial of lorazepam and olanzapine initially. Escitalopram was added for the treatment of underlying depressive disorder. Result: With optimization of treatment, she showed gradual improvement of symptoms. Catatonia resolved followed by improvement of mood and psychotic symptoms. Conclusion: Symptoms of catatonia makes exploration of underlying cause a challenge during initial assessment. In addition, presentation of catatonia due to another medical condition is clinically indistinguishable from catatonia associated with psychiatric disorders. In some cases, catatonia may end up being psychiatric in origin despite having a plausible organic cause. Often, the underlying psychiatry condition may only be identified after treatment of catatonia. Thus, a trial of psychotropic medication should be considered once organic etiology has been ruled out.

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