Agitation after minor trauma: combativeness as a cardinal catatonic feature

BMJ Case Rep. 2013 Jun 3:2013:bcr2012008217. doi: 10.1136/bcr-2012-008217.

Abstract

Catatonia is a syndrome of motor dysregulation, usually associated with psychiatric, neurological, systemic and drug-related diseases. Retarded and excited types exist, both of which often go unrecognised in clinical practice. We describe a 64-year-old woman who gradually developed insomnia, started communicating less, complained of feeling restless and ended up injuring relatives. Initiation of symptoms followed a fibula fracture. The patient was diagnosed with excited-type catatonia with prominent combativeness because of minor trauma and rapidly recovered after lorazepam treatment instatement. Our case demonstrates that catatonia can follow minor traumatic injury and how excited-type catatonic features may go unrecognised in general practitioner and specialist settings. Moreover, we show that catatonia may be recurrent, necessitating long-term treatment and very gradual lorazepam tapering.

Publication types

  • Case Reports

MeSH terms

  • Catatonia / diagnosis*
  • Catatonia / physiopathology
  • Diagnosis, Differential
  • Electroencephalography
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Lorazepam / therapeutic use*
  • Magnetic Resonance Imaging
  • Middle Aged
  • Psychomotor Agitation / drug therapy
  • Psychomotor Agitation / physiopathology*
  • Tomography, X-Ray Computed
  • Urinalysis
  • Wounds and Injuries / physiopathology*

Substances

  • Hypnotics and Sedatives
  • Lorazepam