The initiation of methylphenidate led to significant clinical improvement as evidenced by decreased rigidity and improved speech. Finally, she was started on methylphenidate 5 mg twice a day, which was titrated up to 15 mg twice a day over the course of 3 days. She remained symptomatic despite the trial of lorazepam. She remained selectively mute and negativistic, refusing to engage in treatment, and became aggressive on multiple occasions to the point that she had to be placed in physical restraints to decrease the risk of harming herself or others. Her admission medications were maintained, and she was started on intravenous fluids, nasogastric tube feeding, and lorazepam 2 mg every 4 hours. She exhibited the following symptoms of catatonia: mutism, immobility, posturing, rigidity, and negativism. She refused to eat or drink for 2 days and was admitted to the intensive care unit with a diagnosis of schizophrenia with catatonia ( DSM-5 criteria) after clinical examination, review of old charts, and obtaining information from family. A 25-year-old woman with schizophrenia was prescribed olanzapine 10 mg daily. We successfully treated her with methylphenidate.Ĭase report. We present the case of a young woman with schizophrenia with catatonia who was refractory to benzodiazepine treatment and did not have access to ECT treatment in the hospital. 1 Benzodiazepines and electroconvulsive therapy (ECT) can effectively treat catatonia in most cases with a favorable outcome. The most common causes of catatonia are affective disorders, particularly mania, psychosis, and autism spectrum disorder, as well as general medical and neurologic conditions such as autoimmune diseases, metabolic disorders, and encephalitis. In general, patients with catatonia may show immobility, rigidity, staring, cataplexy, mutism, echolalia or echopraxia, and posturing. In the medical literature, the prevalence of catatonia varies significantly from 15% 2 to 31% 3 in hospitalized psychiatric patients. To the Editor: Catatonia is a distinct syndrome that involves a constellation of up to 40 different symptoms with a complex mixture of psychiatric, motoric, behavioral, and systemic manifestations. Successful Treatment of Catatonia with Methylphenidate in a 25-Year-Old Patient With Schizophrenia
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