Revista de la Asociación Española de Neuropsiquiatría
Print version ISSN 0211-5735
SANCHEZ GARCIA, Javier; REZENDE BORGES, Livia de and VERA LOPEZ, Ignacio. Periodic catatonia or neuroleptic malign syndrom: diagnostic clues. Rev. Asoc. Esp. Neuropsiq. [online]. 2012, vol.32, n.115, pp.597-603. ISSN 0211-5735. http://dx.doi.org/10.4321/S0211-57352012000300010.
Introduction: Psychiatric institutionalized patients suffering severe learning disabilities and coincidental motor symptoms usually represent a challenge in their diagnostic and therapeutic processes. Periodic catatonia may produce neurovegetative and motor symptoms, the first being essential findings for an accurate diagnosis. Otherwise, these constellations of symptoms manifested in patients undergoing antipsychotic therapy might be misidentified as a neuroleptic malignant syndrome. Case report: An institutionalized 45 year-old male with severe learning disability presented for 3 years seasonal behavioural changes: During the last winter weeks he experienced a purposeless excessive motor activity. Every springtime the patient associated insomnia and treatment-resistant hyperkinetic behavioural disturbances as a prelude of akinetic catatonia episodes with intercurrent neurovegetative syndrome (stereotyped movements, sweating, tachycardia, slight fever and severe weight loss). A diagnosis of malignant neuroleptic syndrome was made during his third episode zenith, and antipsychotic treatment removed; the patient must be readmitted to the hospital after severe behaviour disturbances, which remitted after antipsychotics reintroduction. The patient was subsequently diagnosed of periodical catatonia (bipolar disorder with catatonic features) and put on lithium carbonate-based therapy, presenting no relapses in the three next years. Discussion: Some severe mental disorders characteristic from the pre-antipsychotic era can be still diagnosed affecting institutionalized patients commit in residential resources. So in spite of the tendency of considering psychotropic drugs and infections as the sole cause for this disorders, a primary psychiatric disturbance should also be considered in this kind of patients.
Keywords : Psychiatric catatonias; Periodic catatonia; Neuroleptic malign syndrom; Catatonia; Institutionalized psychiatric patients.