Options for the treatment of febrile catatonia

Results:Symmetrel treatment led to a gradual improvement after 2 days, with the patient starting to speak, move and eat freely. Her temperature gradually decreased, normalizing after 3 additional days. After 2 weeks, the patient was again having delusions and auditory hallucinations. Because the catatonic features were in complete remission, clozapine was initiated. The psychotic episode was successfully treated, and the patient was discharged without symptoms after an additional 4 weeks. The patient remained free of symptoms for the next 3 years and successfully completed her bachelor degree at college. After the death of her mother, the patient became acutely psychotic with auditory hallucinations and delusions, which developed into full-blown febrile catatonia. The same pharmacological procedure as the first time was followed. Therapy with Symmetrel was not successful, so ECT was initiated. After 12 sessions, the patient began to improve. An additional 6 sessions led to complete remission of the catatonic and psychotic features.

Indications:1 patient with febrile catatonia characterized by fever, mutism, akinesia, posturing and catalepsy.

Patients:1 patient, a woman aged 24 years at start of therapy. Duration of follow up was >3 years.

TypeofStudy:Symmetrel was given to a patient with febrile catatonia. Case report.

DosageDuration:Dose not stated. Duration: 4 infusions (course 1), not stated (course 2).

AdverseEffects:No adverse events were mentioned.

AuthorsConclusions:This patient's case shows the difficulties in treating catatonia in general and febrile catatonia in particular.

FreeText:The patient presented with auditory hallucination and delusions of persecution. The patient was extremely anxious, confused and agitated. Initial treatment with an atypical neuroleptic (olanzapine) did not significantly improve her acute psychotic state. On the third day, she became mute, developed stupor and posturing and refused to eat. Over the next few days, a full-blown catatonic state with typical features developed, including mutism, akinesia, posturing, catalepsy and psychic head pillow. On the seventh day, she developed fever with a continuous temperature of up to 40°C. The case was treated as a medical emergency. She was taken off all neuroleptics. She was given lorazepam (3 mg given 6 times daily) intravenously over the next 4 days and she showed some initial effects and she appeared less anxious. The catatonic features and the fever persisted with no signs of remission. Four infusions of Symmetrel were given.