AccScience Publishing / JCBP / Online First / DOI: 10.36922/jcbp.4140
CASE REPORT

Recurrent catatonia in a patient with bipolar disorder and polycythemia: A case report

Tiffany Eatz1* Jessica Mikolowsky1 Lisa Oliveri-Naidu1,2
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1 Department of Psychiatry, University of Miami Miller, School of Medicine, Miami, Florida, United States of America
2 Department of Psychiatry, Miami VA Healthcare System, Miami, Florida, United States of America
Submitted: 4 July 2024 | Accepted: 25 September 2024 | Published: 4 November 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

We report the diagnostic and management challenges encountered in a case of a 57-year-old male patient with bipolar I disorder and comorbid polycythemia secondary to obstructive sleep apnea, who was treated in our inpatient psychiatric unit for suicidal ideation and recurrent catatonia. He was found to have catatonia with a Bush–Francis Catatonia Rating Scale score of 18. He subsequently exhibited a positive response to the lorazepam challenge test. Before discharge, his daily lorazepam dose was titrated to 6 mg, which led to resolution of catatonic symptoms, and was tapered to discontinuation. During the second hospitalization, the patient’s catatonia returned, but due to lorazepam-induced bradycardia, he refrained from taking more than 1 mg of the medication. Divalproex sodium and memantine were initiated as off-label catatonic treatment plus lurasidone for bipolar depression. The patient was also found to have a positive antinuclear antibody titer (1:160). The hemato-immunological abnormalities present in our patient complicated his catatonic condition, underscoring the need to explore medical and neuropsychiatric catatonic factors for accurate diagnosis of this neuropsychiatric syndrome.

Keywords
Catatonia
Bipolar disorder
Polycythemia
Neuropsychiatry
Antinuclear antibody
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Print ISSN: 3060-8562, Published by AccScience Publishing