Storms and silence: a case report of catatonia and paroxysmal sympathetic hyperactivity following cerebral hypoxia.
Catatonia
Electroconvulsive therapy
Neuropsychiatry
Psychosomatic medicine
Journal
BMC psychiatry
ISSN: 1471-244X
Titre abrégé: BMC Psychiatry
Pays: England
ID NLM: 100968559
Informations de publication
Date de publication:
29 09 2020
29 09 2020
Historique:
received:
26
07
2020
accepted:
17
09
2020
entrez:
30
9
2020
pubmed:
1
10
2020
medline:
30
12
2020
Statut:
epublish
Résumé
Delayed Post Hypoxic Leukoencephalopathy (DPHL) is a syndrome that occurs after hypoxia, and can present with a variety of neuropsychiatric symptoms, including catatonia and paroxysmal sympathetic hyperactivity (PSH). The gold standard for the treatment of catatonia is electroconvulsive therapy (ECT). However, ECT can exacerbate the paroxysms of sympathetic hyperactivity and complicate recovery from DPHL. The treatment of PSH is not well established. We present a case of a patient with multiple opiate overdoses who presented with altered mental status. He was diagnosed with catatonia and subsequently treated with ECT. His clinical condition worsened, and a revised diagnosis of PSH was established. The patient's condition improved with medical management. This case highlights the need to distinguish between these two related symptom clusters, as the incidence of DPHL and opioid overdose related neuropsychiatric problems increase. This distinction can greatly influence the course of treatment, and the need to consider alternative treatments.
Sections du résumé
BACKGROUND
Delayed Post Hypoxic Leukoencephalopathy (DPHL) is a syndrome that occurs after hypoxia, and can present with a variety of neuropsychiatric symptoms, including catatonia and paroxysmal sympathetic hyperactivity (PSH). The gold standard for the treatment of catatonia is electroconvulsive therapy (ECT). However, ECT can exacerbate the paroxysms of sympathetic hyperactivity and complicate recovery from DPHL. The treatment of PSH is not well established.
CASE PRESENTATION
We present a case of a patient with multiple opiate overdoses who presented with altered mental status. He was diagnosed with catatonia and subsequently treated with ECT. His clinical condition worsened, and a revised diagnosis of PSH was established. The patient's condition improved with medical management.
CONCLUSION
This case highlights the need to distinguish between these two related symptom clusters, as the incidence of DPHL and opioid overdose related neuropsychiatric problems increase. This distinction can greatly influence the course of treatment, and the need to consider alternative treatments.
Identifiants
pubmed: 32993556
doi: 10.1186/s12888-020-02878-5
pii: 10.1186/s12888-020-02878-5
pmc: PMC7523250
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
473Références
Psychosomatics. 2014 Nov-Dec;55(6):525-35
pubmed: 25262046
NeuroRehabilitation. 2012;30(4):329-32
pubmed: 22672948
Cureus. 2018 Apr 15;10(4):e2481
pubmed: 29922522
Mov Disord. 2006 Jun;21(6):868-9
pubmed: 16532457
Child Neurol Open. 2018 Aug 29;5:2329048X18792441
pubmed: 30182033
Lancet Neurol. 2017 Sep;16(9):721-729
pubmed: 28816118
Lancet Psychiatry. 2019 Jul;6(7):610-619
pubmed: 31196794
J Radiol Case Rep. 2014 May 31;8(5):1-8
pubmed: 25426224
PLoS One. 2017 Jan 23;12(1):e0170452
pubmed: 28114315
J Neurol Neurosurg Psychiatry. 1988 Jan;51(1):156-7
pubmed: 3351520
PLoS One. 2017 Oct 26;12(10):e0187156
pubmed: 29073246
Arch Neurol. 1983 Jul;40(7):433-5
pubmed: 6860181
Neurol Int. 2013 Jul 22;5(3):e13
pubmed: 24147210
Psychosomatics. 2001 Nov-Dec;42(6):530-3
pubmed: 11815692
Ann Neurol. 2010 Aug;68(2):126-35
pubmed: 20695005
J Neurol Sci. 2009 Feb 15;277(1-2):147-9
pubmed: 18954879
Gen Hosp Psychiatry. 2012 Jan-Feb;34(1):103.e1-3
pubmed: 21958445
Front Neurol. 2020 Feb 25;11:81
pubmed: 32161563
J Neurotrauma. 2014 Sep 1;31(17):1515-20
pubmed: 24731076
Q J Med. 1967 Oct;36(144):445-55
pubmed: 6077225
Arch Gen Psychiatry. 2009 Nov;66(11):1173-7
pubmed: 19884605
Biomed J. 2020 Apr;43(2):134-142
pubmed: 32386841
Brain Inj. 2004 Dec;18(12):1309-18
pubmed: 15666573
NeuroRehabilitation. 2010;26(1):65-72
pubmed: 20166270