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Background <p>Catatonia due to another general medical condition (CDGMC) is common in consultation-liaison settings. We organize toxic and metabolic etiologies using the MINDSET mnemonic (Miscellaneous; Inflammation of the CNS; Neural injury/Neurodegenerative; Developmental; Structural/space-occupying; Epilepsy; Toxins/Medications), emphasizing the frequently overlooked toxic domain.</p> Methods <p>At our institution, catatonia is assessed by the consultation-liaison psychiatry service using the Bush-Francis Catatonia Rating Scale (BFCRS) and the KANNER Catatonia Rating Scale, alongside focused medical evaluation to identify CDGMC and malignant features.</p> Case 1 <p>A 71-year-old woman with mutism, immobility, and refusal of intake received ceftriaxone (hospital day [HD] 1) for UTI and metoclopramide during endoscopy (HD2). On HD3, BFCRS = 28; KANNER Part I = 3, Part II = 24, Part III = 5. Lorazepam 0.5&#xa0;mg PO TID was initiated with rapid improvement; both agents were discontinued. Further neurologic testing (EEG/imaging) was deferred given temporal association and recovery. She was discharged on HD9 without benzodiazepines and with sustained resolution.</p> Case 2 <p>A 33-year-old woman presented with stupor, mutism, and immobility in the context of polysubstance use; toxicology was positive for methamphetamine, fentanyl, and benzodiazepines. BFCRS = 7; KANNER Part I = 3, Part II = 28, Part III = 5. Lorazepam 1&#xa0;mg IM TID produced marked improvement within 24&#xa0;h. She transferred to a dual-diagnosis facility with no recurrence at short-term follow-up.</p> Key takeaways <p>(1)&#xa0;A MINDSET-guided lens helps clinicians rapidly consider CDGMC, especially toxins/medications; (2) scale-guided bedside assessment supports timely benzodiazepine treatment and discontinuation of potential offending agents; (3) BFCRS and KANNER are feasible and complementary for detection and serial tracking in acute care.</p>

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High hopes: catatonia due to medication and substance abuse in two cases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月20日

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  • Alexandre Yacques,
  • Brendan T. Carroll

摘要

Background

Catatonia due to another general medical condition (CDGMC) is common in consultation-liaison settings. We organize toxic and metabolic etiologies using the MINDSET mnemonic (Miscellaneous; Inflammation of the CNS; Neural injury/Neurodegenerative; Developmental; Structural/space-occupying; Epilepsy; Toxins/Medications), emphasizing the frequently overlooked toxic domain.

Methods

At our institution, catatonia is assessed by the consultation-liaison psychiatry service using the Bush-Francis Catatonia Rating Scale (BFCRS) and the KANNER Catatonia Rating Scale, alongside focused medical evaluation to identify CDGMC and malignant features.

Case 1

A 71-year-old woman with mutism, immobility, and refusal of intake received ceftriaxone (hospital day [HD] 1) for UTI and metoclopramide during endoscopy (HD2). On HD3, BFCRS = 28; KANNER Part I = 3, Part II = 24, Part III = 5. Lorazepam 0.5 mg PO TID was initiated with rapid improvement; both agents were discontinued. Further neurologic testing (EEG/imaging) was deferred given temporal association and recovery. She was discharged on HD9 without benzodiazepines and with sustained resolution.

Case 2

A 33-year-old woman presented with stupor, mutism, and immobility in the context of polysubstance use; toxicology was positive for methamphetamine, fentanyl, and benzodiazepines. BFCRS = 7; KANNER Part I = 3, Part II = 28, Part III = 5. Lorazepam 1 mg IM TID produced marked improvement within 24 h. She transferred to a dual-diagnosis facility with no recurrence at short-term follow-up.

Key takeaways

(1) A MINDSET-guided lens helps clinicians rapidly consider CDGMC, especially toxins/medications; (2) scale-guided bedside assessment supports timely benzodiazepine treatment and discontinuation of potential offending agents; (3) BFCRS and KANNER are feasible and complementary for detection and serial tracking in acute care.