This case study examines the management of a 22-year-old male diagnosed with recurrent refractory catatonia, a challenging neuropsychiatric condition frequently linked with bipolar disorder. Despite comprehensive diagnostic tests, including complete blood count (CBC), liver function (LFT), thyroid function (TFT), renal function (RFT), C-reactive protein (CRP), creatine kinase (CK), and serum electrolytes, the patient's symptoms persisted. Initial treatment with benzodiazepines showed limited success, but the introduction of cariprazine, an atypical antipsychotic, combined with electroconvulsive therapy (ECT), led to marked improvement. This case highlights the complexities of managing treatment-resistant catatonia and the potential of cariprazine in preventing catatonic relapses when standard therapies fail, underscoring the need for further exploration into its efficacy.
Overview of Catatonia and Current Treatment Approaches
Catatonia is characterized by disturbances in motor, behavioral, and autonomic functions, often associated with mood disorders like bipolar disorder. Its pathophysiology is believed to involve dysregulation in neurotransmitter systems, particularly GABA, dopamine, and glutamate. For acute management, benzodiazepines like lorazepam are typically first-line treatments. When unresponsive, ECT is frequently employed. In some cases, however, conventional treatments are insufficient, necessitating innovative strategies. Low-dose atypical antipsychotics like risperidone, olanzapine, and, as emerging evidence suggests, cariprazine, have shown promise in managing catatonia.
Cariprazine, an atypical antipsychotic and D3/D2 partial agonist with a higher affinity for D3 receptors, is approved for bipolar disorder treatment. Its receptor selectivity indicates potential advantages in addressing catatonia, especially where traditional treatments have failed. This case study explores its use alongside ECT to manage recurrent, treatment-resistant catatonia in a young male with bipolar disorder.
Case Presentation and Treatment
The patient presented with mutism and non-responsiveness, standing throughout the examination with no reaction to commands or stimuli. Mental state examination revealed a catatonic state marked by mutism, waxy flexibility, and negativism. Initial treatments, including lorazepam titrated to 8 mg/day and six sessions of ECT, led to symptom improvement, and the patient was discharged on olanzapine and procyclidine.
Following discharge, the patient experienced recurrent catatonia within 10 days. He was readmitted, and despite further ECT, symptoms recurred. Cariprazine was then introduced, titrated from 1.5 mg to 4.5 mg, along with lamotrigine, and after four ECT sessions, the patient showed significant clinical improvement, achieving sustained remission over four months.
Discussion
This case underscores the complexities of treating refractory catatonia, particularly in bipolar disorder. While ECT and lorazepam remain mainstays, cariprazine may offer additional benefits due to its D3/D2 partial agonist activity, particularly in treatment-resistant cases. This dopamine receptor selectivity appears effective in managing manic and catatonic symptoms, as demonstrated in this case, suggesting cariprazine may hold promise as an alternative treatment option when other therapies are ineffective.
Conclusion
The sustained remission observed with cariprazine, in combination with lamotrigine and ECT, highlights its potential as a therapeutic option for treatment-resistant catatonia linked to bipolar disorder. Future studies are warranted to explore its broader application and refine dosing and combination strategies, enhancing outcomes for refractory cases. This case contributes to a growing body of evidence supporting cariprazine as a valuable addition to the management of challenging neuropsychiatric conditions.
Link of article:
Role of Cariprazine in Managing and Preventing Refractory Catatonia: A Case Study | Cureus
