Catatonic schizophrenia as a persistent therapeutic challenge – a case report

Purpose
Catatonic schizophrenia is a rare type of the illness, characterized by the occurrence of agitation or stupor with limited contact with the environment. Characteristic symptoms are catatonic parakinesis (catalepsy, automatic submission, “echo” symptoms, negativisms). Due to difficulties in establishing contact with patients, stupor, negativism and lack of cooperation, the possibilities of pharmacotherapy are usually limited, hence electroconvulsive therapy (ECT) often becomes a life-saving method. The aim of the study was to present the difficulties associated with the treatment of a patient diagnosed with catatonic schizophrenia using the electroconvulsive method, as well as drawing attention to the need to make decisions about ECT therapy at the earliest stage of the disease.

Case description
The patient, treated for chronic schizophrenic process after a history of neuroleptic malignant syndrome, underwent ECT therapy due to the appearance of catatonic symptoms and difficulties with taking food and liquids lasting over 2 months. The course of the disease was severe, and complicated by aspiration pneumonia and appendicitis, which was resolved surgically during the course of the ECT therapy. Eighteen procedures were performed, the final requiring the use of high doses of electrical charge (1152 mC). The therapy resulted in a significant improvement of the catatonic symptoms, activity and food/liquid intake; however, other significant symptoms of cognitive impairment and persistent negative symptoms still prevented the patient from independent functioning.

Comment
Catatonic schizophrenia always presents a major therapeutic challenge. Atypical antipsychotics are often not helpful in this type of schizophrenia, therefore ECT remains a life-saving method. Despite the use of this safe and effective method of treatment, sometimes the patient fails to achieve full recovery and function independently.