1/5. Temporal competency in catatonia.A catatonic patient without known relatives or advance directives faced possible death without electroconvulsive treatment (ECT). The authors describe using medication to restore capacity to permit the patient to give critical history and consent to potentially life-saving treatment. Even had a proxy been available, the jurisdiction in which he fell ill forbade substituted judgment for ECT, permitting only recipients themselves to consent. While emergent ECT was not specifically forbidden in this jurisdiction, a full curative course presumably could not have been administered without some form of consent. THus, the intervention prevented a treatment delay while the court was petitioned and also avoided having to insert a judge into the doctor-patient relationship. This case focuses on a specific condition, medication, and jurisdiction, but it outlines a general paradigm of pharmacologic intervention to restore temporary capacity. We encourage physicians to identify situations in which medication can create temporary "lucid intervals," thereby restoring patient autonomy and self-determination that would otherwise be lost to proxies or courts of law.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. catatonia in the emergency department.The catatonic syndrome has a wide differential diagnosis that includes both psychiatric and organic disorders. We present the cases of two patients with catatonia seen acutely in the emergency department. In these cases, the striking clinical picture proved to be secondary to psychiatric disturbances, and were accompanied by dementia in the second patient. The examining physicians were confused by the presentations, and the correct diagnosis and disposition were delayed. The clinical presentation of the catatonic complex, its differential diagnosis, and the pertinent physical signs are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. catatonia associated with disulfiram therapy.This is the first report of a catatonic syndrome occurring in a patient receiving disulfiram treatment. A causal relationship is strongly suggested by the mode of onset, the absence of a previous history of catatonia, and the rapid resolution of the syndrome within 72 hours of discontinuance of the disulfiram therapy. Neurophysiological mechanisms which aid in elucidating the role of disulfiram in the etiology of catatonia are discussed. It is important that physicians be alerted to this serious, potentially lethal, complication, as it is readily reversible if the disulfiram is discontinued and appropriate supportive measures are taken. Also, it appears that these patients may be more susceptible to complications with future disulfiram usage and should be strongly counseled to seek alternative therapies for their alcohol problems in the future.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Severe imipramine-induced myoclonus in a patient with psychotic bipolar depression, catatonia, and schizencephaly.Mild myoclonus is reasonably common with various cyclic antidepressants. However, antidepressants rarely cause severe myoclonus, and no risk or predisposing factors have been reported in the literature. We report a case of exceptionally severe myoclonus developing at therapeutic doses and modest serum levels of imipramine. The patient went on to experience dystonia and catatonia. Both of these were in typical settings (after haloperidol and with psychotic bipolar depression, respectively) and responded to typical treatment. On further investigation, the patient was found to have left-sided schizencephaly and a corresponding history of very mild developmental delay. We suggest that the onset of one movement disorder after drug therapy (eg, myoclonus) may predict the development of other movement disorders (e.g., catatonia). We further propose that severe tricyclic-induced myoclonus should prompt the physician to rule out a coexisting structural lesion of the central nervous system.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. catatonia and systemic lupus erythematosus.catatonia has generally been assumed by many physicians to be a subtype of schizophrenia. Numerous cases have been reported in the literature associating catatonia with other psychiatric and also medical illnesses. The present report describes a patient with Systemic Lupus Erythematosus (SLE) who presented in a catatonic state. A brief differential diagnosis of catatonia is also included.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |