A case of postinfectious catatonia in an elderly patient with SARS-CoV-2 infection

Carsen Sulzer, MD

VA Boston Healthcare System – Resident
SULZER_CARSEN poster

Scientific Abstract

Background: COVID-19 is well-documented to have pervasive physical and neuropsychiatric effects (1-3). Initial studies describe symptoms of insomnia, mood changes, and psychosis related to this viral syndrome (1-2). We present a case of a patient who developed catatonia after diagnosis with COVID-19, following resolution of all other symptoms.

Case Report: 72-year-old man with schizophrenia but no psychiatric symptoms for many years. It is possible that this diagnosis is better explained by PTSD, rather than a primary psychotic disorder. He presented to urgent care reporting 12 days of upper respiratory symptoms and fatigue and tested positive for COVID-19. Symptoms were mild and resolved in days without treatment. Ten days after initial presentation (22 days after initial COVID-19 symptoms), he re-presented for evaluation of altered mental status, described as “in a fog,” withdrawn, and paranoid.

Medical work-up was unremarkable, prompting psychiatric evaluation which was notable for speech latency, paucity of thought content, blank stare, blunted affect, and psychomotor retardation. Questions regarding suicidality were not fully answered. Due to concern for catatonia or psychotic depression, he was admitted to inpatient psychiatry. Bush-Francis Catatonia Rating Scale (BFCRS) was performed with a score of 5, which increased to 6 after receiving lorazepam 1mg PO. However, he showed clinical improvement with decreased speech latency, increased spontaneous speech production, enhanced attention, and acceptance of food without sedation. Lorazepam was continued with sustained clinical improvement.

Conclusions: Literature review revealed one case series of catatonia secondary to COVID-19, where catatonia manifested concurrently with infectious symptoms (4).  Our case adds to the current literature by describing a patient with catatonia that surfaced several days following the resolution of other COVID-19 symptoms, suggesting catatonia as a possible chronic COVID-19 complication. More research is needed to determine the role infection plays in the development of catatonia, how to predict likelihood of development, and unique aspects of management following COVID-19.

Live Zoom Session – March 9th

research Areas

Authors

Carsen N. Sulzer, MD, Faith Donaghey, MD, Justine Lazatin, DO, Annabel Kuhn, MD, Larkin Elderon Kao, MD

Principal Investigator

Larkin Elderon Kao, MD