Case Report

Catatonia and Mutism: Neurotic, Psychotic, or Organic Disorder?

Table 1

Causes of catatonia (adapted from Jaimes-Albornoz and Serra-Mestres [1]).

Psychiatric and neurodevelopmental
(i) Mania and depression (bipolar disorder), unipolar depression, late-onset depression, schizophrenia, and chronic psychoses
(ii) Anxiety disorder, dissociative disorder and Ganser syndrome, adjustment disorders, acute stress reactions, obsessive-compulsive disorder, Prader–Willi syndrome, autistic spectrum disorders, and Gilles de la Tourette syndrome

Neurological
(i) Cerebrovascular disease, haemorrhagic infarcts
(ii) Neoplasms, paraneoplastic encephalopathy, and malignant and benign central nervous system tumors
(iii) Encephalitis (including anti-NMDAR, herpes, human immunodeficiency virus (HIV), postimmunisation, and encephalitis lethargica), meningitis, and cerebral abscesses
(iv) Postencephalitic states, especially with parkinsonism, progressive multifocal encephalopathy
(v) Epilepsy (absence seizures, complex nonconvulsive partial seizures, generalised and complex partial (focal) status epilepticus, postictal states)
(vi) Neurosyphilis, other central nervous system infections: typhoid fever, tuberculosis, borreliosis, malaria, trypanosomiasis, hidatidosis
(vii) Parkinson’s disease, Lewy body disease, frontotemporal dementia, Alzheimer’s disease, vascular dementia, Creutzfeldt-Jakob disease, fatal familial insomnia
(viii) Motor neuron disease, Wilson’s disease, Huntington’s disease, multiple sclerosis, progressive supranuclear palsy
(ix) Brain trauma acute and squeal, Wernicke’s encephalopathy, hepatic encephalopathy, central pontine myelinolysis
(x) Insomnia, narcolepsy, Tay-Sachs disease, tuberous sclerosis
(xi) Hydrocephalus

Metabolic and endocrine, haematological, and immune
(i) Diabetic ketoacidosis, hypercalcemia, renal failure, liver failure
(ii) Acute intermittent porphyria, homocystinuria, membranous glomerulonephritis, hyponatremia, hypernatremia
(iii) Lysosomal disease, hypothyroidism, hyperthyroidism, hyperparathyroidism, hypoglycemia, Sheehan’s syndrome
(iv) Addison’s disease, Cushing’s disease, syndrome of inappropriate antidiuretic hormone secretion (SIADH)
(v) Vitamin B12 deficiency, nicotinic acid deficiency, pellagra
(vi) Systemic lupus erythematosus, pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS)
(vii) Antiphospholipid syndrome, renal and hepatic transplant, Langerhans carcinoma

Pharmacological, toxic, and other
(i) Typical and atypical antipsychotics (use and withdrawal) including clozapine, levodopa, amantadine, serotonergic drugs (selective serotonin reuptake inhibitors (SSRIs), trazodone, venlafaxine, etc.), lithium, acetyl-cholinesterase inhibitors
(ii) Cephalosporins, ciprofloxacin, levofloxacin, azithromycin, levetiracetam, sodium valproate, gabapentin
(iii) Disulfiram, paracetamol, aspirin, tramadol, hydroxyzine, antiretroviral, adrenocorticotropic hormone (ACTH), steroids
(iv) Cyclosporine, chlorphenamine, methylphenidate, morphine, methadone, meperidine, allopurinol
(v) Benzodiazepine withdrawal, cocaine, cannabis, lysergic acid diethylamide (LSD), mescaline, ketamine, phencyclidine, amphetamines, organophosphates, ethylene, carbon monoxide, severe burns