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Treatment of schizophrenia complicated by catatonia with clozapine in a 16 year old asylum seeker

Published online by Cambridge University Press:  03 March 2011

Ted Agadagba  and
Gordon Bates
Ted Agadagba*
Affiliation:
Staff Grade in Child and Adolescent Psychiatry, Huntercombe Hospital, Stafford, UK
Gordon Bates
Affiliation:
Consultant Child and Adolescent Psychiatrist, Huntercombe Hospital, Stafford, UK
*
Correspondence to: Dr Ted Agadagba, Huntercombe Hospital, Ivetsey Bank, Wheaton Aston, Stafford, ST19 9QT. E-mail: doc_ted2000@yahoo.com
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Abstract

In this case report, we describe the clinical course of a 16 yr old asylum seeker from Afghanistan who developed paranoid schizophrenia complicated by catatonia and was successfully treated with diazepam and clozapine. To our knowledge, this is the first case report of its kind in this age group.

Our patient became psychotic and presented to A&E after cutting off the tip of his nose in response to command hallucinations telling him to kill himself, his mother and his siblings. His catatonic features, which emerged after hospitalization, were those of mutism, akinesia, posturing including the psychological pillow. He did not respond to risperidone or haloperidol; showed a partial response to lorazepam and diazepam. His catatonic features and psychosis only resolved upon the introduction of clozapine.

We go on to review the literature about catatonia in children and adolescents. We discuss the nosological dilemma with classification, the evolution of treatments and the role of anti-psychotic medication in the treatment of catatonia. Specifically, we advocate the usefulness of clozapine as an adjunct and as monotherapy.

Keywords

Catatonianeuroleptic malignant syndromeschizophreniaclozapineanti-psychoticsbenzodiazepinesECT
Type
Case Report
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 1 , April 2012 , pp. 47 - 53
Copyright
Copyright © NAPICU 2011

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