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35th AM (2025) - Poster Session
A Case of Stimulant-Induced Catatonia
A Case of Stimulant-Induced Catatonia
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This case report discusses stimulant-induced catatonia, a rare but serious neuropsychiatric syndrome often linked to schizophrenia, neurodevelopmental disorders, and occasionally stimulant use, particularly methamphetamines. Catatonia symptoms vary from mild behavioral changes to severe, life-threatening conditions and can appear acutely or gradually. Stimulant users and patients on first-generation antipsychotics like haloperidol are at higher risk, with dopamine antagonists potentially worsening the condition or triggering neuroleptic malignant syndrome (NMS).<br /><br />A 51-year-old Black male with treatment-resistant schizophrenia on haloperidol decanoate presented with acute catatonia after methamphetamine use. Symptoms included mutism, stupor, and posturing, scoring 19 on the Bush-Francis Catatonia Rating Scale. Elevated creatine phosphokinase (CPK) and high blood pressure were noted, but no other medical causes were found. Immediate intramuscular lorazepam (2 mg) led to rapid symptom resolution. Due to symptom recurrence, oral benzodiazepines were continued for four days before tapering off. The patient’s vitals normalized, CPK levels declined, and he returned to baseline mental status with no further catatonic episodes. To minimize recurrence risk, his antipsychotic was switched from haloperidol to risperidone.<br /><br />Lorazepam and other benzodiazepines serve as both diagnostic and first-line therapeutic agents for stimulant-induced catatonia, effective in about 90% of acute cases. Electroconvulsive therapy (ECT) is reserved for benzodiazepine-resistant cases. Monitoring vital signs and labs like CPK helps distinguish catatonia from NMS in complex presentations.<br /><br />Clinicians in psychiatric, medical, and emergency settings should consider stimulant-induced catatonia when assessing altered mental status in stimulant users. Prompt benzodiazepine treatment can rapidly reverse symptoms, reducing morbidity and mortality associated with this condition.
Keywords
stimulant-induced catatonia
methamphetamine
schizophrenia
haloperidol
benzodiazepines
lorazepam
neuroleptic malignant syndrome
catatonia symptoms
Bush-Francis Catatonia Rating Scale
electroconvulsive therapy
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