Yesterday Once More: Revisiting Catatonia in an Elderly Stroke Patient
AI Summary
Catatonia is often under-recognised in medically ill older adults, including those with cerebrovascular disease, mandating routine screening.
Lorazepam produced clinical and scale improvements: BFCRS 21 to 11, KANNER Part II 18 to 10, with sustained remission at follow-up.
Despite geriatric cautions, benzodiazepines may be justified for catatonia; include catatonia explicitly as an appropriate indication in prescribing frameworks.
OBJECTIVES: Catatonia in older adults is often under-recognized, particularly when it occurs in the setting of acute medical illness or neurological disease. Benzodiazepines are first-line therapy, yet geriatric prescribing frameworks such as the American Geriatrics Society Beers Criteria discourage benzodiazepine use in older adults, which can contribute to delays in treatment.
METHODS: We report a 71-year-old woman with prior ischemic stroke and major depressive disorder who presented with failure to thrive, behavioral withdrawal, and motor findings consistent with catatonia. Catatonia severity was assessed with the Bush-Francis Catatonia Rating Scale (BFCRS) and the KANNER scale, and she was treated with lorazepam.
RESULTS: BFCRS total score improved from 21 at baseline to 11 following lorazepam titration (0.5 mg three times daily increased to 1 mg three times daily). The KANNER Part II score improved from 18 to 10. Clinically, nursing and therapy documentation noted improved engagement, resumption of oral intake, acceptance of medications and hygiene, and participation in physical therapy. At 1- and 5-month follow-up visits, she had no recurrence of catatonic signs by clinical assessment.
CONCLUSIONS: This case highlights the need for routine screening for catatonia in medically ill older adults, including those with cerebrovascular disease. When catatonia is present, the risk-benefit balance may favor benzodiazepines despite general geriatric cautions. Explicitly listing catatonia among appropriate indications for benzodiazepines in geriatric prescribing frameworks may reduce treatment delays.
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