Project Title

"Don't Sleep on Zolpidem: A Case demonstrating benefit of Zolpidem in Malignant Catatonia"

Authors' Affiliations

Nigel Dsouza, Department of Psychiatry, East Tennessee State University, Johnson City, TN Scott Sprabery, Department of Psychiatry, James H. Quillen Veteran's Affairs Medical Center

Faculty Sponsor’s Department

Psychiatry & Behavioral Sciences

Type

Oral Non-Competitive

Classification of First Author

Medical Resident or Clinical Fellow

Project's Category

Medicine

Abstract Text

Catatonia is a neuropsychiatric condition characterized by physical presentations ranging from profound immobility to excessive motor activity. In the past, catatonia was considered a variant of schizophrenia. However, newer data suggests catatonia is a clinical expression of many different medical or psychiatric components. A prompt diagnostic evaluation should identify any underlying diseases with consideration of somatic pathologies, especially those affecting central nervous system function. The recognition of catatonia among providers is relatively poor. It is often seen as a historical diagnosis. Because of this, catatonia is often undiagnosed. If patients in catatonic states are not diagnosed, their condition is likely to progress with a risk of increased morbidity and potentially fatal outcome. Lorazepam or electroconvulsive therapy (ECT) are considered the standard of care for treatment of catatonia. Zolpidem has been used successfully as a rapid test for patients suspected to be catatonic.This case report explores zolpidem as a long-term treatment option when standard therapies are not tolerated or ineffective. In order to recognize catatonia, apart from thorough and repeated observation, a clinical examination is needed. The Bush-Francis Catatonia Rating Scale is a quantifiable examination designed to screen and diagnose the possibility of catatonia. We investigated Zolpidem’s impact on a patient’s Bush-Francis Catatonia Rating Scale score. Scores were collected weekly for two months. There were five different resident physicians who conducted these examinations. Results of this work identified a reduction in Bush-Francis Catatonia ratings in seven out of the eight weeks of this study, suggesting that there may be a link between Zolpidem use and a reduction in catatonic symptoms. Limitations to this study included the subjective nature of the rating scale, along with the potential for variability in assessment standards, stemming from the fact that multiple examiners were used to conduct ratings. Because catatonia is a medical emergency, it is of utmost importance to gather a detailed history and conduct a rigorous medical workup to help confirm the diagnosis. While Lorazepam and ECT remain the standard of care, this study demonstrates that there may be a potential benefit to the use of Zolpidem in catatonia.

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"Don't Sleep on Zolpidem: A Case demonstrating benefit of Zolpidem in Malignant Catatonia"

Catatonia is a neuropsychiatric condition characterized by physical presentations ranging from profound immobility to excessive motor activity. In the past, catatonia was considered a variant of schizophrenia. However, newer data suggests catatonia is a clinical expression of many different medical or psychiatric components. A prompt diagnostic evaluation should identify any underlying diseases with consideration of somatic pathologies, especially those affecting central nervous system function. The recognition of catatonia among providers is relatively poor. It is often seen as a historical diagnosis. Because of this, catatonia is often undiagnosed. If patients in catatonic states are not diagnosed, their condition is likely to progress with a risk of increased morbidity and potentially fatal outcome. Lorazepam or electroconvulsive therapy (ECT) are considered the standard of care for treatment of catatonia. Zolpidem has been used successfully as a rapid test for patients suspected to be catatonic.This case report explores zolpidem as a long-term treatment option when standard therapies are not tolerated or ineffective. In order to recognize catatonia, apart from thorough and repeated observation, a clinical examination is needed. The Bush-Francis Catatonia Rating Scale is a quantifiable examination designed to screen and diagnose the possibility of catatonia. We investigated Zolpidem’s impact on a patient’s Bush-Francis Catatonia Rating Scale score. Scores were collected weekly for two months. There were five different resident physicians who conducted these examinations. Results of this work identified a reduction in Bush-Francis Catatonia ratings in seven out of the eight weeks of this study, suggesting that there may be a link between Zolpidem use and a reduction in catatonic symptoms. Limitations to this study included the subjective nature of the rating scale, along with the potential for variability in assessment standards, stemming from the fact that multiple examiners were used to conduct ratings. Because catatonia is a medical emergency, it is of utmost importance to gather a detailed history and conduct a rigorous medical workup to help confirm the diagnosis. While Lorazepam and ECT remain the standard of care, this study demonstrates that there may be a potential benefit to the use of Zolpidem in catatonia.

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