Malignant Catatonia

  • Stephan C. Mann
  • Stanley N. Caroff
  • E. Cabrina Campbell
  • Henry R. Bleier
  • Robert A. Greenstein
Part of the Current Clinical Neurology book series (CCNEU)


Patient 1: A 27-year-old woman with a personal and family history of bipolar disorder has taken no psychiatric medications for the past 6 months. One week prior to admission, she develops elevated mood, pressured speech, and flight of ideas. Over the ensuing days, she grows markedly agitated and unable to sleep, talks constantly, paces relentlessly, and refuses to eat or drink. On admission to the psychiatric unit, she requires four-point restraints. She is confused and intensely hyperactive, with periods of incoherent chatter alternating with hostile verbal outbursts. She frequently thrashes from side to side, is delusional, and appears to be responding to both auditory and visual hallucinations. She exhibits muscular rigidity, posturing, echolalia, and echopraxia. Temperature is 39° with tachycardia, tachypnea, profuse diaphoresis, and a blood pressure of 170/120 mmHg. Laboratory abnormalities include leukocytosis, elevation in creatine phosphokinase (CPK) (2800 IU) and serum transaminases, and a serum iron of 38 µg/dL (75–175 µg/dL). Lumbar puncture, electroencephalogram and computed tomography scan of the head are normal.


Neuroleptic Malignant Syndrome Muscular Rigidity Antipsychotic Drug Treatment Akinetic Mutism Excited Phase 
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Copyright information

© Humana Press Inc. 2005

Authors and Affiliations

  • Stephan C. Mann
    • 1
  • Stanley N. Caroff
    • 1
  • E. Cabrina Campbell
    • 1
  • Henry R. Bleier
    • 1
  • Robert A. Greenstein
    • 1
  1. 1.Department of PsychiatryUniversity of Pennsylvania School of Medicine and the Department of Veterans Affairs Medical CenterPhiladelphia

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