Title:Treatment of Catatonia with Asenapine in a Patient with Schizotypal Personality Disorder, Psychotic Depression and Septic Shock from SARSCoV- 2 - A Case Report
Volume: 20
Issue: 5
Author(s): Federica Fiaschè*, Barbara Adriani, Iginia Mancinelli and Aldo Taranto
Affiliation:
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome,Italy
Keywords:
Catatonia, catatonic, symptoms, diazepam, asenapine, sars-cov-2.
Abstract:
Introduction: Catatonia is a psychomotor syndrome that presents with severe symptoms
which can lead to dangerous and lethal conditions if not diagnosed and treated properly. SARS--
CoV-2 is a positive-sense single-stranded RNA virus that can occur in severe cases with acute
pneumonia, ARDS, sepsis and septic shock. In these cases, ICU admission is necessary.
Case Summary: A 59-year-old Caucasian man with septic shock and bilateral interstitial pneumonia
from SARS-CoV-2 and schizotypal personality disorder presented with catatonic behaviour
manifested by soporous state, response to intense painful stimuli with the opening of the eyes, execution
of simple verbal commands, maintenance of the same position, catalepsy, immobility, rigidity
and mutism. At the same time, there were symptoms of septic shock and catatonic symptoms,
causing greater difficulty in the correct formulation of the diagnosis. During the course of his hospitalization,
he was treated with asenapine 20 mg/day. The catatonia responded rapidly and significantly
to the asenapine.
Discussion: To date, the pathophysiology of catatonia is unclear, and few guidelines are available
for the treatment of catatonia. In the literature, studies have reported the efficacy of benzodiazepines
such as lorazepam and diazepam, GABAA agonists such as zolpidem, NMDA receptor antagonists
such as memantine, antidepressant SSRIs such as fluoxetine and paroxetine, and antipsychotics
such as olanzapine, clozapine and aripiprazole. We demonstrate that the antipsychotic asenapine
is also effective in treating catatonic symptoms in psychiatric disorders.
Conclusion: Asenapine produced a rapid and significant reduction in catatonic symptoms in our patient
with schizotypal personality disorder.
