27th National Clinical Education Symposium Presentation Abstracts
29 APRIL 2025, MONDAY
13:00-14:00 POSTER PRESENTATION SESSION-2
The Diagnostic Challenge of Organic Catatonia: A Case of CLN3 Disease Presenting with Severe Neurological and Psychiatric Symptoms
Cemre Terzi1, İnci Timur1, Şuheda Tapan Çelikkaleli1
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1. Department of Psychiatry, Yuzuncu Yıl University, Van, Turkey
DOI: 10.5080/kes27.abs138 Page 164
OBJECTIVE:Organic catatonia is a life-threatening neuropsychiatric syndrome that may arise from numerous psychiatric disorders as well as general medical conditions, including neurodegenerative, metabolic, and genetic diseases. Early identification of catatonia due to organic causes is crucial, as delayed treatment may lead to permanent neurological impairment. This case report presents a 20-year-old female with progressive neurological deterioration and catatonia, ultimately diagnosed with CLN3 disease (Batten disease). CASE (The patient consent must be provided and specified with appropriate terms.):A 20-year-old female with a history of epilepsy, progressive visual impairment, and mild intellectual disability presented with a six-month history of worsening gait disturbance, cognitive decline, severe weight loss (~30 kg) along with increased seizure frequency. Three months prior, following an emotional stressor, she developed persecutory delusions, visual hallucinations, mutism, and food refusal. She became increasingly withdrawn, irritable, and physically aggressive, leading her family to seek medical attention. Neurological and psychiatric evaluations resulted in levetiracetam, quetiapine, and olanzapine prescriptions; however, medication adherence was poor. Fifteen days prior to admission, her symptoms deteriorated further with autonomic instability, spasticity, and worsening catatonic features. After her transfer to our facility, neuroimaging and laboratory tests were unremarkable. She was admitted to the ICU with a preliminary diagnosis of organic catatonia and treated with diazepam. Despite partial improvement, rigidity persisted, necessitating electroconvulsive therapy (ECT). Following 10 ECT sessions, her psychomotor rigidity significantly improved, and she regained some verbal and social engagement, yet she remained unable to walk. Subsequent genetic testing revealed homozygous CLN3 mutation, confirming Batten disease. Informed consent was obtained. DISCUSSION:This case highlights the importance of recognizing organic causes in treatment-resistant catatonia, particularly in patients with neurodevelopmental disorders and progressive neurological symptoms. Early intervention with benzodiazepines and ECT remains crucial, yet underlying metabolic or genetic conditions should be explored when catatonia persists. A multidisciplinary approach is essential for accurate diagnosis and optimal management.