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PP-23 Catatonia Following Traumatic Brain Injury: A Case Report Responding to Lorazepam and Transcranial Direct Current Stimulation - Page 222
Zahid Emre Kösecik, Rahime Gök, Taha Can Tuman, Mehmet Yücel Ağargün

PP-24 Management of a Rare Case of Maculopapular Exanthema with Escitalopram Use in a Patient with Anxiety and Restless Leg Syndrome - Page 224
Nihan Nur Ceran Gurlek

PP-27 Acute Psychotic Disorder Triggered by Traumatic Bereavement and Major Self-Mutilation: A Case Report - Page 225
Gamze Burhan, Duçem Selena İşmar, Güneş Devrim Kıcalı

PP-29 Long-Term Outcomes of Intranasal Esketamine in Treatment-Resistant Depression: Evidence from Clinical Trials and Real-World Studies - Page 226
Çağla İyice, Deniz Kaya, Güneş Devrim Kıcalı

PP-30 Anhedonia and Increased Alcohol Consumption Following Tirzepatide Use: A Case Report - Page 227
Deniz Kaya, Çağla İyice, Güneş Devrim Kıcalı

PP-31 Lithium-Induced Severe Hypothyroidism Presenting with Psychotic Mania in a Patient with Bipolar Disorder: A Case Report - Page 229
Ayşe Köksal

20 APRIL 2026, MONDAY
PP-22 Is Catatonia a Risk Factor for Neuroleptic Malignant Syndrome? A Case Report

PP-22 Is Catatonia a Risk Factor for Neuroleptic Malignant Syndrome? A Case Report

Elif Ehliz Tatlıdede1, Aslıhan Özdemir Yaşaran1, Cansu Bak1, Sare Aydın1

1. Psychiatry Department, Gaziosmanpasa Unıversity, Tokat, Turkey

DOI: 10.5080/61upk.ozt514 Page 220
Is Catatonia a Risk Factor for Neuroleptic Malignant Syndrome?A Case Report INTRODUCTION: Catatonia and neuroleptic malignant syndrome(NMS)are severe neuropsychiatric conditions with overlapping features including altered consciousness,motor abnormalities,autonomic instability,and hyperthermia(1).NMS usually emerges shortly after antipsychotic initiation or dose escalation and is characterized by hyperthermia,muscle rigidity,autonomic instability,altered consciousness,and elevated CK(2). Hypodopaminergic activity in catatonia may be exacerbated by dopamine blockade.Dehydration or inadequate oral intake may further precipitate NMS(3).We report NMS developing after antipsychotic treatment in a patient with schizophrenia presenting with prominent catatonic features. Case A 30-year-old male with schizophrenia was admitted with standing motionless for hours,marked psychomotor retardation,unresponsiveness,refusal of oral intake,and perseverative religious-themed thought content after discontinuing antipsychotics one month earlier. Evaluation revealed mutism,negativism,posturing,and decreased responsiveness consistent with stupor.According to DSM-5,at least four catatonic symptoms(mutism,negativism,posturing,stupor)were present.He was hospitalized with a diagnosis of catatonic syndrome. Due to persecutory delusions,quetiapineXR300mg/day,quetiapineIR50mg/day,and vortioxetine 20mg/day were initiated.On day two,he developed fever>38°C,sinus tachycardia,diaphoresis,and CK8,816U/L.With suspected NMS,he was transferred to intensive care. Antipsychotics were discontinued.Because of absent oral intake,diazepam2×10mgIV was administered for four days instead of lorazepam.Dantrolene20mgIV and bromocriptine2×2.5mg were briefly added.Hyperthermia,rigidity,elevated CK,and autonomic instability gradually resolved. Catatonic symptoms(mutism,posturing,negativism)persisted,and he returned to the psychiatry ward.Benzodiazepine treatment and supportive care were continued. Consent Written informed consent was obtained from the patient’s relatives. Discussion Catatonia and NMS overlap in motor symptoms,autonomic instability,and altered consciousness.Beyond symptomatic similarity,a possible pathophysiological association has been proposed(4). Dopamine D2 receptor blockade underlies NMS,and dopaminergic dysfunction also contributes to catatonia.Antipsychotics may exacerbate catatonic symptoms(5),suggesting that initiating treatment during catatonia may increase vulnerability to NMS. Reports describe interaction between antipsychotic-induced catatonia and NMS(6).In this case,NMS developed shortly after antipsychotic initiation in a patient with catatonic features,supporting the view that catatonia may represent a potential risk factor for NMS.Careful assessment before initiating antipsychotics in catatonic patients is therefore clinically essential. References 1.WhiteDA,RobinsAH.CNSSpectr.2000;5(7):58-65.doi:10.1017/S1092852900013419 2.WhiteDA,RobinsAH.BrJPsychiatry.1991;158:419-421.doi:10.1192/bjp.158.3.419 3.SatoI,etal.BMJSupportPalliatCare.2020;10(3):265-270. 4.Sienaert P,et,al.FrontPsychiatry.2014;5:181.doi:10.3389/fpsyt.2014.00181 5.HirjakD,et,al.MolPsychiatry.2021;26:6112-6114. 6.VirolleJ,et.al.SchizophrRes.2023. Keywords: CATATONIA, NEUROLEPTIC MALİGNANT SYNDROME, SCHIZOPHRENIA