AffiliationUniv Arizona, Dept Emergency Med
MetadataShow full item record
PublisherELSEVIER SCIENCE INC
CitationIserson, K. V., & Durga, D. (2020). Catatonia-Like Syndrome Treated With Low-Dose Ketamine. The Journal of emergency medicine, 58(5), 771–774. https://doi.org/10.1016/j.jemermed.2019.12.030
JournalJOURNAL OF EMERGENCY MEDICINE
RightsCopyright © 2019 Elsevier Inc. All rights reserved.
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at email@example.com.
AbstractBackground Ketamine's application in psychiatry have expanded, but it appears never to have been previously used to diagnose and treat patients with catatonia-like syndrome that occasionally present to emergency departments. Case Report A 23-year-old male was observed to suddenly stop talking. His ED GCS was 8 and had normal vital signs. While verbally unresponsive, he refused to open his eyes, demonstrated waxy flexibility of his arms, but the balance of his physical, neurological, and laboratory exams were normal. Strongly suspecting a catatonic state, they needed to rapidly confirm that diagnosis or begin evaluating him for potentially life-threatening non-psychiatric illnesses. Lacking other diagnostic modalities, they administered low-dose ketamine boluses. Ketamine 25 mg (1 mL) was diluted in 9 mL NS (2.5 mg/mL). Based on similar protocols, 1 mL of the solution (0.03 mg/Kg) was given intravenously every few minutes. After 12.5 mg ketamine, he was conscious and verbal. Subsequent history confirmed a prior episode requiring an extensive, non-productive medical evaluation. Psychiatry later confirmed the diagnosis. Why Should an Emergency Physician Be Aware of This? Patients with catatonia-like states pose a difficult diagnostic and therapeutic dilemma. Multiple interventions have been used with varying success. Optimal interventions provide a rapid resolution (or demonstrate that a psychiatric cause is not likely), be safe, encompass few contraindications, and be familiar to the clinician. In our patient, subanesthetic doses of ketamine fulfilled these criteria and successfully resolved the condition. If shown effective in other cases, ketamine would be a valuable addition to our psychiatric armamentarium.
Note12 month embargo; published online: 27 January 2020
VersionFinal accepted manuscript
- [Catatonia in a 14 year-old girl: treatment with clorazepam and carbamazepine, a 10-year follow-up].
- Authors: Askenazy F, Dor E, Benoit M, Dupuis G, Serret S, Myquel M, Seddiki Y
- Issue date: 2010 Feb
- [Catatonia de novo, report on a case: immediate vital prognosis and psychiatric prognosis in longer term].
- Authors: Patry L, Guillem E, Pontonnier F, Ferreri M
- Issue date: 2003 Jan-Feb
- [Catatonia: resurgence of a concept. A review of the international literature].
- Authors: Pommepuy N, Januel D
- Issue date: 2002 Nov-Dec
- [Acute catatonia: Questions, diagnosis and prognostics, and the place of atypical antipsychotics].
- Authors: Belaizi M, Yahia A, Mehssani J, Bouchikhi Idrissi ML, Bichra MZ
- Issue date: 2013 Jun
- [Psychiatric manifestations of lupus erythematosus systemic and Sjogren's syndrome].
- Authors: Ampélas JF, Wattiaux MJ, Van Amerongen AP
- Issue date: 2001 Nov-Dec