Covid-19 Induced Catatonia: A Review Of This Rare Phenomenon.

BACKGROUND: Catatonia is a psychomotor syndrome characterized by numerous clinical features, a few being stupors which is the most common sign, posturing, forced grasping, echopraxia, etc. There have been cases documented in the literature of Catatonia occurring with COVID-19. This article will focus on the complete and brief overview of catatonia observed in patients with COVID-19 infection. METHODS: We outline the evidence of the pathophysiology of COVID-19 in the CNS system, the effect of the virus in inducing catatonia, and its outcome. The literature used in the article is mostly case reports from different parts of the world thus; we have generalized our review taking into consideration multiple factors. RESULTS: In patients with COVID-19, neuropsychiatric manifestations are very commonly appreciated. Catatonia has been documented in many patients along with respiratory symptoms such as fever, shortness of breath, and cough. There are multiple etiologies associated with this presentation which have been discussed in detail in this article. In many patients, there was no history of any psychiatric illness. The timing of presenting with catatonic features was also different for different individuals. CONCLUSIONS: COVID-19 has been believed to contribute to the presentation of catatonia. There is no specific timeline between the onset of symptoms and the presence of COVID-19 infection. However, coronavirus can be responsible in a few ways for inducing catatonia in patients with or without any previous psychiatric illness. Therefore, COVID-19 should be considered as one of the major factors in this complex psychiatric disease, catatonia.

Treatment of Catatonia with Asenapine in a Patient with Schizotypal Personality Disorder, Psychotic Depression and Septic Shock from SARSCoV- 2 - A Case Report.

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.