ABSTRACT
OBJECTIVE: The case of a schizoaffective patient suffering from a malignant catatonic syndrome following combined lithium-risperidone therapy is explored. METHOD: A case report and relevant deliberations regarding pathophysiology of the catatonic dilemma are discussed. CONCLUSIONS: There are two critical transitions in the development of a malignant catatonic syndrome. Dopaminergic system and psychopharmacological factors are supposed to play a key role. However, other neurotransmitter systems and the individual predisposition must be considered.
Subject(s)
Antimanic Agents/toxicity , Antipsychotic Agents/toxicity , Catatonia/chemically induced , Lithium Carbonate/toxicity , Psychotic Disorders/drug therapy , Risperidone/toxicity , Antimanic Agents/administration & dosage , Antimanic Agents/pharmacokinetics , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/pharmacokinetics , Brain/drug effects , Brain/physiopathology , Catatonia/diagnosis , Catatonia/drug therapy , Catatonia/physiopathology , Clozapine/administration & dosage , Diagnosis, Differential , Dopamine/metabolism , Dose-Response Relationship, Drug , Drug Interactions , Drug Therapy, Combination , Electroencephalography/drug effects , Humans , Hypnotics and Sedatives/administration & dosage , Lithium Carbonate/administration & dosage , Lithium Carbonate/pharmacokinetics , Long-Term Care , Lorazepam/administration & dosage , Male , Middle Aged , Psychotic Disorders/blood , Risperidone/administration & dosage , Risperidone/pharmacokinetics , Serotonin/metabolismABSTRACT
UNLABELLED: Automutilistic behaviour is frequently correlated with personality disorders and should be differentiated from suicidal behaviour during acute episodes of affective disorders. The aim of the study was to investigate psychotherapeutically and psychodynamically significant personality traits and affect regulation. The dimensions "relationship", "conflict" and "structure" were examined by means of Operationalized Psychodynamic Diagnostics. SAMPLE: 20 female patients with depression and automutilistic behaviour and 20 age-matched female subjects with a similar educational background, suffering from depression without automutilistic behaviour. RESULTS The female patients with depression and automutilistic behaviour could be differentiated from the control group in all categories in the OPD dimension "structure". They showed an "isolated" and "disclosed" self-image. This negative self-perception corresponded with a negative countertransference. There were no differences between the patients with automutilistic behaviour and the control group regarding the OPD dimension "conflict". Low and moderate levels of integration were prominently correlated with the autonomy-dependence conflict. CONCLUSION The results underline the significance of aspects of personality structure in automutilistic behaviour seen in female patients with depression. Operationalized Psychodynamic Diagnostics can reveal therapeutically relevant personality dimensions for empirical research.