A Case is presented of a 23-year-old woman with progressive onset of paranoid psychosis and catatonia, who was ultimately found to have both 12 deficiency">vitamin B12 deficiency and a family history of bipolar disorder. The patient was initially diagnosed with schizophrenia and treated with the antipsychotic medication ziprasidone. Her condition rapidly worsened to a state consistent with either neuroleptic malignant syndrome or malignant catatonia. Work-up then revealed 12 deficiency">vitamin B12 deficiency and a family history of bipolar disorder. Her symptoms improved rapidly but partially with benzodiazepines and electrocon-vulsive therapy, and completely with addition of valproic acid, vitamin B12 replacement, and re-introduction of antipsychotic medication in the form of olanzapine. The authors discuss the differential diagnosis of catatonia as reflecting a high likelihood of underlying mood disorder; the evaluation and management of malignant catatonia and malignant neuroleptic syndrome; and the role of 12 deficiency">vitamin B12 deficiency in precipitating psychotic symptoms. The case also illustrates the problems of diagnosing and managing a multifactorial disorder with psychiatric, general medical, and perhaps iatrogenic components.
*Medical University of South Carolina, Charleston.
†Clinical Professor and Vice Chair for Clinical Affairs, Department of Psychiatry, Columbia University College of Physicians and Surgeons
The authors declare no conflict of interest.
Malignant catatonia in a patient with bipolar disorder, B12 deficiency, and neuroleptic malignant syndrome: One Cause or Three?: Erratum
In the article that appeared on page 415 of the September issue, Christopher Pelic, MD, Associate Dean of Students and Assistant Professor and Associate Residency Director in Psychiatry, Medical University of South Carolina, should have been listed as the second author of the case presentation for the article. An erratum has been published in Volume 15, Number 6 of the Journal..
Lewis L, Kahn DA. Malignant catatonia in a patient with bipolar disorder, B12 deficiency, and neuroleptic malignant syndrome: One Cause or Three? J Psychiatr Pract 2009 Sep;15(5):415-22.