Apparent rapid response to the combination of zolpidem, memantine and aripiprazole in a case of schizophrenic catatonia
DOI:
https://doi.org/10.20453/rnp.v86i3-1.4980Keywords:
catatonia, stupor, GABA-A receptorsAbstract
Objective: The treatment of catatonia usually involves the use of benzodiazepines and, if these fail, electroconvulsive therapy is applied. Nevertheless, hypothetical neurobiological pathways involved in catatonia postulate beneficial effects of GABAergic drugs and glutamate blockers. Clinical case: A 45-year-old female patient, diagnosed with paranoid schizophrenia who developed a catatonic stupor (with no response to benzodiazepines) and various medical complications; however, the condition improved rapidly with the combination of zolpidem, memantine and aripiprazole. Result: A favorable outcome was obtained in this case, not achieved with the previous use of standard benzodiazepine therapy. Conclusions: The combination of GABAergic drugs and glutamate blockers can be beneficially implemented in cases of catatonic stupor that fail to respond to the usual management with
benzodiazepines.
References
Organización Mundial de la Salud. Clasificación Internacional de Enfermedades, undécima revisión (CIE-11) [Internet]. OMS; 2019/2021. Disponible en: https://icd.who.int/browse11/l-m/es
American Psychiatric Association. Manual Diagnóstico y Estadístico de los Trastornos Mentales DSM-5.
Madrid: Editorial Médica Panamericana; 2014.
Walther S, Stegmayer K, Wilson JE, Heckers S. Structure and neural mechanisms of catatonia. Lancet Psychiatry [Internet]. 2019; 6(7): 610-619. Disponible en: https://www.thelancet.com/journals/ lanpsy/article/PIIS2215-0366(18)30474-7/fulltext
Mormando C, Francis A. Catatonia revived: a unique syndrome updated. Int Rev Psychiatry [Internet].
; 32(5-6): 403-411. Disponible en: https://www. tandfonline.com/doi/abs/10.1080/09540261.2020.17
?journalCode=iirp20
Solmi M, Pigato GG, Roiter B, Guaglianone A, Martini L, Fornaro M, et al. Prevalence of catatonia and its
moderators in clinical samples: results from a metaanalysis and meta-regression analysis. Schizophr Bull [Internet]. 2018; 44(5): 1133-1150. Disponible en: https://academic.oup.com/schizophreniabulletin/ article/44/5/1133/4626666
Tachibana M, Ishizuka K, Inada T. Catatonia and delirium: similarity and overlap of acute brain dysfunction. Front Psychiatry [Internet]. 2022; 13: 876727. Disponible en: https://www.frontiersin.org/ articles/10.3389/fpsyt.2022.876727/full
Lin CC, Huang TL. Benzodiazepine treatment of catatonia. Future Neurol [Internet]. 2015; 10(5): 439-
Disponible en: https://www.futuremedicine. com/doi/10.2217/fnl.15.33
Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G. A clinical review of the treatment of catatonia. Front Psychiatry [Internet]. 2014; 5: 181. Disponible en: https://www.frontiersin.org/
articles/10.3389/fpsyt.2014.00181/full
Pelzer ACM, Van der Heijden FMMA, Den Boer E. Systematic review of catatonia treatment. Neuropsychiatr Dis Treat [Internet]. 2018; 2018(14): 317-326. Disponible en: https://www.dovepress.com/systematic-review-of-catatonia-treatment-peerreviewed-fulltext-article-NDT
Thomas P, Rascle C, Mastain B, Maron M, Vaiva G. Test for catatonia with zolpidem. Lancet [Internet].
; 349(9053): 702. Disponible en: https://www. thelancet.com/journals/lancet/article/PIIS0140-6736(05)60139-0/fulltext
Javelot H, Michel B, Steiner R, Javelot T, Cottencin O. Zolpidem test and catatonia. J Clin Pharm Ther
[Internet]. 2015; 40(6): 699-701. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/jcpt.12330
Ellul P, Choucha W. Neurobiological approach of catatonia and treatment perspectives. Front Psychiatry
[Internet]. 2015; 6: 182. Disponible en: https://www. frontiersin.org/articles/10.3389/fpsyt.2015.00182/ full
Obregon DF, Velasco RM, Wuerz TP, Catalano MC, Catalano G, Kahn D. Memantine and catatonia:
a case report and literature review. J Psychiatr Pract [Internet]. 2011; 17(4): 292-299. Disponible en: https://journals.lww.com/practicalpsychiatry/abstract/2011/07000/memantine_and_catatonia__a_case_report_and.9.aspx 14. Lee JWY. Neuroleptic-induced catatonia: clinical presentation, response to benzodiazepines, and
relationship to neuroleptic malignant syndrome. J Clin Psychopharmacol [Internet]. 2010; 30(1): 3-10. Disponible en:https://journals.lww.com/psychopharmacology/abstract/2010/02000/neuroleptic_induced_catatonia__clinical.2.aspx
Carroll BT, Goforth HW, Thomas C, Ahuja N, McDaniel WW, Kraus MF, et al. Review of adjunctive glutamate antagonist therapy in the treatment of catatonic syndromes. J Neuropsychiatry Clin Neurosci [Internet]. 2007; 19(4): 406-412. Disponible en: https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.2007.19.4.406
Sichert V, Volz HP. Rapid efficacy of aripiprazole in the treatment of catatonic depression/catatonia with consideration of the drug’s unique receptor profile: a case report. Fortschr Neurol Psychiatr
[Internet]. 2021; 89(4): 178-181. Disponible en: https://www.thieme-connect.de/products/ejournals/ abstract/10.1055/a-1183-3887
Sasaki T, Hashimoto T, Niitsu T, Kanahara N, Iyo M. Treatment of refractory catatonic schizophrenia
with low dose aripiprazole. Ann Gen Psychiatry [Internet]. 2012; 11(1): 12. Disponible en: https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/1744-859X-11-12
Appiani FJ, Duarte JM, Sauré M, Rodríguez-Cairoli F, Momeño V, Yaryour C, et al. Catatonia and delirium: assessment of comorbidity, prevalence, and therapeutic response in medically ill inpatients from a university hospital. J Clin Psychopharmacol [Internet]. 2023; 43(1): 55-59. Disponible en:
Roy K, Warnick SJ, Balon R. Catatonia delirium: 3 cases treated with memantine. Psychosomatics [Internet]. 2016; 57(6): 645-650. Disponible en: https://www.sciencedirect.com/science/article/pii/S0033318216300652?via%3Dihub
RNP is distributed under a 