A Case of Conversion Catatonia Misdiagnosed for 24 Years

Pauline K. Wiener, M.D.

INTRODUCTION Catatonia is a syndrome whose etiology may be both diverse and difficult to substantiate . Ms. H. is a 45-year-old black female with 18 previous psychiatric hospitalizations beginning at age 21 . A common characteristic to all hospitalizations was a catatonic presentation (i.e ., the patient was mute with marked muscular rigidity; she would refuse to eat or follow orders). In ea ch of her previous 18 hospitalizations, the patient was thought to be psychotic. It was found that each catatonic episode could be related to a severe psychological stressor. The patient’s illness never involved delusions, hallucinations or disturbances in thought form. Upon detailed evaluation of this patient’s history she was found to have symptoms consistent wit h conversion disorder. I report here the identification of a conversion disorder presenting as recurrent episodes of catatonia. Intramuscular lorazepam was found to be repeatedly successful in resolving the ca tatonic state .

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