Missed Diagnosis of Major Depressive Disorder with Catatonia Features

Abstract

Catatonia is often a presentation of extreme anxiety and depression. Missing the diagnosis of catatonia would lead to improper treatment, which could be life-threatening. A thorough physical and psychiatric assessment is required for detecting the catatonic symptoms, especially, mutism and negativism in patients with depression. We discuss the case of a 58-year-old female that was incorrectly diagnosed and treated for major depressive disorder (MDD). The patient was then correctly diagnosed with MDD with catatonic features and improved once benzodiazepine (BZD) was started. The preferred BZD was lorazepam, with a success rate of complete remission of up to 80% in adults. Treatment was started with lorazepam 1–2 mg and improvement was seen within the first ten minutes. We believed the addition of BZD in a psychotropic regimen could improve both catatonia and depression, and should be continued for 3–6 months to prevent relapses and recurrences.