Prevention of Catatonia With Olanzapine Long-Acting Injectable

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The patient was a 31-year-old divorced white woman living with her parents in an urban area. She was diagnosed with paranoid schizophrenia at the age of 22, before Graduation of the Faculty of Economics. After the first admission in the Psychiatry and Neurology Hospital of Brasov, Romania, she managed to complete her studies but soon relapsed with the second paranoid episode. As a particularity of the case, we noted the evolution with 3 paranoid episodes followed by the last 3 consecutive catatonic episodes between 2009 and 2011. The patient's files and her family statements revealed that the side effects were the main reasons for the patient's nonadherence to the antipsychotic treatment: haloperidol induced acute dystonia, risperidone induced akathisia, and amisulpride induced amenorrhea. The patient response was very good to olanzapine 10 mg/d, but the patient followed the treatment only for a short period (2–3 months) after discharge. The paranoid episodes consisted in auditory hallucinations, persecutory delusions, and aggressive behavior. Usually, she was admitted in the Acute Psychiatric Department involuntarily. After 4 years, she was medically retired, and she spent all day smoking and watching TV with minimal social interaction.
In August 2011, she suddenly became bizarre with refusal of meals and leaving her bed. After 2 days of mutism and total refusal of any food or water, she was admitted into an emergency psychiatric unit. The patient's brother affirmed that he was pretty sure that a new catatonic episode occurred (similarity with the previous 2 catatonic episodes was striking), and he decided to ask for psychiatric help immediately. He also declared that 4 months ago, at the end of April 2011, the patient informed her family using the sentence: “I'm cured and the treatment is no longer needed.” Despite her family and the warnings of the psychiatrist, she refused to follow the antipsychotic treatment with oral olanzapine. During the medical examination, she showed passive resistance to any attempts to move her arms and legs with waxy flexibility. Routine complete blood count, electrolytes, creatinine, and liver function tests were normal as well as the electrocardiogram. Urine toxicology was negative. The patient had normal vital signs. The brain computed tomography with contrast substance was normal.
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