From the College of Medicine, University of Nebraska Medical Center, Omaha, NE (NJM); and Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE (VMMK, AAB).
J Addict Med. 2024;18(6):730-732. doi: 10.1097/ADM.0000000000001353. Epub 2024 Jul 23.
Malignant catatonia is a potentially lethal neuropsychiatric syndrome characterized by psychomotor abnormalities and autonomic instability. Patients with this syndrome require immediate treatment. Various psychiatric conditions and nonpsychiatric medical problems can trigger malignant catatonia. Use of psychostimulant drugs, including methamphetamine and cocaine, has not been previously reported to precipitate malignant catatonia.
This case concerns a 35-year-old man hospitalized for psychosis due to methamphetamine and cocaine intoxication. He developed malignant catatonia the day after admission. He was treated with lorazepam for malignant catatonia, and his blood pressure was controlled with clonidine. Over 7 days, his condition resolved, and his mental status and vital signs returned to baseline. He was discharged to the community in stable condition and has returned to his baseline functional status. He remains free of catatonia and has maintained abstinence from methamphetamine and cocaine.
Acute intoxication with psychostimulant drugs is a possible trigger for malignant catatonia, and administration of high potency first-generation antipsychotics in this setting may increase the risk. Patients hospitalized for stimulant intoxication should be monitored for signs and symptoms of catatonia, and D 2 receptor antagonist medications should be used with caution in this population. Our case supports the potential role of altered dopamine and norepinephrine signaling in the pathogenesis of malignant catatonia. The patient provided written and verbal consent to publish the information in this case report.
恶性紧张症是一种潜在致命的神经精神综合征，其特征为精神运动异常和自主神经不稳定。此类患者需要立即接受治疗。各种精神疾病和非精神医学问题都可能引发恶性紧张症。包括冰毒和可卡因在内的精神兴奋剂药物的使用此前并未被报道会引发恶性紧张症。
该病例涉及一名 35 岁男性，因冰毒和可卡因中毒导致精神错乱住院。他在入院后第二天出现恶性紧张症。他接受了劳拉西泮治疗恶性紧张症，并用可乐定控制血压。在 7 天内，他的病情得到缓解，精神状态和生命体征恢复基线水平。他出院时情况稳定，已恢复基线功能状态。他目前没有紧张症，且保持对冰毒和可卡因的戒断。
急性精神兴奋剂药物中毒可能是恶性紧张症的一个诱因，在此情况下使用高效价第一代抗精神病药物可能会增加风险。因兴奋剂中毒住院的患者应监测紧张症的迹象和症状，并且在该人群中应谨慎使用 D2 受体拮抗剂药物。我们的病例支持多巴胺和去甲肾上腺素信号改变在恶性紧张症发病机制中的潜在作用。患者提供了书面和口头同意，允许发表本病例报告中的信息。
