Houston Methodist Hospital, Houston, Texas, USA.
Pharmacotherapy. 2024 Oct;44(10):822-824. doi: 10.1002/phar.4612. Epub 2024 Oct 5.
Benzodiazepines and electroconvulsive therapy (ECT) are mainstay treatments for catatonia, a potentially life-threatening psychomotor syndrome characterized by a range of symptoms, including immobility, mutism, stupor, posturing, and sometimes even agitation. It can be a manifestation of various underlying psychiatric or medical conditions, such as schizophrenia, mood disorders, or neurological disorders. When conventional treatments fail to alleviate symptoms, ketamine, a dissociative anesthetic, has emerged as a potential therapeutic option for catatonia. However, its precise mechanism of action in treating catatonia remains to be fully elucidated. The use of ketamine in treating treatment-resistant catatonia in patients with schizophrenia has not been described.
We describe a unique case of a 77-year-old female with schizophrenia for 15 years who presented with hallucinations, generalized weakness, immobility, stupor, and mutism consistent with severe catatonia. The electroencephalogram did not show seizures, and brain imaging was negative for stroke. Her catatonia was resistant to treatment with benzodiazepines and haloperidol. However, ECT was unavailable due to the COVID-19 pandemic. She was successfully treated with a single intravenous infusion of ketamine administered at a dose of 0.5 mg/kg over 40 min with complete rapid recovery and remained stable as an outpatient.
Intravenous ketamine single infusion may be a safe and feasible option in schizophrenia patients with drug-resistant catatonia, particularly in patients for whom standard therapies are ineffective. However, its use should be approached cautiously due to the risk of exacerbation of psychosis in patients with schizophrenia.
Further research is warranted to better understand the role of ketamine in the management of catatonia in this patient population.
苯二氮䓬类药物和电抽搐治疗（ECT）是治疗紧张症的主要方法，紧张症是一种潜在危及生命的精神运动综合征，其特征是一系列症状，包括不动、缄默、昏迷、姿势异常，有时甚至出现激越。它可能是各种潜在精神或医学状况的表现，如精神分裂症、情绪障碍或神经障碍。当常规治疗无法缓解症状时，分离麻醉剂氯胺酮已成为紧张症的潜在治疗选择。然而，其在治疗紧张症的确切作用机制仍有待充分阐明。氯胺酮在治疗精神分裂症患者的难治性紧张症中的应用尚未被描述。
我们描述了一例独特的病例，一名 77 岁女性，患有精神分裂症 15 年，表现为幻觉、全身无力、不动、昏迷和缄默，符合严重紧张症。脑电图未显示癫痫发作，脑部影像学检查无中风。她的紧张症对苯二氮䓬类药物和氟哌啶醇的治疗无反应。然而，由于 COVID-19 大流行，ECT 无法进行。她成功地接受了单次静脉注射氯胺酮治疗，剂量为 0.5mg/kg，静脉滴注 40 分钟，迅速完全缓解，并且作为门诊患者保持稳定。
氯胺酮单次静脉输注可能是一种安全可行的选择，适用于药物难治性紧张症的精神分裂症患者，特别是对于标准治疗无效的患者。然而，由于氯胺酮可能会加重精神分裂症患者的精神病，因此应谨慎使用。
需要进一步研究以更好地了解氯胺酮在管理该患者人群中紧张症的作用。
