Open AccessPublished 02/19/2021
Copyright © Copyright 2021Sheikh et al. This is an open accessposter distributed under the terms of theCreative Commons Attribution LicenseCC-BY 4.0., which permits unrestricteduse, distribution, and reproduction in anymedium, provided the original author andsource are credited.
Distributed under Creative Commons CC-BY 4.0
Atypical Presentation Of Postpartum Psychosis: A Mixture Of RetardedAnd Excited Features Of Catatonia
Batool Z. Sheikh , Divya Periasamy , Rana Tahir
1. Psychiatry and Behavioral Sciences, Brookdale University Hospital Medical Center, New York, USA 2. Psychiatry andBehavioral Sciences, Brookdale University Hospital Medical Center, Brooklyn, USA
Corresponding author: Batool Z. Sheikh, [email protected]
Categories: Obstetrics/Gynecology, Psychiatry, PsychologyKeywords: bush francis catatonia scale, post-partum psychosis, catatonia, subtypes of catatonia, lorazepam, excited catatonia, retardedcatatonia, atypical case of post-partum psychosis
How to cite this posterSheikh B Z, Periasamy D, Tahir R (2021) Atypical Presentation Of Postpartum Psychosis: A Mixture Of Retarded And Excited Features OfCatatonia . Cureus 13(2): e.
AbstractTitle:Atypical Presentation of Postpartum Psychosis: A mixture of Retarded and Excited Features ofCatatonia
Author:Batool Sheikh, MD, Brookdale University Hospital Medical Center, New York; Divya Periasamy MD,Brookdale University Hospital Medical Center; New York, Rana Tahir, MD Brookdale University HospitalMedical Center, New York
Background:Catatonia is a syndrome of psychomotor symptoms. There are two subtypes of catatonia; retarded andexcited. Cases have been reported where patients presented with postpartum psychosis mostly with retardedcatatonia. Our case report showed postpartum psychosis with symptoms of retarded and excited catatoniaconcurrently.
Aim:The aim is to bring awareness of atypical symptoms of catatonia in patients with postpartum psychosis inorder to reduce morbidity and mortality.
Case Description:An 18 years old female with a history of ADHD, postpartum day 30, presented with disorganized behaviorsitting on a toilet seat for hours not responding to verbal stimuli. The patient was admitted for proctitis dueto inserting unrelated objects in her anus. On initial psychiatric evaluation, the patient exhibiteddisorganized and stereotyped behavior, attempting to insert a plastic utensil in the rectum. On follow-up,she presented with retarded symptoms of catatonia which included mutism, immobility, staring, andwithdrawal. Bush-Francis Catatonia Rating Scale (BFCRS) score 18. The patient was started on Lorazepam.Within hours the patient was exhibiting excited symptoms of catatonia including combative, impulsive, andstereotypy behavior. BFCRS score increased to 24. The patient was transferred to inpatient psychiatry formanagement of acute psychosis. She was treated with Lorazepam and Haloperidol for catatonia andpsychosis respectively. Her symptoms continued to have fluctuating episodes of retarded and excitedcatatonia. She started to improve over time. It was also revealed that the patient was suffering fromdepression which eventually progressed to post-partum psychosis. The patient was stabilized onEscitalopram and was discharged at her baseline.
Conclusion:Postpartum psychosis can present in different ways. Our patient presented with an atypical presentation ofpostpartum psychosis with both subtypes of catatonia. Her symptoms were fluctuating rapidly and thediagnosis was challenging due patient's atypical presentation. However, she received proper treatment andreached the baseline. Postpartum psychiatric illnesses are serious conditions and can lead to suicide orinfanticide. The evaluation should be comprehensive and differential diagnosis should be broad to preventany misdiagnosis.
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