Withdrawal Catatonia: A Rare Case of Treatment-Resistant Catatonia Secondary to Quetiapine Withdrawal

Introduction: Catatonia is a psychomotor syndrome with well-defined clinical characteristics, although the neurological mechanisms involved remain unknown. In this study, we report a case of a patient who developed treatment-resistant withdrawal catatonia upon sudden reduction of quetiapine dosage. This case represents a newly reported instance of treatment-resistant catatonia induced by quetiapine withdrawal. Presentation: A 63-year-old male with type I bipolar disorder presented with altered mental status and lethargy after returning from a domestic trip one week prior. During this trip, the patient voluntarily decreased his daily quetiapine dose by 400 milligrams (mg). On examination, he received a score of 18 on the Bush Francis Catatonia Scale. The patient initially responded to 2 mg of intravenous lorazepam given as a bolus however improvement was not sustained despite subsequent dosage increases. Eventually, the patient's catatonia was deemed resistant to benzodiazepines and he was transferred to a psychiatric hospital to receive electroconvulsive therapy. Discussion: This case demonstrates the intricate nature of catatonia in relation to antipsychotic medications. In absence of urgent indications for rapid de-escalation of antipsychotic dose, adjustments to antipsychotics should be gradual and the importance of medication adherence and adequate follow-up should be reiterated with patients. Furthermore, treatment-resistant catatonia is unusual, and most cases occur in patients with chronic catatonia or schizophrenia. Our patient had neither of these risk factors which demonstrates the potential danger of quetiapine withdrawal. References: 1. Hasoglu T,et al. J Acad Consult Liaison Psychiatry. 2022;63(6):607-618. 2. Valido R, et al. Prim Care Companion CNS Disord. 2022;24(6):22cr03268.