A Case of Conversion Catatonia Misdiagnosed for 24 Years

Catatonia is a synd rome whose etiology may be both diverse and di fficul t to subs tantiate . Ms. H. is a 45-year-old black female wit h 18 previous psychiatr ic hospital izations beginning at age 21 . A common characteristi c to all hosp ital izations was a catatonic presentation (i.e ., the patient was mute with marked muscul ar rigidity; sh e would refuse to eat or fo llow orders) . In ea ch of her previous 18 hospitali zations, the patient was thought to be psycho tic. It was found that each ca ta to nic episode co u ld be related to a severe psychological stressor. The patient 's illness never involv ed delusio ns, hallucinations o r disturbances in thought form. Upon d etailed evaluation of thi s pat ien t 's hi sto r y she was found to have symp toms co nsistent wit h conversion di sorder. I report here the identification of a conversion d isorder presenting as recurrent episodes of catatonia. Intramuscular lorazepam was fou nd to be repea tedly success fu l in resolving the ca ta tonic sta te .