Catatonia in Renal Failure and Major Depressive Disorder: A Case Series

Catatonia is an acutely evolving and severe medical emergency. It occurs in several medical and psychiatric disorders but is often missed or misdiagnosed. There are majorly three different categories; the retarded, excited and malignant types. The latter is the most severe due to the associated autonomic instability. Much is unknown about the pathophysiology, but dysfunction of cortico-cortical modulation and a "top-down modulation" of the basal ganglia resulting from a deficiency of GABA in the cerebral cortex, resulting in motor dysfunction and glutamate hyperactivity and dopamine hypoactivity at the D2 receptor have been proposed. Benzodiazepines, especially Lorazepam, are reportedly effective, but reports of other benzodiazepines, Zopiclone and trials of mood stabilisers are documented. Electroconvulsive therapy is the suggested next line of action in case benzodiazepine fail, while the use of antipsychotic in catatonia is inconclusive. We present a case series of catatonia in 1) acute on chronic renal failure, complicated with uraemic encephalopathy and 2) severe depressive disorder with psychotic features. Physicians are encouraged to have a high index of suspicion to forestall the lethal complications.