Management of catatonia in Parkinson’s disease with comorbid bipolar disorder: A case report and review of literature

Table 3 Clinical profile of patients with Parkinson’s disease presenting with catatonia

Patient reports
Ref.	Patient	Primary diagnosis	Catatonic features	Treatment	Outcome
Suzuki et al[49], 2006	62-year-old woman	PD with psychosis	Acute onset of catatonic excitement followed by stupor, features of neuroleptic malignant syndrome, probably induced by quetiapine	Quetiapine stopped, dantrolene for neuroleptic malignant syndrome, reinstatement of levodopa, and 12 ECT sessions	Marked improvement: Near-complete resolution of catatonia and psychiatric symptoms with ECT
Kamigaichi et al[50], 2009	75-year-old woman	PD with psychosis	Acute onset of catatonic stupor following withdrawal of some dopaminergic medications. Associated psychotic symptoms, but no features of neuroleptic malignant syndrome. No cognitive impairment	Increase in the dose of levodopa. Did not respond to benzodiazepines. Two ECT sessions	Complete resolution of catatonia with ECT
Poyraz et al[51], 2016	80-year-old woman	PD with psychosis	Past history of catatonic stupor. Acute onset of catatonic stupor associated with psychotic symptoms. Features of delirium	Partial response to benzodiazepines. Optimisation of anti-parkinsonian treatment and increase in the dose of levodopa. Six sessions of ECT once the patient was clinically stable	Improvement in catatonic symptoms with ECT, but residual catatonia and mild cognitive impairment persisted
Ramesh et al[52], 2019	55-year-old man	PD with psychosis	Acute onset of catatonic stupor following institution of quetiapine	Treatment with levodopa. Partial response to lorazepam. Six sessions of ECT	Complete resolution of catatonia and marked improvement in psychotic symptoms with ECT
Elefante et al[36], 2022	56 and 58-year-old women	PD with BD, type I and type II. Comorbid anxiety	Acute onset of catatonic stupor during depressive episodes with psychotic symptoms. No cognitive impairment	Antiparkinsonian medication. Poor response to lorazepam. Eight to fifteen ECT sessions	Complete resolution of catatonia with ECT
Longitudinal cohort study
Study	Patient sample	Prevalence of catatonia	Other features
Onofrj et al[29], 2021	Clinical cohort of 250 patients with BD and PD. Followed up at 3 and 6 years. BD preceded the onset of PD by several years	Seven per cent of the patients (n = 14) with BD and PD had catatonia. Prevalence was significantly greater than in patients with only PD (1%)	The prevalence of catatonia was considerably lower than that of depression, psychosis, and dementia. Two patients were carriers of GBA gene mutations

PD: Parkinson’s disease; BD: Bipolar disorder; ECT: Electroconvulsive therapy.