Reply by the authors

It was with great interest that we read Prof. Dose’s commentary on our case report [1], in which he drew our attention on neuroleptic-induced pseudo-catatonia as a possible explanation of the symptoms observed in our patient. We fully agree that pseudocatatonia should be considered as an important differential diagnosis. However, we did not include it in our report due to space restrictions. In his recent review in Pharmacopsychiatry, Prof. Dose has described an impressive case of neuroleptic-induced pseudocatatonia with stupor and negativism [2]. The patient in our case report had additional symptoms, that is, posturing and waxy flexibility. While neuroleptic-induced pseudocatatonia responds to anticholinergic treatment and cessation of antipsychotic treatment, the first-choice treatment in patients with catatonia and benzodiazepine withdrawal-induced catatonia are benzodiazepines. In our patient, all catatonic and psychotic symptoms disappeared rapidly and completely after treatment with lorazepam at 3 mg, while antipsychotic treatment was continued with risperidone. Therefore, both psychopathology and the patient’s rapid response to benzodiazepines suggest that he suffered from withdrawal-induced catatonia rather than antipsychotic-induced pseudocatatonia. As we fully agree with Prof. Dose’s argument that there is too little awareness of the mental side effects associated with antipsychotic treatment, we appreciate his critical input.

References

• 9 Deuschle M, Lederbogen F. Benzodiazepine withdrawal-induced catatonia.  Pharmacopsychiatry. 2001;  34 41-42
• 10 Dose M. Recognition and management of acute neuroleptic-induced extrapyramidal motor and mental syndromes.  Pharmacopsychiatry. 2000;  33 (Suppl) 3-13