Description

ABSTRACT

Psychomotor dysfunction manifesting with disturbances of sensorium, cognition, tone, and movements is a commonly faced condition among the critically ill patients admitted in intensive care units. It may present as agitation or retardation and can imitate delirium, extra-pyramidal syndrome, akinetic mutism, neuroleptic malignant syndrome, or in extreme cases, catatonia. Up to a third of these patients have pre-existing psychiatric illnesses that get aggravated due to organic disorders including but not limited todrug interactions, metabolic encephalopathy, central nervous system infections, sepsis, cerebrovascular accidents, nonconvulsive status.In addition, the ICU environment may itself initiate or aggravate psychotic symptoms. The alteration of gamma aminobutyric acid, glutamate, serotonin and dopamine transmissions have been implicated in its pathogenesis. We report a patient, a known case of schizophrenia, who developed catatonia after starting antitubercular treatment consisting of rifampicin, isoniazid, pyrazinamide and ethambutol. He was admitted in medical ICU in catatonic state. His response to lorazepam challenge was suggestive of catatonia. He was managed with satisfactory outcome.

Key words: Psychomotor Dysfunction, Dystonia, Catatonia, Drug Interaction, Antitubercular therapy, Antipsychotics