CPCP: Catatonia by Medical Student Tyler Mouw

Tyler Mouw M4

Tyler Mouw M4

Coming at you with another fine Clinical Problems in Consultation Psychiatry (CPCP) presentation, this one on catatonia, by medical student Tyler Mouw. He’s planning to do his residency in surgery. Interestingly enough, he chose to dig into the medical literature about catatonia, not because of what he saw in the general hospital on the psychiatry consult service, but based on what he observed during a day he was in our emergency room (ER). There he witnessed one of our ER psychiatrists try the intravenous lorazepam challenge test on a patient who appeared to have the mute, immobile form catatonia. The response was not dramatic but piqued his interest.

I’m always encouraged by this initiative on the part of the medical students. It’s this drive to know more that gives me hope that we, as teachers, can stave off the death of the idea that lifelong learning can blossom from the inside out rather than by imposing it from the outside by regulators and the government. The path to persuading leaders this essential truth can be hindered and geezers like me can often feel like we’re trying to drive with one headlight.

But it’s worth the making the trip.

These experiences are vitally important in medical student education. A surgeon can see catatonia post-operatively just as well as a psychiatrist can see catatonia occur in a patient with either mania or major depression. It can happen because a patient’s benzodiazepine was abruptly stopped in the context of a surgical procedure. I’ve actually published a case report about benzodiazepine-withdrawal-induced catatonia,

Amos, J. J. (2012). “Lorazepam withdrawal-induced catatonia.” Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists 24(2): 170-171.

Furthermore, many experts describe a catatonic subtype of delirium, which I’ve seen as well. Catatonia is not just a bizarre neuropsychiatric phenomenon seen only in patients with psychiatric illness. Seeing the practice of medicine through that either/or lens is a trap and can also be like trying to drive with only one headlight. It’s relevant to the practice of almost all physicians, so it’s helpful (and can even be life-saving) to keep it in mind, especially when caring for hospitalized patients.

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