Psychosis, Catatonia and Post-psychosis PTSD

Abstract

We are describing the case of a 27-year-old female with no previous psychiatric history who developed post-psychotic PTSD after presenting with first episode catatonia and psychosis. The patient initially presented to the emergency department with increasingly disorganized behavior and paranoid thinking over the course of one week in the context of multiple life stressors. Soon after admission, the patient became catatonic; demonstrating mutism, stereotyped behaviors, and echolalia. After ruling out an organic cause for the catatonia, the patient was treated with Lorazepam, which minimaly improved her catatonia, but revealed active psychosis. In particular, she voiced a scenario that she was sexually assaulted by several men at her mother’s home in the time leading up to her admission. An investigation by law enforcement ruled out the occurrence of assault. However, the patient, expressed vivid dreams, nightmares, and distress centered on her assault. Various anti-psychotics were trialed with little effect (Risperidone, Olanzapine, Haloperidol, and Clozapine). Given that she exhibited several characteristics of PTSD, other agents inlucluding: Escitalopram, Prazosin, and Divalproic were initiated to target her PTSD-like symptoms. On this regimen, the patient showed significant improvement in her mental status and functioning. Thiothixene was added to target residual symptoms of her psychosis. She was discharged to home in the care of her mother and on follow-up remembered little of her psychosis and denied any trauma or occurrence of sexual assault in the past.