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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0871

Hidden catatonia in treatment-resistant depression

HIDDEN CATATONIA IN TREATMENT-RESISTANT DEPRESSION

In severe depression presumed to be treatment-resistant, psychomotor slowing may conceal a reversible catatonic syndrome that responds to lorazepam within hours.

The aim of this case report is to demonstrate that mutism, withdrawal, and marked psychomotor slowing in severe depression may be misinterpreted as melancholic inhibition or treatment resistance. The method is a clinical case report based on longitudinal observation, detailed psychopathological examination, and a targeted literature review. A 46-year-old woman with recurrent major depressive disorder was referred following the failure of sequential antidepressant and augmentation strategies; over an eight-week period, she developed near-mutism, staring, immobility, reduced oral intake, and marked functional impairment. These symptoms were initially attributed to severe depressive psychomotor retardation, and her condition was considered treatment-resistant depression. Bedside examination identified negativism (resistance or lack of response to instructions or external stimuli), posturing (spontaneous maintenance of a posture against gravity), ambitendency (motor indecision characterized by alternating approach and withdrawal), and gegenhalten (resistance proportional to the force applied), none of which could be explained by depressive slowing. The Bush–Francis Catatonia Rating Scale supported a diagnosis of catatonia associated with a depressive episode. A lorazepam challenge produced rapid improvement within hours; speech returned, spontaneous movement increased, and interpersonal engagement improved. Continued benzodiazepine treatment and revision of the treatment plan resulted in substantial clinical remission. The authors emphasize that a positive lorazepam response supports the diagnosis and may predict response to benzodiazepines, but is not entirely specific on its own; therefore, catatonia should be systematically assessed before severe depression is labeled treatment-resistant.

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