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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.

EV1093

Delayed recognition of catatonia during investigation for hematologic malignancy: a psycho-oncology case report

DELAYED RECOGNITION OF CATATONIA DURING HEMATOLOGIC MALIGNANCY WORKUP: A PSYCHIATRIC ONCOLOGY CASE REPORT

Catatonia can be overlooked during a medically complex oncologic evaluation; structured assessment and a lorazepam challenge enabled rapid diagnosis and treatment.

The aim of this report is to present a case of catatonia recognized late during investigation for suspected hematologic malignancy and to emphasize the importance of structured assessment and timely intervention. The patient was a 28-year-old woman with no psychiatric history who had been diagnosed with monoclonal gammopathy of undetermined significance (MGUS) approximately 18 months earlier; the assessment included the Bush-Francis Catatonia Rating Scale (BFCRS) and a lorazepam challenge. She was admitted with fatigue and severe anemia, with a hemoglobin level of approximately 6 g/dL. Laboratory findings included gamma globulin 2.8, IgA 550, IgG 2689, IgM 355, free kappa light chains 80.7 and free lambda light chains 34.3 (kappa/lambda ratio 2.35), negative ANA, and an absolute eosinophil count of 646. Her clinical presentation included mutism, blunted affect, bizarre behavior, aphasia-like symptoms, stereotyped movements, and a 75-pound weight loss over approximately 18 months; these findings were initially interpreted as delirium exacerbated by medication exposure. Brain MRI showed no acute findings, while spinal MRI revealed marked circumferential epidural enhancement at L5–S1. Cerebrospinal fluid cytology and meningoencephalitis panels were negative, cultures showed no growth on day 3, and EEG was normal. During the psycho-oncology consultation, her initial BFCRS score was 34 (severe), decreasing to 7 within 20 minutes after administration of 2 mg of intravenous lorazepam. The next day, the abnormal movements had resolved and her BFCRS score had fallen to 0. She was monitored for 3 days without recurrence and treated with 2 mg of intravenous lorazepam every 6 hours for catatonia of unclear etiology; AVD chemotherapy was initiated on hospital day 7. This case demonstrates that catatonia should be considered early in medically complex patients with persistent unexplained motor, behavioral, or speech disturbances, and that a lorazepam challenge can be both diagnostic and therapeutic.

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