Catatonia-Like Syndrome Treated With Low-Dose Ketamine.

K. Iserson; Dellon Durga

doi:10.1016/j.jemermed.2019.12.030

Catatonia-Like Syndrome Treated With Low-Dose Ketamine.

K. Iserson, Dellon Durga

Journal of Emergency Medicine January 27, 2020 DOI: 10.1016/j.jemermed.2019.12.030 (opens in new tab)

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Study at a glance

AI-extracted from the abstract

Characteristics	Case report Peer reviewed
Sample size	1
Population	23-year-old male with catatonia-like syndrome in an emergency department
Intervention	Ketamine
Dose	12.5 mg
Topics	Esketamine Ketamine
Key findings	Subanesthetic doses of ketamine (12.5 mg) rapidly resolved a catatonia-like state in a 23-year-old male, allowing him to become conscious and verbal.

Abstract

BACKGROUND Ketamine's application in psychiatry have expanded, but it appears never to have been previously used to diagnose and treat patients with catatonia-like syndrome that occasionally present to emergency departments. CASE REPORT A 23-year-old male was observed to suddenly stop talking. His ED GCS was 8 and had normal vital signs. While verbally unresponsive, he refused to open his eyes, demonstrated waxy flexibility of his arms, but the balance of his physical, neurological, and laboratory exams were normal. Strongly suspecting a catatonic state, they needed to rapidly confirm that diagnosis or begin evaluating him for potentially life-threatening non-psychiatric illnesses. Lacking other diagnostic modalities, they administered low-dose ketamine boluses. Ketamine 25 mg (1 mL) was diluted in 9 mL NS (2.5 mg/mL). Based on similar protocols, 1 mL of the solution (0.03 mg/Kg) was given intravenously every few minutes. After 12.5 mg ketamine, he was conscious and verbal. Subsequent history confirmed a prior episode requiring an extensive, non-productive medical evaluation. Psychiatry later confirmed the diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with catatonia-like states pose a difficult diagnostic and therapeutic dilemma. Multiple interventions have been used with varying success. Optimal interventions provide a rapid resolution (or demonstrate that a psychiatric cause is not likely), be safe, encompass few contraindications, and be familiar to the clinician. In our patient, subanesthetic doses of ketamine fulfilled these criteria and successfully resolved the condition. If shown effective in other cases, ketamine would be a valuable addition to our psychiatric armamentarium.

Comparable studies

Other case reports and case series on ketamine, most cited first.

Study	Year	Design	Participants
The destruction of the lower urinary tract by ketamine abuse: a new syndrome? Young recreational abusers of street-ketamine in Hong Kong referred to urology units	2008	Retrospective case series	n = 59
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety...	2025	Case report	n = 1
Treatment of compulsive behaviour in eating disorders with intermittent ketamine infusions Chronic and treatment-resistant eating disorder patients	1998	Case series	n = 15
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants	2009	Case series	n = 4
A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Patients with enduring eating disorders and treatment-resistant depression	2021	Case series	n = 4

Citations in the library

Cited by 5

Cites 1

Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms Pharmacological Reviews June 26, 2018