Oral and Intranasal Ketamine Use in Treatment-Resistant Catatonia: A Clinical Case Report.
Elizabeth A Gregor, Wanhong Zheng
The American journal of case reports April 25, 2023 DOI: 10.12659/ajcr.939530 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 63-year-old woman with schizoaffective disorder and severe catatonia |
| Interventions | Ketamine Esketamine |
| Dose | 50 mg twice a week (sublingual ketamine) |
| Measures | Bush-Francis Catatonia Rating Scale |
| Topics | Esketamine Ketamine |
| Key findings | The authors report that a 63-year-old woman with chronic catatonia unresponsive to lorazepam, ECT, and transcranial magnetic stimulation improved after sublingual ketamine 50 mg twice weekly, with her Bush-Francis Catatonia Rating Scale score decreasing steadily, and that she worsened after missing a dose but improved again when it was resumed. They suggest sublingual ketamine and esketamine nasal spray may be treatment options when other treatments fail. |
Abstract
Background: Benzodiazepines and electroconvulsive therapy (ECT) are standard treatment options for catatonia, a life-threatening psychomotor syndrome in people with serious mental illness. The purpose of this study was to discuss the use of ketamine in treatment-resistant catatonia, which has not been established in current literature. CASE REPORT A 63-year-old woman with schizoaffective disorder and many previous psychiatric hospitalizations was initially admitted to a psychiatric unit for severe catatonic condition, including mutism, psychomotor retardation, poor intake, and significant weight loss. She had historically failed many ECT treatments and a course of transcranial magnetic stimulation. She scored 12 on the Bush-Francis Catatonia Rating Scale. After she had no response to lorazepam or ECT, she was started on sublingual ketamine, 50 mg twice a week. She showed significant improvement and her Bush-Francis Catatonia Rating Scale score decreased steadily. She was successfully discharged home but had a quick readmission after missing a dose of ketamine. After it was resumed, she progressively improved and was again discharged home. She continued taking sublingual ketamine, until her insurance approved esketamine nasal spray. Due to a change in insurance approval, later she was switched to a combination of esketamine and sublingual ketamine. She steadily resumed her baseline activities and remained clinically stable. She did not require acute hospitalization in the months that followed.
Conclusions: This case highlights a potential use of sublingual ketamine and esketamine nasal spray as a treatment option in patients with chronic catatonia when other treatment choices fail to be effective.