Results and discussion
Catatonic stupor is a psychopathological
syndrome characterized by immobility combined
with lack of verbal contact and increase of muscle
tone. Catatonia has traditionally been regarded
as a sign of endogenous psychosis, especially
schizophrenia. However, this syndrome is not
nosologically specific and can occur in many
diseases: up to 20-25% of its cases are
somatogenously caused (Dunaievskiy. Kuznetsov,
2019). Constantine von Economo was the first who
described catatonic syndrome after acute
respiratory disease in detail in the structure of
lethargic encephalitis, which affected some
patients after the Spanish flu during the pandemic
of 1918-1920. In May 2020, during the COVID-19
pandemic, Italian doctors were among the first to
report an atypical curative case of "akinetic
mutism". In retrospect, it was regarded as a
catatonic stupor (Cooper, Ross, 2020). In the
same month, British doctors reported a case of
catatonia, manifested by stupor and
accompanied by disorders of perception, in a
man with COVID-19 (Caan, Lim, Howard, 2020). In
the systematic review of the literature as of
20.04.2021, in addition to the above, there are 7
more relevant cases of catatonia due to COVID-
19 (Schneider, Smith, Wohlleber, Malone,
Schwartz, 2021). The authors consider its
appearance as a consequence of the complex
impact of the infectious process, namely systemic
inflammation and direct neurotoxicity of SARS-
CoV-2 virus on the nervous system, as well as
psychosocial factors leading to post-traumatic
stress, anxiety and depression. Differential
diagnosis with hypokinetic delirium is proposed,
which in particular consists in a rapid positive
response to benzodiazepines: patients quickly,
significantly improved after their prescription,
which is not typical for delirium.
Below is our own clinical case of catatonic
stupor, which developed in a patient as a result of
COVID-19.
In the life history, the burden of heredity on
mental illnesses is remarkable: the father is
"commissioned" from armed forces after the
transferred TBI on a line of psychiatry, the aunt on
a line of the father suffers from depression. The
patient underwent regular medical examinations
during military service and was considered
healthy. At work, family and friends are
characterized positively. Patient does not smoke,
denies the abuse of psychoactive substances.
Case history: from 08.03.2021 there was a
general weakness, increased body T to 38.0 ° C.
10.03.2021 performed PCR with real-time
detection, during study of nasopharyngeal lavage
revealed RNA of SARS-CoV-2 virus. Outpatient
treatment was started: hepacef, moxifloxacin,
xarelto, pulmobriz, serrata, vitamin therapy, tonic
therapy, physiotherapy. D-dimer from 12.03.2021
103.0 ng FEU / ml. CT of the chest from
16.03.2016: "CT signs of viral pneumonia. High
probability of COVID-19. CT-I (area of the affected
parenchyma up to 15%)". Antibiotic therapy was
continued. Feelings began to improve, the body's
T decreased, staying in the range of 35.9-36.5 ° C.
From 21.03.2021 due to the fact that the condition
was regarded as recovery, treatment was
canceled.
During the illness there was a pronounced
somatopsychic asthenia, in particular, weight loss
of 7 kg, complained of fatigue, patient was weak,
lethargic, anxious, suspicious, for example, many
times a day measured the saturation of oxygen in
the blood. Despite the improvement in somatic
condition, general weakness, fatigue and anxiety
aggravated. Obvious changes in mental status
from 22.03.2021: he spoke in a quiet, hoarse
voice, became retarded, tense, reacted
sluggishly to others, decreased appetite, and
almost stopped sleeping at night. On March 23,
2021, due to the expiration of the term of
outpatient treatment, he tried to start military
service, due to severe asthenia; his release from
duty was extended. On March 24, 2021,
stereotypical movements appeared the patient
stared straight ahead, could not pay attention to
anything. 25.03.2021 consulted a psychiatrist,
recommended MRI of the brain. In the process of
preparation for MRI in the X-ray room finally
stopped moving, did not respond to painful stimuli,
and did not respond to the spoken language. MRI
of the brain from 25.03.2021: "MR data for the
presence of changes in the volume of the
substance in the brain at the time of the
examination was not detected. MR signs of focal
process of the brain, most likely against the
background of neuroinfection. Hospitalization with
a diagnosis of catatonic syndrome is
recommended. On admission to the hospital,
examined while lying on a couch, his face tense,
with his eyes tightly closed, he resisted the attempt
to open them. On the language, painful stimuli did
not respond; muddy. He showed waxy flexibility in
the muscles of the upper extremities, there were
elements of passive submission: he allowed
himself to sit on the couch, stuck in this position with
his arms outstretched. Body T = 37.4 ° C, blood
pressure = 130/100 mm PC, Ps = 120 / min., Sp
O2 = 97%. Laboratory tests within normal limits
(leukocyte count 7.9 x 109 cells / l). Delivered to
the department on a stretcher. Introduced solution
of Diazepam 5 mg / ml 4.0 ml v./m. About 30
minutes after the injection of Diazepam, opened