Meeting abstract

https://doi.org/10.24869/spsih.2026.264

Psychotic Decompensation or the Onset of Severe Somatic Disease? The Importance of a Multidisciplinary Approach to Diagnostic and Therapeutic Challenges in a Patient With Catatonic Schizophrenia

Dora Herceg ; Clinic for Psychiatry, Sisters of Charity University Hospital, Vinogradska cesta 29, 10000 Zagreb, Croatia *
Ivan Ljoka ; Clinic for Psychiatry, Sisters of Charity University Hospital, Vinogradska cesta 29, 10000 Zagreb, Croatia
Ante Silić ; Clinic for Psychiatry, Sisters of Charity University Hospital, Vinogradska cesta 29, 10000 Zagreb, Croatia; School of Medicine, Catholic University of Croatia, Ilica 244, 10000 Zagreb, Croatia
Dalibor Karlović ; Clinic for Psychiatry, Sisters of Charity University Hospital, Vinogradska cesta 29, 10000 Zagreb, Croatia; School of Medicine, Catholic University of Croatia, Ilica 244, 10000 Zagreb, Croatia

* Corresponding author.

Abstract

Catatonia is a complex psychopathological syndrome
that may accompany various psychiatric
and somatic disorders. Due to the overlap of
psychiatric, neurological, and internal medicine
symptoms, it often represents a considerable diagnostic
challenge and requires interdisciplinary
collaboration. We present the case of a 58-yearold
patient with a history of schizophrenia spanning
more than twenty years, in whom psychotic
decompensation was accompanied by catatonic
symptoms and severe somatic complications. The patient was initially admitted due to psychomotor
retardation, insomnia, auditory perceptual
disturbances, and suddenly developed gait instability
with a history of multiple falls. Emergency
workup (brain CT, EEG, and cerebrospinal fluid
analysis) ruled out an acute neurological event.
During hospitalization, the patient developed
fever, elevated inflammatory markers, impaired
consciousness, and acute respiratory failure. He
was transferred to the intensive care unit, where
he was mechanically ventilated, and further evaluation
revealed mucopurulent tracheobronchitis
and bacterial pneumonia on the basis of chronic
obstructive pulmonary disease. Multiple respiratory
infections with isolation of multidrug-resistant
pathogens significantly complicated the
course of treatment. Internal medicine management
led to respiratory and hemodynamic stabilization
with regression of inflammatory parameters
and radiologic resolution of infiltrates.
After returning to the psychiatric ward, pharmacological
treatment with benzodiazepines and antipsychotics
was continued, followed by further
remission of psychotic symptoms and marked
improvement in the patient’s overall condition.
The case presented poses a diagnostic dilemma
between primarily psychiatric, neurological, and
somatic etiologies of the clinical picture. Catatonic
phenomena, psychotic symptomatology, alterations
in consciousness, and the development of
life-threatening somatic complications required
ongoing dialogue among psychiatrists, neurologists,
intensivists, pulmonologists, and infectious
disease specialists. Timely recognition and treatment
of somatic complications were crucial for a
favorable outcome. This report underscores the
importance of a multidisciplinary approach to
managing somatic complications in psychiatric
patients with severe psychotic decompensation.

Keywords

acute respiratory failure; catatonia; multidisciplinary approach; schizophrenia

Hrčak ID:

352917

URI

https://hrcak.srce.hr/352917

Publication date:

15.6.2026.

Article data in other languages: croatian

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