Treatment-Resistant Depression With Catatonia Presenting as a Feature of Creutzfeldt-Jakob’s Disease

Division

North Florida

Hospital

Coliseum Medical Centers

Document Type

Case Report

Publication Date

5-26-2020

Keywords

catatonia, creutzfeldt–jakob disease, pseudo-dementia, real-time quaking inverse conversion, 14-3-3, electroconvulsive therapy

Disciplines

Internal Medicine | Nervous System Diseases | Neurology | Psychiatry

Abstract

A high-functioning middle-aged successful businessman developed a rapid decline in his cognitive, behavioral, and motor abilities within one year. He was initially diagnosed with dementia by a neurologist and was then diagnosed with pseudo-dementia secondary to major depressive disorder with catatonia by a psychiatrist who initiated treatment with Ativan. He was referred to our psychiatric facility for an evaluation to undergo electroconvulsive therapy (ECT) as a potential treatment for medically refractory depression complicated with catatonia and pseudo-dementia. The neurology team and internal medicine team were consulted by a psychiatrist for clearance to begin a course of ECT. In this process, with a coordinated effort and prompt workup and evaluation, including neurological testing, imaging, and positive cerebrospinal fluid analysis for real-time quaking inverse conversion (RT-QuIC) and 14-3-3, the patient was diagnosed with Creutzfeldt-Jakob’s disease.

There are many organic causes of dementia and catatonia that should be explored in depth, especially when the clinical picture is challenging and atypical.

Publisher or Conference

Cureus

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