• Stephanie L Smith, David J Grelotti, Reginald Fils-Aime, Eugenie Uwimana, Jean-Sauveur Ndikubwimana, Tatiana Therosme, Jennifer Severe, Dominique Dushimiyimana, Clemence Uwamariya, Robert Bienvenu, Yoldie Alcindor, Eddy Eustache, Giuseppe J Raviola, and Gregory L Fricchione.
• Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA 02115; Partners In Health, 888 Commonwealth Avenue, 3rd Floor, Boston, MA USA 02215; Division of Medical Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA USA 02115. Electronic address: Stephanie_Smith@hms.harvard.edu.
• Gen Hosp Psychiatry. 2015 Jan 1; 37 (1): 89-93.

ObjectiveThe catatonic syndrome ("catatonia") is characterized by motor and motivation dysregulation and is associated with a number of neuropsychiatric and medical disorders. It is recognizable in a variety of clinical settings. We present observations from the treatment of four individuals with catatonia in Haiti and Rwanda and introduce a treatment protocol for use in resource-limited settings.MethodsFour patients from rural Haiti and Rwanda with clinical signs of catatonia and a positive screen using the Bush-Francis Catatonia Rating Scale were treated collaboratively by general physicians and mental health clinicians with either lorazepam or diazepam. Success in treatment was clinically assessed by complete remittance of catatonia symptoms.ResultsThe four patients in this report exhibited a range of characteristic and recognizable signs of catatonia, including immobility/stupor, stereotypic movements, echophenomena, posturing, odd mannerisms, mutism and refusal to eat or drink. All four cases presented initially to rural outpatient general health services in resource-limited settings. In some cases, diagnostic uncertainty initially led to treatment with typical antipsychotics. In each case, proper identification and treatment of catatonia with benzodiazepines led to significant clinical improvement.ConclusionCatatonia can be effectively and inexpensively treated in resource-limited settings. Identification and management of catatonia are critical for the health and safety of patients with this syndrome. Familiarity with the clinical features of catatonia is essential for health professionals working in any setting. To facilitate early recognition of this treatable disorder, catatonia should feature more prominently in global mental health discourse.Copyright © 2015 Elsevier Inc. All rights reserved.

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