Nutritional and diabetic neuropathy presenting as Catatonia

BACKGROUND: Catatonia is caused by variety of Psychiatric, Neurological and Medical diseases. Many Vitamin deficiencies are associated with peripheral neuropathy and B12 deficiencies with demyelinating condition Subacute Combined degeneration. Diabetes is also associated with neuropathy. However catatonia is rarely associated with such neuropathies. CASE DESCRIPTION: A 40 year old lady was brought to Casualty with 2 days history being mute, reduced responsiveness, stereotyped movements and rigidity. On detailed history patient had history of talking to self and animals since 4 years and poor intellectual functioning since young. No evidence of organicity like fever, loss of consciousness, seizures, head injury,vomiting etc., was present. Therefore initial diagnosis of Catatonia due to schizophrenia v/s Unspecified Catatonia was made. Catatonia symptoms improved with Inj Lorazepam, which revealed weakness in all four limbs, ataxia, tingling and numbness in all four limbs.Patient was diagnosed with new onset Diabetes Miletus which was treated with OHA.Patient was empirically started on vitamin injection (Thiamine 100mg, Cyanocobalamine 1000mcg, Pyridoxine 100mg, Nicotinamide 100mg, D-Panthenol 50mg) weakness and ataxia improved significantly over next 10 days but not completely. Serum sodium was on lower side at admission and Total WBC count was slightly elevated. LFT, RFT were within normal limits. MRI brain and spine and EEG were unremarkable. HIV, and VDRL were negative. Patient received Lorazepam for 2 days and later continued on OHA and vitamin supplements. RESULT: At discharge some weakness, ataxia and sensory deficits remained, but patient achieved significant functional independence. Patient is awaited for further follow up. CONCLUSION: Importance of screening for Neuropathies in catatonic patients even if history suggests of Psychiatric disorders. (1)Dr. Harish.K.S, (2)Dr.Anupama.M (1)POSTGRADUATE (2)PROFESSOR, DEPARTMENT OF PSYCHIATRY, J.J.M., MEDICAL COLLEGE, DAVANGERE Author for correspondence: Dr.Harish.K.S, POSTGRADUATE DEPARTMENT OF PSYCHIATRY, J.J.M. MEDICAL COLLEGE, DAVANGERE-577004. Ph.-9731756137 Email id.- harishksjjmmc@gmail.com Aim: