Joshua D. Bess

Catatonia following surgery for temporal lobe epilepsy successfully treated with electroconvulsive therapy

Catatonia is a psychomotor and behavioral syndrome associated with mood disorders, psychotic disorders, neurological disease, and general medical conditions. Catatonia has also been described as a manifestation of partial onset seizures. We describe a case of catatonia following successful epilepsy surgery. A 38-year-old patient with congenital hydrocephalus and left hippocampal sclerosis underwent selective left amygdalohippocampectomy for medically refractory seizures. Three days after surgery, she became progressively less interactive. Verbal output was dramatically reduced. She exhibited waxy flexibility, stupor, mutism, posturing, rigidity, negativism, and grimacing. Video/EEG monitoring showed no evidence of ongoing seizure activity. She was treated with high-dose benzodiazepines for presumed catatonia, but the behavioral pattern did not resolve. Subsequently the patient underwent a full course of electroconvulsive therapy. Catatonia resolved over the ensuing 3 weeks. Following discharge from the hospital, the patients global functioning returned to the premorbid level, and she has been seizure free for more than 4 years.

The academic psychiatric hospitalist: a model for treatment and training in the academic inpatient setting.

Recent years have seen the expanding presence of hospitalists, most prominently in internal medicine, but also in other areas such as neurology, pediatrics, and psychiatry. In contrast to a burgeoning literature on general medicine hospitalists, very little has been written about the role of psychiatric hospitalists-psychiatrists who work exclusively in the hospital setting-and the advantages of this model in the inpatient setting. The authors trace the history of hospitalists in psychiatry and argue that this model can fit well with the clinical and teaching mission of the modern academic psychiatry inpatient program. High quality care of acutely ill psychiatric inpatients involves a body of knowledge and a set of core competencies that may be best served by psychiatric hospitalists.