When Psychosis Conceals a Motor Crisis: A Misleading Case of Catatonia Unveiling Parkinson’s Disease off Phenomenon
Abstract
Psychosis is a frequent comorbidity in Parkinson’s disease (PD) and often complicates the evaluation of motor and behavioral fluctuations. Distinguishing between psychosis-related catatonia and a PD off phenomenon presents a significant diagnostic challenge. We describe the case of a 48-year-old male with PD and depression who was admitted to a psychiatric ward following an episode of aggressive behavior and persecutory delusions. During hospitalization, he developed mutism, rigidity, and immobility – initially interpreted as catatonia. A Bush–Francis Catatonia Rating Scale score of 16 was documented, but a lorazepam challenge failed to elicit improvement. These symptoms coincided with the tapering of dopaminergic therapy, particularly pramipexole. Neurological consultation on hospital day 11 identified the presentation as a severe PD off state. Restoration of dopaminergic therapy, focusing on extended-release formulations and optimized timing, resulted in marked clinical improvement within 1 week. Dopamine agonists were avoided due to concern for exacerbating psychosis. This case highlights the importance of distinguishing catatonia from PD off states in patients with overlapping motor and psychiatric symptoms. Careful medication history, response to benzodiazepines, and interdisciplinary collaboration are critical to diagnostic accuracy and treatment success.
Related
- Ekbom Spectrum Psychosis Associated with 24-hour Continuous Subcutaneous Foslevodopa/Foscarbidopa Infusion in Parkinson’s Disease
- Unveiling Asymptomatic Atrioventricular Reciprocating Tachycardia in a Patient With Wolff-Parkinson-White Syndrome and Multiple Sclerosis
- Diagnostic Challenge of Primary Psychiatric Catatonia Versus Seronegative Autoimmune Encephalitis in Pediatrics: A Case Report
- Recovery from catatonia follows a hierarchical precision order
- Sycophancy in Large Language Models in Oral and Maxillofacial Radiology: The Impact of Misleading Context on Image- and Text-Based Diagnostic Scenarios
BibTeX
@article{tsai2026when,
title = {{When Psychosis Conceals a Motor Crisis: A Misleading Case of Catatonia Unveiling Parkinson’s Disease off Phenomenon}},
author = {Wen-Wen Tsai and Pei-Hsin Kao and Kuan-Hsien Lu and Sheng-Hsiang Yang},
journal = {Acta Neurologica Taiwanica},
year = {2026},
month = jul,
doi = {10.4103/ant.ant-d-25-00052},
url = {https://doi.org/10.4103/ant.ant-d-25-00052},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - When Psychosis Conceals a Motor Crisis: A Misleading Case of Catatonia Unveiling Parkinson’s Disease off Phenomenon
AU - Wen-Wen Tsai
AU - Pei-Hsin Kao
AU - Kuan-Hsien Lu
AU - Sheng-Hsiang Yang
PY - 2026
DA - 2026/07/01
JO - Acta Neurologica Taiwanica
DO - 10.4103/ant.ant-d-25-00052
UR - https://doi.org/10.4103/ant.ant-d-25-00052
AB - Psychosis is a frequent comorbidity in Parkinson’s disease (PD) and often complicates the evaluation of motor and behavioral fluctuations. Distinguishing between psychosis-related catatonia and a PD off phenomenon presents a significant diagnostic challenge. We describe the case of a 48-year-old male with PD and depression who was admitted to a psychiatric ward following an episode of aggressive behavior and persecutory delusions. During hospitalization, he developed mutism, rigidity, and immobility – initially interpreted as catatonia. A Bush–Francis Catatonia Rating Scale score of 16 was documented, but a lorazepam challenge failed to elicit improvement. These symptoms coincided with the tapering of dopaminergic therapy, particularly pramipexole. Neurological consultation on hospital day 11 identified the presentation as a severe PD off state. Restoration of dopaminergic therapy, focusing on extended-release formulations and optimized timing, resulted in marked clinical improvement within 1 week. Dopamine agonists were avoided due to concern for exacerbating psychosis. This case highlights the importance of distinguishing catatonia from PD off states in patients with overlapping motor and psychiatric symptoms. Careful medication history, response to benzodiazepines, and interdisciplinary collaboration are critical to diagnostic accuracy and treatment success.
SN - 1028-768X
ER -