Catatonia requires in-person evaluation, but expansion of telehealth raises questions about virtual diagnosis and treatment. This case series examines outcomes of catatonia care delivered through telepsychiatry for patients with Intellectual Disability and other Neurodevelopmental Disorders. A retrospective chart review was conducted of patients seen through Ohio's Telepsychiatry Project (2009-present). Inclusion required diagnosis and treatment of catatonia via telehealth. Data collected included demographics, comorbidities, medications, and outcomes. Fourteen patients met inclusion criteria (ages 14-69; 87% male). All had Intellectual Disability; 60% also had autism spectrum disorder. Lorazepam was the primary treatment, titrated virtually, with clinical improvement in 71.4% of cases. Benefits included reduced aggression, self-injury, and regression, though a minority experienced worsening psychosis. Findings suggest telepsychiatry may be a feasible approach for diagnosis and management of catatonia in individuals with neurodevelopmental disorders. Structured assessment and ongoing monitoring remain essential. Future studies can address treatment response and outcomes of catatonia using telepsychiatry.

Loratadine is a common over-the-counter second-generation H1-antihistamine used to relieve and treat seasonal allergy symptoms. While first-generation H1-antihistamines are historically known to cause central nervous system (CNS) side effects, these effects are thought to be far less common in second-generation antihistamines. Similarly, alcohol is known to have CNS effects. We report a case of a 26-year-old female who presented to the emergency department (ED) after a suicide attempt involving loratadine and alcohol ingestion. Emergency medical services (EMS) reported that the patient became unresponsive upon arrival at the ED. An empty loratadine bottle that was supposed to contain 60 tablets was found at the scene. Additionally, an empty bottle of wine was also found at the scene. Initial vital signs and glucose levels were normal, but on examination, the patient had a Glasgow Coma Scale of 3 with rightward eye deviation and developed tonic-clonic seizures, which were quickly controlled with 4 mg of intravenous (IV) lorazepam. She gradually regained responsiveness and received 3200 mg of levetiracetam IV. Toxicological workup revealed a serum ethanol level of 119 mg/dL and a urine toxicology screen positive for benzodiazepines, likely due to lorazepam administration. The patient had mildly elevated lactate and creatine kinase levels consistent with seizure, which normalized after fluid resuscitation. The patient recovered fully without further seizures and was not prescribed antiepileptic medication upon discharge. We present the case to document a potential seizure provoked by the combined ingestion of loratadine and alcohol.

Catatonia is a neuropsychiatric syndrome characterised by motor, behavioural, and speech abnormalities. Although benzodiazepines and electroconvulsive therapy (ECT) are considered first-line treatments, a proportion of patients fail to show improvement. Emerging evidence suggests role for zolpidem in treatment-resistant catatonia cases. A 52-year-old woman presented with a 10-year history of decreased interaction, reduced speech, staring, posturing, immobility, and dependence for activities of daily living. She was diagnosed with catatonia and had a Bush-Francis Catatonia Rating Scale (BFCRS) score of 9. Treatment with lorazepam was initiated and gradually escalated to 12 mg/day over 2 weeks, resulting in only transient improvement. Subsequently, 5 sessions of ECT were given with no significant improvement. A 12-week trial of trifluperazine was also given which did not bring changes in symptom profile. Zolpidem sublingual spray was initiated at 5 mg/day and increased to 10 mg/day. Following dose optimisation, the patient demonstrated significant improvement with restoration of spontaneous speech, increased activity, and improved social interaction. Her BFCRS score decreased from 9 to 0 and the improvement was sustained for more than 2 months. Zolpidem, a selective GABA-A receptor α1 subunit agonist, may improve catatonic symptoms through modulation of dysfunctional motor circuits. The sublingual spray formulation offers rapid absorption and ease of administration. This case highlights the potential utility of zolpidem sublingual spray as an effective treatment option for refractory catatonia and highlights the need for further research to establish its efficacy and safety.

Benzodiazepines (BZDs) are central nervous system depressants, prescribed to slow brain activity during anxiety, seizures, insomnia, etc. However, their long-term usage is associated with health risks such as physical and physiological dependence and cognitive decline. Poisoning due to BZDs is frequently encountered in forensic toxicology, which requires their rapid and robust detection. However, their low availability in biological samples and the lack of sensitive and rapid detection methods pose challenges. In this study, we standardized a protocol for the detection and quantification of lorazepam (LZ), clonazepam (CZ), and alprazolam (AZ), the short-to-intermediate and long-acting BZDs, without employing any derivatization steps and using gas chromatography-mass spectrometry (GC-MS). The detection limit (LOD) of BZDs by GC-MS was 5 ng/mL, and the detection was linear between 5 and 50 ng/mL, with coefficients of determination (R [2]) of 0.9984, 0.9968, and 0.9936 for LZ, CZ, and AZ, respectively. Further, rapid dispersive liquid-liquid microextraction allowed enriching BZDs from human urine samples for following GC-MS analysis. Interday and intraday detection precisions were analyzed, which were within agreeable limits. Together, we have developed a green analytical chemistry protocol for the rapid detection of BZDs that can be employed in forensic toxicology and analytical chemistry laboratories for criminal cases, drug overdoses, or drug monitoring.

Place- and culture-associated psychiatric syndromes describe acute psychiatric presentations precipitated by emotionally and spiritually intense experiences in culturally significant settings. We report the case of a 59-year-old widowed Tajik woman with no prior psychiatric history who developed an acute manic episode with psychotic features during her first Umrah pilgrimage to Makkah. The episode was preceded by approximately five days of prodromal decreased sleep, irritability, and repetitive ritualistic behaviors, progressing to elevated and labile mood, pressured speech, flight of ideas, severe behavioral disinhibition, grandiose religious delusions (including the belief that she was a prophet), and persecutory delusions. She required emergency psychiatric admission and rapid tranquillization with intramuscular haloperidol 5 mg and intramuscular lorazepam 2 mg. A comprehensive medical workup, including complete blood count, electrolytes, renal and liver function tests, thyroid profile, inflammatory markers, electrocardiography, and neuroimaging, was unremarkable. She achieved acute clinical stabilization within approximately 40 hours, regained insight, and expressed remorse for her behavior. Her presentation fulfilled DSM-5-TR criteria for a manic episode with mood-incongruent psychotic features, consistent with a diagnosis of Bipolar I Disorder, current episode manic, severe. The duration criterion was satisfied by the need for hospitalization. Differential diagnoses, including delirium, brief psychotic disorder, substance- or medication-induced disorder, and secondary (organic) mania, were systematically excluded. This case illustrates how the convergence of acute physiological stressors (sleep deprivation and circadian disruption), heightened religious salience, and a layered vulnerability profile (late-life onset, positive family psychiatric history, and long-standing unresolved psychosocial trauma) may precipitate acute manic episodes in pilgrimage settings. It is hypothesis-generating and highlights a possible association between pilgrimage-related stressors and psychiatric decompensation in susceptible individuals, warranting systematic study.