Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 4443  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (140 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References

 Article Access Statistics
    Viewed5105    
    Printed111    
    Emailed7    
    PDF Downloaded171    
    Comments [Add]    
    Cited by others 3    

Recommend this journal


 


 
LETTERS
Year : 2007  |  Volume : 53  |  Issue : 1  |  Page : 75-76

Clozapine-resistant mutism in noncatatonic schizophrenia


Department of Psychiatry, Christian Medical College, Vellore - 632 002, Tamil Nadu, India

Correspondence Address:
K K Basanth
Department of Psychiatry, Christian Medical College, Vellore - 632 002, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.30337

Rights and Permissions




How to cite this article:
Basanth K K, Gopalakrishnan R, Jacob K S. Clozapine-resistant mutism in noncatatonic schizophrenia. J Postgrad Med 2007;53:75-6

How to cite this URL:
Basanth K K, Gopalakrishnan R, Jacob K S. Clozapine-resistant mutism in noncatatonic schizophrenia. J Postgrad Med [serial online] 2007 [cited 2019 Nov 18];53:75-6. Available from: http://www.jpgmonline.com/text.asp?2007/53/1/75/30337


Sir,

Mutism is defined as functional inhibition of speech and vocalization. Mutism has been reported in various types of schizophrenia.[1],[2] There are reports of mutism in catatonic schizophrenia lasting for years.[3] Cognitive dysfunction in schizophrenia and duration of untreated psychosis have also been implicated in the development of mutism.[3] Mutism can occur as a severe form of poverty of speech.

The largest report on mutism associated with noncatatonic schizophrenia is from the Kosraean population, where it is described as a specific cultural variant of psychopathology.[3] Mutism has lasted from a few days to 20 years in this community and is noted in the initial part of the illness, predicting relapse. Most of these patients use nonverbal methods of communication.

To our knowledge, only one case associated with paranoid schizophrenia has been reported.[1] Mutism is now rare in developed countries. Mutism in catatonic schizophrenia responds well to benzodiazepines, electroconvulsive therapy and antipsychotics, including clozapine.[4] The response to treatment in the Kosraean population has been good.[3] We report a case of mutism in noncatatonic schizophrenia.

A 32-year-old single male presented with a 17-year history of illness. The initial five years were characterized by vague somatic complaints, insomnia and anger outbursts. Persecutory and referential delusions along with auditory hallucinations appeared following the death of his mother 11 years ago. There was a decline in socio-occupational functioning and deterioration in personal hygiene. Mutism had developed over a period of the last four years. There was no history to suggest seizures, substance use, dementia, confusion or a mood disorder. On examination, he was mute but would indicate his needs by gesturing and limited writing. The reason for being mute and other psychopathology could not be explored.

Clozapine was started, as he had not responded to risperidone, olanzapine and three courses of electroconvulsive therapy. The dose of clozapine was gradually increased to 450 mg/day. After several months on clozapine, his eye contact improved. He was less defensive and was willing to communicate. He consented to video record an interview where he communicated in writing. The reason for his silence he wrote, "I am not speaking on my own accord. I do not enjoy talking". He wrote about fear, hearing voices and wanting to work in his father's grocery shop but was reluctant to elaborate. He became defensive and stopped writing on detailed questioning. He has been on a daily dose of over 300 mg for eight months. He continues to be mute and unemployed, although there is some improvement in negative symptoms. However, he is able to meet his day-to-day needs.

In our patient, we considered a diagnosis of paranoid schizophrenia, where mutism had occurred later in the course of illness and did not respond to treatment. Catatonic schizophrenia was not considered due to prominent delusions and hallucinations. Mutism, which was secondary to delusional beliefs, was the only catatonic symptom present among the list in ICD-10.[5] We infer that the psychotic symptoms are resistant to clozapine and hence the patient continues to be mute.

Dismissing mutism as an old phenomenon, which occurs only with catatonic schizophrenia, may be too simplistic. It could occur in other types of schizophrenia and at varying times during the course of illness. Mutism while being a rare phenomenon can be resistant to treatment and requires further study.

 
 :: References Top

1.Altshuler LL, Cummings JL, Mills MJ. Mutism: Review, differential diagnosis and report of 22 cases. Am J Psychiatry 1986;143:1409-14.   Back to cited text no. 1  [PUBMED]  
2.Stompe T, Ortwein-Swoboda G, Ritter K, Schanda H, Friedmann A. Are we witnessing the disappearance of catatonic schizophrenia? Compr Psychiatry 2002;43:167-74.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Waldo MC. Schizophrenia in Kosrae, Micronesia: Prevalence, gender ratios and clinical symptomatology. Schizophr Res 1999;35:175-81.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Hung YY, Yang PS, Huang TL. Clozapine in schizophrenia patients with recurrent catatonia: Report of two cases. Psychiatr Clin Neurosciences 2006;60:256-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic criteria for research. Geneva: WHO; 1992.  Back to cited text no. 5    



This article has been cited by
1 Mutism in non-catatonic schizophrenia: Psychotic symptom and adaptive behavioral strategy
Kyle P. Smith,Julie B. Penzner
Schizophrenia Research. 2015; 168(1-2): 569
[Pubmed] | [DOI]
2 electroconvulsive therapy for long-term mutism in a case of noncatatonic paranoid schizophrenia
basu, a. and singh, p. and gupta, r. and kundu, s.
innovations in clinical neuroscience. 2013; 10(7-8): 10-12
[Pubmed]
3 17 years of treatment-resistant mutism in non- catatonic, childhood-onset schizophrenia: a rare case report
khairkar, p. and jain, v. and bhatnagar, a. and saoji, n.
journal of neuropsychiatry and clinical neurosciences. 2012; 24(1): e39-e40
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow