Hopeloos verliefd: een ongewone uiting van ernstige katatonie?

Hopelessly in love: an unusual manifestation of severe catatonia? Catatonia is still a common syndrome in psychiatry with affective disorders being the most frequent underlying cause. In 20% of cases, another medical cause can be found. The clinical presentation can be varied and sometimes atypical, with symptoms fluctuating over time, which increases the risk of underdiagnosis. However, early recognition is critical, as the syndrome can worsen and progress to the malignant form, despite being generally treatable. In this article, we present the case of a 58-year-old man, referred to our centre due to psychosis. He had been treated with multiple antipsychotics, without adequate effect. The diagnosis was further delayed because we focused on prominent behavioral symptoms, in particular a sudden, intense infatuation with a nurse. This symptom led to other potential diagnoses being considered first. It was only after his condition worsened and his psychomotor symptoms escalated that treatment with lorazepam was initiated. The response was immediate and an underlying severe psychotic depression emerged. This case highlights the importance of having a thorough understanding of catatonia, with standardized and timely assessment. A comprehensive patient history, careful observation and attention to the potential effects of medication are essential for proper diagnosis and treatment.