Fig. 1

Clinical course of a case of catatonia associated with late paraphrenia. A 66-year-old man with catatonic stupor initially responded to benzodiazepine therapy, and his psychotic symptoms became clinically evident because he stated that “someone was trying to kill me, so I jumped to escape. I don’t want to talk about anything because I am being seen and heard by someone.” He subsequently developed delirium with fever and creatine kinase (CK) level elevation and the dose of lorazepam was tapered to 2 mg/day. After normalization of CK levels, a blonanserin patch at a dose of 20 mg/day was added for his underlying psychotic symptoms. The dose of the blonanserin patch was increased to 40 mg/day, and lorazepam was terminated; however, it was not effective. Although he was a suitable candidate for ECT, it was unavailable in our facility. Lithium was, therefore, added, and the blonanserin patch was terminated; his catatonic and psychotic symptoms were finally relieved by lithium monotherapy. He said that “I have always been able to hear hallucinations, but now I cannot. I want to recover from the injury and go home immediately.” Although the dose of lithium was temporarily increased to 600 mg/day (0.86 mEq/ml), the dose of 400 mg/day (0.50 mEq/ml) was maintained after obtaining informed consent, based on the blood concentration results. Li blood concentration of lithium, CK creatine kinase