Memantine and Catatonic Schizophrenia

Mr. A, a 56-year-old man with schizophrenia, was admitted after police discovered him wandering the streets responding to auditory hallucinations. His symptoms included mutism, staring, posturing, perseveration, stupor, and stereotypy (retrospectively assessed with the Bush Francis Catatonia Rating Scale, score=16) (2). His hospital course was prolonged because of partial response to olanzapine, haloperidol, ziprasidone, and risperidone. There were several psychotic relapses with polydipsia, staring, mutism, immobility, and somatic delusions. He was transferred several times between the acute care and extended care units.

Memantine, 5 mg/day, was started, ziprasidone was discontinued, and clozapine was initiated. The next day, Mr. A’s symptoms improved greatly. He spoke more freely, and a feeling of his head being warm had subsided, as well as his preoccupation with drenching himself in baptismal fashion. His memantine and clozapine doses were titrated to 10 mg b.i.d. and 300 mg/day, respectively. His clozapine level was measured at 509 ng/ml.

Uncertainty as to the efficacy of memantine promoted its discontinuation 9 days after initiation. Mr. A’s condition subsequently worsened, with a return of staring and soaking himself. Memantine was restarted, and his symptoms again significantly improved. Clozapine and memantine were continued, and his Bush Francis Catatonia Rating Scale score was 3, with automatic obedience.