Agitation after minor trauma: Combativeness as a cardinal catatonic feature

Catatonia is a syndrome of motor dysregulation, usually associated with psychiatric, neurological, systemic and drug-related diseases. Retarded and excited types exist, both of which often go unrecognised in clinical practice. We describe a 64-year-old woman who gradually developed insomnia, started communicating less, complained of feeling restless and ended up injuring relatives. Initiation of symptoms followed a fibula fracture. The patient was diagnosed with excited-type catatonia with prominent combativeness because of minor trauma and rapidly recovered after lorazepam treatment instatement. Our case demonstrates that catatonia can follow minor traumatic injury and how excited-type catatonic features may go unrecognised in general practitioner and specialist settings. Moreover, we show that catatonia may be recurrent, necessitating long-term treatment and very gradual lorazepam tapering.