Catatonia in Bipolar Disorder at the Neuropsychiatric–Metabolic Interface: A Case of Hyperglycemia and Hyponatremia

Catatonia is a reversible neuropsychiatric syndrome characterized by psychomotor, behavioral, and autonomic disturbances. While conventionally associated with schizophrenia, it occurs more frequently in mood disorders, with metabolic disturbances potentially acting as precipitants. We describe a 55-year-old woman with bipolar disorder and type 2 diabetes mellitus who developed severe catatonia following medication discontinuation, with concurrent uncontrolled hyperglycemia and hyponatremia. Lorazepam challenge is used for diagnostic confirmation and produces marked improvement within 2 h. Combined benzodiazepine therapy, metabolic correction, and reinstitution of mood stabilizers resulted in complete remission. This case demonstrates that concurrent metabolic derangements may precipitate catatonia in vulnerable patients with mood disorders, underscoring the importance of systematic metabolic evaluation and integrated psychiatric-metabolic management in catatonic presentations.