Atypical First-Episode Psychosis With Prolonged Catatonia and Neuroleptic Malignant Syndrome: Diagnostic Challenges and Improvement With Clozapine: A Case Report and Literature Review

Authors

  • Aditi Sarker, MD PGY2 Resident, Psychiatry Residency Program, Baptist Hospitals of Southeast Texas, Beaumont, TX
  • Adil Elahi, MD PGY2 Resident, Psychiatry Residency Program, Baptist Hospitals of Southeast Texas, Beaumont, TX
  • Gursimrat Bhatti, MD PGY2 Resident, Psychiatry Residency Program, Baptist Hospitals of Southeast Texas, Beaumont, TX
  • Abraham Williams, DO PGY1 Resident, Psychiatry Residency Program, Baptist Hospitals of Southeast Texas, Beaumont, TX
  • Muhammad Yusuf, MD PGY1 Resident, Psychiatry Residency Program, Baptist Hospitals of Southeast Texas, Beaumont, TX
  • David Murdock, MD Core Faculty, Psychiatry Residency Program, Baptist Hospitals of Southeast Texas, Beaumont, TX
  • Nhu Mai Vu, MD Child and Adolescent Psychiatry Specialist, Baptist Hospitals of Southeast Texas, Beaumont, TX
  • Michael Gillespie, MD Program Director, Psychiatry Residency Program, Baptist Hospitals of Southeast Texas, Beaumont, TX
  • Raheel Imtiaz Memon, MD Child, Adolescent & Adult Psychiatrist, Medical Director, Associate Program Director, Psychiatry Residency Program, Baptist Hospitals of Southeast Texas, Beaumont, TX

DOI:

https://doi.org/10.56570/8tfw6a02

Keywords:

Schizophrenia, psychotic disorder, DSM-5, catatonia, NMS, neuroinflammation, antipsychotics, clozapine

Abstract

Schizophrenia is a long-term mental illness that usually shows typical positive symptoms, but some patients have unusual symptoms that make diagnosis and treatment difficult. Catatonia and neuroleptic malignant syndrome (NMS) can occur in schizophrenia, yet atypical early-onset cases are not well described. This case explores the first episode of atypical psychosis with prolonged catatonia and NMS, focusing on diagnostic challenges and response to clozapine.
This case report describes a 24-year-old Hispanic male, admitted with unclear depression, suicidal thoughts, disorganized behavior, and unclear psychosis, without hallucinations or delusions. Later developed prolonged catatonia overlapped with NMS following treatment with antipsychotics. Extensive medical, neurologic, autoimmune, and infectious evaluations were negative. Multiple treatments, including benzodiazepines and several antipsychotics, resulted in minimal improvement. After failure of standard treatments for five months, clozapine was started and slowly increased, following guidelines. The patient showed marked improvement, including improved speech, behavior, affect, and participation in therapy. No significant adverse effects were reported.

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Published

2026-01-23

Issue

Vol. 5 No. 1 (2026): Vol 5 Issues 1 (2026)

Section

Articles

How to Cite

1.
Sarker A, Elahi A, Bhatti G, et al. Atypical First-Episode Psychosis With Prolonged Catatonia and Neuroleptic Malignant Syndrome: Diagnostic Challenges and Improvement With Clozapine: A Case Report and Literature Review. Journal For International Medical Graduates. 2026;5(1). doi:10.56570/8tfw6a02