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The patient endorsed paranoia and trespassed a property in a neighborhood that led him to the county jail for 1. Following his release from the jail, the patient had isolated himself from his family, and became unresponsive and mute.

The patient did not take care of himself and had a very poor appetite with a significant 35-pound unintentional weight loss in the past three months. The patient was born Intralipid 20% (20% I.V.

Fat Emulsion)- FDA raised in Oklahoma and was the oldest of two siblings. His childhood was uneventful, without any trauma. His relationship with his deceased father was "rocky". He graduated from high school and about to start working for "Amazon" before his arrest for trespassing. He has no significant past medical or surgical history. He does not international journal of hospitality management a history of substance or alcohol use.

On admission, the patient was started on fluoxetine 20 mg by mouth international journal of hospitality management, every morning (qAM) for depression, haloperidol 5 mg PO twice a day (BID) for psychosis, lorazepam 1 mg PO three times a day (TID) for catatonia, and benztropine 1 mg PO BID for prophylaxis of extrapyramidal symptoms (EPS).

On day 3, the patient was mute, responded to internal stimuli, and refused to participate with the treatment team meeting. Haloperidol was increased to 10 mg PO BID. The next day, the patient continues to be non-verbal with waxy flexibility and posturing, and so lorazepam was increased to 1. Subsequently, the patient was selectively mute with the treatment team and later responded to simple one-step commands.

However, the patient continues to have a blunted affect, selective mutism, and psychomotor inactivity with waxy flexibility; therefore, lorazepam was increased to 2 mg PO TID, haloperidol was increased to 15 mg PO BID for psychosis, and fluoxetine was increased to 40 mg PO qAM for depression. On day 5, nurses reported that the patient had been verbalizing in short answers and went to the basketball arena to play with other peers, and so the patient was tapered off lorazepam over the next five days, and simultaneously fluoxetine was titrated to 60 mg PO qAM.

On day 11, the patient verbalized in short sentences with the treatment team for the first time and agreed with the plan of a long-acting injectable (LAI): haloperidol decanoate 150 mg intramuscular (IM) and then every four weeks. Mirtazapine 15 mg PO every nighttime (qHS) was added to augment antidepressant action and improve appetite.

On day 15, the patient demonstrated significant improvement as he was able to maintain a good conversation with the treatment team and stated that his psychotropic regimen worked well for his depression rating it 3 to 4 out of 10 (was 10 out of 10 on admission).

The patient also discussed his short-term goals of resuming playing music and start working to sustain his finances, and for the first time showed a willingness to speak with his mother and family. Mirtazapine was titrated to international journal of hospitality management mg PO qHS and on day 19, the patient rated his depression 0 out of 10 and appreciated the treatment team for helping him with his depression and current situation.

The patient had a linear and goal-directed thought process, with an improved insight and judgment, and agreed to be compliant with his psychotropic regimen by following up at psychiatric outpatient. In catatonia caused by clozapine withdrawal, clozapine is the first-line treatment. Other beneficial SGAs for catatonia include aripiprazole and olanzapine. Aripiprazole is a partial agonist at the dopamine d2 receptor, decreasing catatonia international journal of hospitality management, without increasing the risk of EPS and NMS.

Very few international journal of hospitality management reports have discussed the benefit of mirtazapine in psychotic depression. Furthermore, Ruberto et al. A case by Cheng and Shen involved a 42-year-old female without past psychiatric history, who was in shock after the sudden loss of international journal of hospitality management johnson artist and presented with catatonic behavior to the hospital.

In our case report, the patient had shown a profound improvement after tapering off lorazepam and administering haloperidol LAI, and most important is augmenting the antidepressant action of fluoxetine with mirtazapine.

Mirtazapine is an atypical antidepressant with pronounced antihistaminic activity at low doses, and at higher doses it has more noradrenergic activity and antagonist effects on alpha-2-adrenergic receptors, histamine h1 receptors, and serotonin receptors international journal of hospitality management, 5-ht2c, 5-ht3).

They contribute to activating the mesocortical dopamine pathway, specifically the nigrostriatal and mesolimbic pathway that leads to the reduction of catatonic symptoms.

International journal of hospitality management is the treatment of choice for treating catatonia, and SGAs should be added in patients presenting with psychotic symptoms.

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