An Unexpected Arousal Effect of Etomidate in a Patient on High-dose Steroids

Abstract

CATATONIA presents with stupor, excitement, or alternating stupor and excitement 1 and covers a broad group of movement disorders sometimes seen in psychotic illness. It is most often associated with schizophrenia but can also be found in connection with mania and depression. 2 Other conditions in which catatonia can be present include neurologic disorders, systemic metabolic disorders, and as a side effect of certain medications. Any two of the following signs manifests catatonia: motor immobility, excessive motor activity, negativism or mutism, peculiarities of voluntary movement, echolalia, or echopraxia. 2 Motor immobility may be manifested as a waxy flexibility. The excessive motor activity apparently is purposeless and is not influenced by external stimuli. There may be extreme negativism that is manifested by resistance to all instructions or the maintenance of a rigid posture against attempts to be moved. Additional features may include stereotypes, mannerisms, and automatic obedience or mimicry. 2 What follows is a case in which etomidate produced an unexpected arousal effect, rather than sedation, in a patient with catatonia caused by a high dose of steroids.