PMC6473553_01
Clinical time course. (A) Patient's MRI, sample horizontal planes (3 mm) at the height of ventricles, taken on a 3-Tesla scanner. Upper image: Turbo-Inversion Recovery-Magnitude (TIRM) sequence with fluid suppression; bottom: T2 blade sequence. (B) The time course of NCRS and PANSS scores is depicted on the upper and the lower subplots, respectively. The patient was independently scored at five time points throughout treatment and follow-up (as marked on the upper x axis) by the two first authors of the paper; then, the mean score was calculated. Big cyan-filled circles represent the total scores; small red, blue, and green dots represent the subdomains of the tests. Major therapeutic and diagnostic milestones are marked on the bottom x axis. Treatment 1-4: 1, enforced medication with lorazepam and isotonic infusions; 2, enforced medication with lorazepam and oral olanzapine 10-15 mg daily; 3, enforced medication with intramuscular olanzapine 300 mg biweekly; 4, voluntary medication with intramuscular olanzapine 300 mg biweekly.
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The Positive and Negative Syndrome Scale (PANSS) on admission added up to 148 points; the Northoff Catatonia Rating Scale (NCRS) added up to 30 points in total, indicating severe psychosis and catatonia, respectively (see also Figure 1B). Initial blood tests, clinical examination, and cranial magnetic resonance tomography (Figure 1A) were without significant pathological findings. Administration of oral olanzapine 20 mg daily over the course of 2 weeks and a subsequent intramuscular injection of 300 mg of its depot formulation resulted in further remission (Figure 1B) and allowed for a more in-depth exploration and neuropsychiatric testing. He was discharged in good physical and mental condition after 101 days of treatment (Figure 1B).