Bansal H, Kamal N, Chakrabarti S. Management of catatonia in Parkinson’s disease with comorbid bipolar disorder: A case report and review of literature. World J Clin Cases 2026; 14(23): 121781 [DOI: 10.12998/wjcc.121781]
Corresponding Author of This Article
Subho Chakrabarti, MD, FRCPsych, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, 12 Sector, Chandigarh 160012, India. subhochd@yahoo.com
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Psychiatry
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case-report
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Bansal H, Kamal N, Chakrabarti S. Management of catatonia in Parkinson’s disease with comorbid bipolar disorder: A case report and review of literature. World J Clin Cases 2026; 14(23): 121781 [DOI: 10.12998/wjcc.121781]
World J Clin Cases. Aug 16, 2026; 14(23): 121781 Published online Aug 16, 2026. doi: 10.12998/wjcc.121781
Management of catatonia in Parkinson’s disease with comorbid bipolar disorder: A case report and review of literature
Himaly Bansal, Nikhil Kamal, Subho Chakrabarti
Himaly Bansal, Nikhil Kamal, Subho Chakrabarti, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Bansal H, Kamal N, and Chakrabarti S were involved in the management of this patient, conducted the literature review and prepared the first draft of the manuscript, and prepared the revised version of the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
AI contribution statement: No AI tools have been used to prepare this manuscript.
Informed consent statement: The patient has given written informed consent for the details of his illness to be submitted for publication. This has been included. The case report does not include any identifying details of the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Subho Chakrabarti, MD, FRCPsych, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, 12 Sector, Chandigarh 160012, India. subhochd@yahoo.com
Received: April 1, 2026 Revised: May 24, 2026 Accepted: June 25, 2026 Published online: August 16, 2026 Processing time: 133 Days and 10.6 Hours
Abstract
BACKGROUND
Non-motor symptoms are very common in Parkinson’s disease (PD) and can appear decades before motor symptoms. They occur at all stages of PD and may overshadow motor symptoms in advanced stages. These symptoms are disabling, reduce quality of life, and lead to early institutionalisation and increased caregiver burden. Bipolar disorder (BD) is less commonly reported but is more likely to be associated with PD compared to the general population. Patients with both BD and PD may occasionally develop catatonia.
CASE SUMMARY
This report describes the case of a 68-year-old with comorbid BD and PD who developed catatonia. He had type II BD with 2 hypomanic episodes and 5 episodes of severe, disabling, and poorly-responsive depression. The index depressive episode was chronic and severe, with anxiety, apathy, constipation, and urinary incontinence. Parkinsonian symptoms became evident during this episode, 30 years after the onset of BD. Lithium and levodopa led to some improvement, but were followed by worsening. He developed catatonic stupor within 3-4 days of adding quetiapine (75 mg/day) for depression. He had no sustained improvement after stopping quetiapine and adding lorazepam. However, there was a marked improvement in catatonic symptoms, depressive features, and parkinsonian symptoms with 6 treatments of electroconvulsive therapy (ECT). Subsequently, he received 6 continuation ECTs over 3 months. Continuation pharmacotherapy included mirtazapine and lithium, and levodopa for PD. He has remained asymptomatic for 18 months with this treatment.
CONCLUSION
ECT can lead to the resolution of catatonia and depressive symptoms, and improve motor symptoms in comorbid PD and BD.
Core Tip: Bipolar disorder (BD) is an infrequently reported but disabling non-motor manifestation of Parkinson’s disease (PD). The presentation of a 68-year-old man with comorbid BD and PD illustrates the comorbidity’s typical features, such as BD occurring in the pre-motor phase of PD, its association with anxiety, apathy, and other non-motor symptoms, and its poor prognosis. Catatonia is an uncommon manifestation of treatment-resistant depressive episodes in comorbid BD and PD. When benzodiazepines for catatonia fail, clinicians should actively consider electroconvulsive therapy. Close collaboration between psychiatrists and neurologists is essential for early detection and proper management of coexisting BD and PD with catatonia.
