Using Chess as a Novel Means to Cure Treatment Refractory Catatonia

This work was sponsored by Lehigh Valley Health Network Catatonia is a clinical syndrome involving psychomotor disruptions in speech, movement, and emotion. Catatonia comes in three main forms: akinetic, hyperkinetic, and malignant catatonia, and although these forms can present differently and can be triggered by an array of conditions, it is widely recognized that the Bush-Francis catatonia rating scale is the gold standard for accurately diagnosing catatonia. Catatonia is often associated with schizophrenia, as it is comorbid in 20% of catatonia cases, but mood disorders are present in almost half of all cases of catatonia. Other causes of catatonia include traumatic brain injury, epilepsy, systematic lupus erythematous, encephalopathy, and it is commonly associated with autism spectrum disorder. Catatonia has also been found to be a sequela of COVID-19 infection. Potential complications from catatonia can include DVT, pressure sores, cardiac arrythmia, autonomic instability, acute kidney injury, and infection. The pathophysiology is poorly understood, but first line treatment for catatonia is benzodiazepines, specifically lorazepam, and ECT is agreed to be the gold standard in managing treatment refractory catatonia. Beyond these two options, there has been some success using Zolpidem. Otherwise, few medications or treatments have been found to be effective, as there is a lack of research in this area leading to difficulty managing treatment refractory catatonia. Chess is an ancient strategic board game that requires intensive attention and concentration, spatial reasoning, working memory, and executive decision making. Here we present a case of a patient with treatment refractory catatonia which resolved following the initiation of a game of chess.