Non-Catatonic Mutism as a Presentation of Psychosis: A Case Study.

OBJECTIVE

To describe a rare case of non-catatonic mutism as the primary presentation of psychosis in a patient with complex comorbidities, highlighting diagnostic differentiation and antipsychotic response.

METHODS

Case report of a 47-year-old female with bipolar II disorder, post-traumatic stress disorder, polysubstance use, and homelessness presenting with intermittent mutism. Diagnostic evaluation included clinical history, Bush-Francis Catatonia Rating Scale (BFCRS), and exclusion of alternative etiologies. Treatment involved antipsychotics with legal authorization.

RESULTS

BFCRS score of 3 ruled out catatonia. Mutism resolved with haloperidol 4 mg daily after initial olanzapine failure, with no overt psychotic symptoms. Integrated care addressed social determinants.

CONCLUSIONS

Non-catatonic mutism may represent isolated psychosis, responsive to antipsychotics. Systematic evaluation is crucial in atypical presentations with psychosocial complexity.