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Mutism. What to expect?

Published online by Cambridge University Press:  01 September 2022

I. Santos Carrasco
Affiliation:
Clinical Hospital of Valladolid, Psychiatry, Valladolid, Spain
J. Gonçalves Cerejeira
Affiliation:
Hospital Clínico Universitario de Valladolid, Psychiatry, Valladolid, Spain
M. Fernández Lozano
Affiliation:
Clinical Hospital of Valladolid, Psychiatry, Valladolid, Spain Hospital Clínico Universitario de Valladolid, Psiquiatría, VALLADOLID, Spain Hospital Clínico Universitario, Psiquiatría, Valladolid, Spain
A. Gonzaga Ramírez
Affiliation:
Hospital Clínico Universitario de Valladolid, Psychiatry, Valladolid, Spain
M. Queipo De Llano De La Viuda
Affiliation:
Hospital Clínico Universitario de Valladolid, Psychiatry, Valladolid, Spain
G. Guerra Valera
Affiliation:
Hospital Clínico Universitario de Valladolid, Psychiatry, Valladolid, Spain
C. Vallecillo Adame
Affiliation:
Clinical Hospital of Valladolid, Psychiatry, Valladolid, Spain Hospital Clínico Universitario, Psiquiatría, Valladolid, Spain
C. De Andrés Lobo
Affiliation:
Hospital Clínico Universitario de Valladolid, Psiquiatría, VALLADOLID, Spain
T. Jiménez Aparicio
Affiliation:
Hospital Clínico Universitario, Psiquiatría, Valladolid, Spain
B. Rodríguez Rodríguez
Affiliation:
Hospital Clínico Universitario, Psiquiatría, Valladolid, Spain
N. Navarro Barriga
Affiliation:
Hospital Clínico Universitario, Psiquiatría, Valladolid, Spain
M.J. Mateos Sexmero
Affiliation:
Hospital Clínico Universitario de Valladolid, Psychiatry, Valladolid, Spain Hospital Clínico Universitario, Psiquiatría, Valladolid, Spain
E. Pérez
Affiliation:
Hospital Clínico Universitario de Valladolid, Psychiatry, Valladolid, Spain
L. Gallardo Borge*
Affiliation:
Hospital Clínico Universitario, Psiquiatría, Valladolid, Spain
*
*Corresponding author.

Abstract

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Introduction

Mutism is the inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output. Mutism is a common manifestation of psychiatric, neurological, and drug-related illnesses. Psychiatric disorders associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurological disorders causing mutism affect the basal ganglia, frontal lobes, or the limbic system.

Objectives

Outline the importance of setting a differential diagnosis of mutism in the Emergency Room.

Methods

Review of scientific literature based on a relevant clinical case.

Results

Male, 58 years old. He has lived in a residence for 3 months due to voluntary refusal to ingest. Diagnosed with paranoid personality disorder. He is refered to the Emergency Service due to sudden mutism. During this day, he has been stable and suitable with a good functionality. For 3 hours he is mutist, oppositional attitude and stiff limbs, refusing to obey simple orders. Hyperalert and hyperproxia. Not staring. After ruling out organic pathology: normal blood tests, negative urine toxins and cranial CT without alterations, he was admitted to Psychiatry for observation and, finally, he was diagnosed with Psychotic Disorder NOS.

Conclusions

Mutism most often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. The most common disorder of behavior occurring with mutism is catatonia. The differential diagnosis of mutism is complex. In some cases the diagnosis will be clarified only by careful observation and after a neurological evaluation. Published studies show neurological disorders presenting with mutism can be misdiagnosed as psychiatric.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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