Negativism associated urinary bladder overdistension: a case report -

Abstract

Negativism is known as resistance to instructions, contrary comportment to what asked. Negativism is mostly associated with catatonia. Genitourinary complications like urinary retention or urinary incontinence or infections can be seen in catatonia. Here we describe a case of negativism associated urinary bladder overdistension without catatonia. We aim to call attention that urinary bladder overdistension may be associated with negativism without catatonia. A 37 years old female patient had a history of psychotic depression for seven years. She had been on olanzapine treatment during last year until she learnt that she was pregnant six weeks ago. In the past ten days, the patient has not talked, eaten, drunk or slept so she was hospitalized in psychiatry inpatient clinic. Abdominal ultrasound revealed that her bladder volume was nearly 1500 cc and compressing on uterus. A urinary catheter was placed and urinary bladder overdistension resolved. After seven sessions of Electroconvulsive therapy (ECT), she recovered completely. Pulmonary complications like pulmonary embolism, pneumonia and aspiration; gastrointestinal complications like constipation due to decreased food intake and dehydration; dental complications due to decreased oral hygiene; genitourinary complications like urinary retention or urinary incontinence or infections; flexion contractures, postural nerve palsies and rhabdomyolysis due to immobilization can be seen in catatonia. Urinary bladder overdistension was associated with catatonia in literature but in our case urinary bladder overdistension was associated with negativism without full criteria of catatonia. Caution should be given to negativist pregnant woman because urinary bladder overdistension could be concealed by pregnancy.