{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T05:53:05Z","timestamp":1776750785887,"version":"3.51.2"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Schizophrenia is a severe psychiatric disorder. Catatonia is relatively common in schizophrenia; its main manifestations include catatonic stupor, mutism, negativism, and other psychomotor symptom clusters. Patients with schizophrenia are at increased risk of infections, which are also recognized triggers for Guillain\u2013Barr\u00e9 syndrome (GBS). GBS typically presents with limb weakness, paresthesia, facial weakness, respiratory muscle paralysis, and autonomic symptoms, and may similarly result in severe immobility and impaired communication. Consequently, when schizophrenia (especially with catatonic features) coexists with GBS, history taking and clinical assessment can be challenging, increasing the risk of misdiagnosis or delayed diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 28-year-old man with a 3-year history of schizophrenia who was found after 2 weeks of lost contact and admitted emergently. His first episode featured hallucinations, persecutory delusions, and catatonia, which remitted with antipsychotic and other medications treatment. He subsequently relapsed twice after discontinuing medication; both relapses presented mainly with hallucinations and delusions without catatonia and remitted after re-treatment, followed by regular risperidone maintenance. In the current episode, hallucinations and delusions recurred and progressed to apathy, reduced speech and activity, and eventually complete mutism, immobility, and inability to perform self-care. Schizophrenia was initially diagnosed per DSM-5 criteria and risperidone was initiated. Further evaluation revealed pulmonary infection with limb weakness and decreased tendon reflexes, differing from the increased muscle tone typical of catatonia. Cerebrospinal fluid showed albuminocytologic dissociation (protein 0.61 g\/L; leukocytes 1.2\u00d710^6\/L), and comorbid Guillain\u2013Barr\u00e9 syndrome was considered. He was transferred to neurology and treated with intravenous immunoglobulin (25 g\/day for 5 days) plus rehabilitation, with gradual improvement. During the 1-year follow-up, the patient continued risperidone 4 mg as maintenance to prevent psychiatric relapse; his symptoms had essentially resolved, and he returned to normal work and daily life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In psychiatric practice, mutism and immobility are often attributed to primary psychiatric illness, particularly in patients with established diagnoses, which can lead to missed or delayed detection of medical conditions. This case underscores the importance of thorough neurologic examination and timely investigations in uncooperative patients, especially after antecedent infection, including consideration of lumbar puncture to evaluate for comorbid neurologic disorders such as Guillain\u2013Barr\u00e9 syndrome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1826383","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T05:34:12Z","timestamp":1776749652000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: When catatonia-like symptoms are not catatonia: Guillain\u2013Barr\u00e9 syndrome in a patient with schizophrenia"],"prefix":"10.3389","volume":"17","author":[{"given":"Lishan","family":"Ren","sequence":"first","affiliation":[{"name":"Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People\u2019s Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People\u2019s Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongjing","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People\u2019s Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaiyuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine, Affiliated Mental Health Center & Hangzhou Seventh People\u2019s Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn113661-20230520-00104","article-title":"Proposal of Chinese clinical practice guidelines for the prevention and treatment of schizophrenia, 3rd edition","volume":"56","year":"2023","journal-title":"Chin J Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2022.09.001","article-title":"Catatonia is associated with higher rates of negative affect amongst patients with schizophrenia and schizoaffective disorder","volume":"263","author":"Kline","year":"2024","journal-title":"Schizophr Res"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2022.12.019","article-title":"Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types","volume":"263","author":"Hirjak","year":"2024","journal-title":"Schizophr Res"},{"key":"B4","unstructured":"International classification of diseases 11th revision\u00a0(ICD-11)\n          \n          2021"},{"key":"B5","volume-title":"Diagnostic and Statistical Manual of Mental Disorders 5th edn, text revision (DSM-5-TR)","year":"2022"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbt068","article-title":"Lack of use in the literature from the last 20 years supports dropping traditional schizophrenia subtypes from DSM-5 and ICD-11","volume":"39","author":"Braff","year":"2013","journal-title":"Schizophr Bull"},{"key":"B7","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1038\/s41572-024-00534-w","article-title":"Catatonia","volume":"10","author":"Hirjak","year":"2024","journal-title":"Nat Rev Dis Primers"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1177\/02698811231158232","article-title":"Evidence-based consensus guidelines for the management of catatonia: recommendations from the British Association for Psychopharmacology","volume":"37","author":"Rogers","year":"2023","journal-title":"J Psychopharmacol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2116304","article-title":"Catatonia","volume":"389","author":"Heckers","year":"2023","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000001408","article-title":"New insights in the immune treatment of Guillain-Barr\u00e9 syndrome","volume":"38","author":"Wiegers","year":"2025","journal-title":"Curr Opin Neurol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-20-00244","article-title":"Understanding the experience of diagnostic overshadowing associated with severe mental illness from the consumer and health professional perspective: a qualitative systematic review protocol","volume":"19","author":"Molloy","year":"2021","journal-title":"JBI Evid Synth"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3390\/neurolint13040057","article-title":"Catatonia: Clinical overview of the diagnosis, treatment, and clinical challenges","volume":"13","author":"Edinoff","year":"2021","journal-title":"Neurol Int"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1080\/01616412.2022.2075661","article-title":"Guillain\u2013Barr\u00e9 syndrome from an emergency department view: how to better predict the outcome","volume":"44","author":"Covino","year":"2022","journal-title":"Neurol Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1951.TB09665.x","article-title":"Interpretation of the pandy test","volume":"26","author":"Bullock","year":"1951","journal-title":"Acta Psychiatr Scand"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaclp.2025.05.001","article-title":"Catatonia: american psychiatric association resource document","volume":"66","author":"Wilson","year":"2025","journal-title":"J Acad Consultation-Liaison Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101808","article-title":"The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracy","volume":"56","author":"Hosseini","year":"2023","journal-title":"EClinicalMedicine"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2021.110660","article-title":"Clinical features of catatonic non-convulsive status epilepticus: a systematic review of cases","volume":"151","author":"Ogyu","year":"2021","journal-title":"J Psychosom Res"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1177\/08850666221114303","article-title":"Malignant catatonia: a review for the intensivist","volume":"38","author":"Connell","year":"2023","journal-title":"J Intensive Care Med"},{"key":"B19","volume-title":"Chinese guidelines for the prevention and treatment of schizophrenia","author":"Zhao","year":"2015"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2025.9","article-title":"The use of antipsychotics in the treatment of catatonia: a systematic review","volume":"68","author":"Redon","year":"2025","journal-title":"Eur Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2022.11.015","article-title":"Treatment of schizophrenia with catatonic symptoms: a narrative review","volume":"263","author":"Caroff","year":"2024","journal-title":"Schizophr Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1586\/17476348.2014.957186","article-title":"Do benzodiazepines contribute to respiratory problems","volume":"8","author":"Vozoris","year":"2014","journal-title":"Expert Rev Respir Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2023.04.004","article-title":"Catatonia and ECT across the lifespan","volume":"263","author":"Karl","year":"2024","journal-title":"Schizophr Res"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3109\/15622975.2012.696143","article-title":"World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance","volume":"13","author":"Hasan","year":"2012","journal-title":"World J Biol Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.5505\/kpd.2022.70846","article-title":"Guillain-Barre like syndrome associated with risperidone use: A case report","volume":"25","author":"K\u0131cal\u0131","year":"2022","journal-title":"J Clin Psy"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2026.1718815","article-title":"Case Report: Atypical neuroleptic Malignant syndrome induced by paliperidone palmitate\u2014diagnostic challenges and clinical considerations","volume":"17","author":"Oumary","year":"2026","journal-title":"Front Psychiatry"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.4088\/PCC.25lr04102","article-title":"Psychotropic-related aspiration hazards: A call for action","volume":"28","author":"Sayegh","year":"2026","journal-title":"Prim Care Companion CNS Disord"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn113694-20230309-00171","article-title":"Guillain-barr\u00e9 syndrome","volume":"56","author":"Guo","year":"2023","journal-title":"Chin J Neurol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1002\/mus.27816","article-title":"Increased risk of depression after Guillain-Barr\u00e9 syndrome","volume":"67","author":"Levison","year":"2023","journal-title":"Muscle Nerve"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/cjn.2025.10107","article-title":"Systematic review: mental health outcomes in Guillain-Barr\u00e9 syndrome and chronic inflammatory demyelinating polyneuropathy","author":"Li","year":"2025","journal-title":"Can J Neurol Sci"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/jns.12087","article-title":"Post-traumatic stress symptoms in Guillain-Barr\u00e9 syndrome patients after prolonged mechanical ventilation in ICU: a preliminary report","volume":"19","author":"Le Guennec","year":"2014","journal-title":"J Peripher Nerv Syst"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2023.152370","article-title":"Association between autoimmune diseases of the nervous system and schizophrenia: a systematic review and meta-analysis of cohort studies","volume":"122","author":"Cao","year":"2023","journal-title":"Compr Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn113694-20240220-00099","article-title":"Chinese guideline on diagnosis and treatment of Guillain-Barr\u00e9 syndrome 2024","volume":"57","year":"2024","journal-title":"Chin J Neurol"},{"key":"B34","article-title":"Systematic review of the side effects of benzodiazepines","volume":"161","author":"Seldenrijk","year":"2017","journal-title":"Ned Tijdschr Geneeskd"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1826383\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T05:34:18Z","timestamp":1776749658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1826383\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":34,"alternative-id":["10.3389\/fpsyt.2026.1826383"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1826383","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]},"article-number":"1826383"}}