Severe Depression with Catatonic Features and Dehydration in Young Adult

Case at a Glance

A 20-year-old male presented with severe behavioral changes including extreme social withdrawal, significant reduction in food and fluid intake, and rapid weight loss over a two-week period, accompanied by visual hallucinations and physical weakness.

Patient's Story

The patient reported being largely bedbound for approximately one week, leaving bed only once daily for bathroom use. His oral intake had dramatically decreased to one small meal and one cup of water per day. He described complete loss of appetite and thirst, stating he 'did not like food' and experienced no hunger or thirst sensations. The patient reported a significant weight loss from 75kg to 67kg over two weeks. He complained of physical weakness, tremors, and cognitive difficulties including impaired concentration and thinking. Most concerning, he began experiencing visual hallucinations, specifically seeing flies and flashes of light in his peripheral vision. The patient expressed complete anhedonia and lack of motivation to engage in any activities.

Initial Assessment

Physical examination would likely reveal signs of dehydration, malnutrition, and possible orthostatic hypotension. Mental status examination indicated severe depression with possible catatonic features, including stupor, reduced motor activity, and anhedonia. The presence of visual hallucinations raised concerns for either severe psychiatric decompensation or underlying medical causes.

The Diagnostic Journey

The clinical presentation suggested multiple differential diagnoses including major depressive disorder with catatonic features, delirium secondary to dehydration and malnutrition, substance use disorders, or underlying medical conditions such as endocrine disorders, autoimmune conditions, or neurological diseases. The rapid onset and severity of symptoms, combined with visual hallucinations, warranted urgent medical evaluation to rule out organic causes.

Final Diagnosis

Major Depressive Disorder with Catatonic Features, complicated by severe dehydration and malnutrition with associated visual hallucinations secondary to metabolic disturbances.

Treatment Plan

Immediate medical intervention was recommended including same-day physician evaluation, likely requiring hospitalization for fluid and electrolyte correction, nutritional rehabilitation, and psychiatric assessment. Treatment would include IV hydration, gradual refeeding under medical supervision, and initiation of antidepressant therapy with possible consideration of electroconvulsive therapy given the severity of catatonic features.

Outcome and Follow-up

Patient was advised to seek immediate medical attention through emergency services or urgent GP home visit. Long-term follow-up would include psychiatric care, nutritional counseling, and monitoring for treatment response and prevention of relapse.