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Berthet F, Niculcea DA, Younes N, Brunet-Gouet E. Brief psychotic disorder revealing a SARS-COV-2 encephalopathy in a patient with myasthenia gravis: A case report. L'ENCEPHALE 2023; 49:202-204. [PMID: 35973847 PMCID: PMC9117262 DOI: 10.1016/j.encep.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022]
Affiliation(s)
- F Berthet
- Service hospitalo-universitaire de psychiatrie de l'adulte et d'addictologie, centre hospitalier de Versailles, 78157 Le Chesnay, France; Team DevPsy, CESP, université Versailles Saint-Quentin, université Paris Saclay, 94807 Villejuif, France.
| | - D-A Niculcea
- Service hospitalo-universitaire de psychiatrie de l'adulte et d'addictologie, centre hospitalier de Versailles, 78157 Le Chesnay, France; Team DevPsy, CESP, université Versailles Saint-Quentin, université Paris Saclay, 94807 Villejuif, France
| | - N Younes
- Service hospitalo-universitaire de psychiatrie de l'adulte et d'addictologie, centre hospitalier de Versailles, 78157 Le Chesnay, France; Team DevPsy, CESP, université Versailles Saint-Quentin, université Paris Saclay, 94807 Villejuif, France; UFR des sciences de la santé Simone-Veil, université de Versailles Saint-Quentin-en-Yvelines, 78280 Versailles, France
| | - E Brunet-Gouet
- Service hospitalo-universitaire de psychiatrie de l'adulte et d'addictologie, centre hospitalier de Versailles, 78157 Le Chesnay, France; Team DevPsy, CESP, université Versailles Saint-Quentin, université Paris Saclay, 94807 Villejuif, France
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Wu H, Wu C, Zhou Y, Huang S, Zhu S. Catatonia in adult anti-NMDAR encephalitis: an observational cohort study. BMC Psychiatry 2023; 23:94. [PMID: 36750806 PMCID: PMC9903498 DOI: 10.1186/s12888-022-04505-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/28/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most prevalent autoimmune encephalitis and is closely related to catatonia. This study aimed to investigate the clinical features and disease outcomes of adult catatonic anti-NMDAR encephalitis patients. METHODS Adult patients diagnosed with anti-NMDAR encephalitis between January 2013 and October 2021 were retrospectively enrolled in this study. According to the Bush Francis Catatonia screening instrument (BFCSI), patients were divided into two groups: those with catatonia and those without catatonia. The modified Rankin scale (mRS), Clinical Assessment Scale for Autoimmune Encephalitis (CASE), Neuropsychiatric Inventory (NPI), Patient Health Questionnaire-9 (PHQ-9) and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) scores were assessed at follow-up. The Mann-Whitney U test (nonparametric), Student's t test (parametric), and chi-squared test were used to analyse the differences between the two groups. RESULTS Eighty-four patients were recruited, including twenty-five catatonic patients and fifty-nine noncatatonic patients. Among them, 28 had positive antibody only in cerebrospinal fluid (CSF), 4 had positive antibody only in serum and 52 had positive antibody both in CSF and serum. Catatonic patients experienced more disturbance of consciousness (p = 0.01), aggression (p = 0.046) and affective disorders (p = 0.043) than noncatatonic patients. The mRS scores of the catatonia group assessed at admission (p = 0.045) were worse than those of the non-catatonia group. Catatonic patients were more inclined to develop deep vein thrombosis (p = 0.003), decubitus (p = 0.046), pneumonia (p = 0.025), and to be admitted to the intensive care unit (ICU) (p = 0.011) than noncatatonic patients. All patients in the catatonia group received first-line immunotherapy. At the 24-month follow-up, 2 patients in the catatonia group did not achieve good outcomes. At the last follow-up, the catatonia group had more relapses (p = 0.014) and more neuropsychiatric problems (p = 0.035). CONCLUSIONS Adult anti-NMDAR encephalitis patients with catatonia present distinct clinical features in disease course and are prone to experience more relapses and long-term neuropsychiatric problems than those without catatonia.
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Affiliation(s)
- Huiting Wu
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Chunmei Wu
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Yingying Zhou
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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Neuroleptic Malignant Syndrome or Catatonia? A Case Report. J Crit Care Med (Targu Mures) 2020; 6:190-193. [PMID: 32864466 PMCID: PMC7430361 DOI: 10.2478/jccm-2020-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/27/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction A review of the literature has shown that there are many similarities in the presentation of neuroleptic malignant syndrome (NMS) and catatonia. Attempts to reconcile the differences have been made by suggesting that NMS and catatonia may represent different presentations of the same illness or that they lie within the same spectrum of a poorly understood clinical syndrome. The described case is of a patient who presented with NMS and catatonia which was difficult to diagnose, but which responded to treatment with intravenous diazepam. Case presentation The case concerns a 22-year-old male admitted for pulmonary hypertension to an intensive care unit (ICU). Three days following admission, he developed a high fever that did not respond to antibiotics. The patient then developed rigidity, nocturnal agitation, decreased responsiveness, and somnolence. Without the use of bromocriptine (Novartis, Basel, Switzerland) or dantrolene (Par Pharmaceuticals, Chestnut Ridge, USA) discontinuation of neuroleptics combined with intravenous diazepam (Pfizer, NY, USA) led to a very rapid response and marked improvement in the case. Conclusions Early recognition and management of NMS and MC in a complex, gravely ill patient, may be accomplished in the ICU despite obfuscation of traditional signs and symptoms of the NMS and MC syndrome. Such interventions can have life-saving effects on patients in danger of fatal autonomic instability.
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Tormoehlen LM, Rusyniak DE. Neuroleptic malignant syndrome and serotonin syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:663-675. [PMID: 30459031 DOI: 10.1016/b978-0-444-64074-1.00039-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The clinical manifestation of drug-induced abnormalities in thermoregulation occurs across a variety of drug mechanisms. The aim of this chapter is to review two of the most common drug-induced hyperthermic states, serotonin syndrome and neuroleptic malignant syndrome. Clinical features, pathophysiology, and treatment strategies will be discussed, in addition to differentiating between these two syndromes and differentiating them from other hyperthermic or febrile syndromes. Our goal is to both review the current literature and to provide a practical guide to identification and treatment of these potentially life-threatening illnesses. The diagnostic and treatment recommendations made by us, and by other authors, are likely to change with a better understanding of the pathophysiology of these syndromes.
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Affiliation(s)
- Laura M Tormoehlen
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Emergency Medicine, Division of Medical Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Daniel E Rusyniak
- Department of Emergency Medicine, Division of Medical Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States.
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Electroconvulsive therapy in the intensive care unit for the treatment of catatonia: a case series and review of the literature. Gen Hosp Psychiatry 2016; 38:37-41. [PMID: 26589764 DOI: 10.1016/j.genhosppsych.2015.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/12/2015] [Accepted: 09/23/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Catatonia is an underdiagnosed syndrome that may occur in severely ill patients. The malignant subtype, consisting of motor symptoms, autonomic instability and fever, is associated with high mortality rates, though exact current mortality rates are unknown. This subtype requires a fast detection and treatment with high doses of a benzodiazepine or electroconvulsive therapy (ECT), preferably in an intensive care unit (ICU) setting. METHOD Case series and qualitative literature review. RESULTS This paper presents four patients admitted to the ICU of an academic hospital diagnosed with malignant catatonia. All patients received ECT after an ineffective trial of high-dose intravenous benzodiazepine treatment. The duration of ECT ranged from 6 to 23 treatments after which the catatonic features partially or fully remitted. In addition, we have reviewed the diagnostic challenges, neurobiology, possible causes, differential diagnosis and treatment options of catatonia, focusing on the treatment with ECT and the importance of detection and multidisciplinary collaboration. CONCLUSION Malignant catatonia is an underdiagnosed, potentially life-threatening syndrome that requires fast recognition and prompt treatment, preferably in an ICU setting.
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Javelot H, Michel B, Steiner R, Javelot T, Cottencin O. Zolpidem test and catatonia. J Clin Pharm Ther 2015; 40:699-701. [PMID: 26547135 DOI: 10.1111/jcpt.12330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE There is no consensus regarding treatment of catatonia and the main recent therapeutic progress has been the development of the zolpidem diagnostic and therapeutic test. We report on the use of this test in one of our patients. CASES SUMMARY Mr. S. suffered from a paranoid schizophrenia. Three episodes of catatonia are described to illustrate the effect of zolpidem in a patient for whom lorazepam was ineffective or inadequate. WHAT IS NEW AND CONCLUSION Zolpidem with appropriate testing appears to be a credible alternative to electroconvulsive therapy or increased lorazepam dosing and allows continuation of antipsychotic administration.
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Affiliation(s)
- H Javelot
- Clinical Pharmacy Service - Mental Health Establishment (EPSAN), Brumath, France
| | - B Michel
- Faculté de Pharmacie - Laboratoire HuManiS (EA 7308), Service Pharmacie - CHU de Strasbourg, Strasbourg, France
| | - R Steiner
- Service G06, Mental Health Establishment (EPSAN), Brumath, France
| | - T Javelot
- Equipe de Liaison et de Soins en Addictologie, Centre Hospitalier Saint Jean de Dieu, Lyon, France
| | - O Cottencin
- Department of Psychiatry and Addiction Medicine, Fontan 2 Hospital, University Hospital of Lille, University of Lille, CHU de Lille, Lille, France
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Wilson JE, Niu K, Nicolson SE, Levine SZ, Heckers S. The diagnostic criteria and structure of catatonia. Schizophr Res 2015; 164:256-62. [PMID: 25595653 DOI: 10.1016/j.schres.2014.12.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The classification of catatonia has fluctuated and underwent recent changes in DSM-5. The current study examines the prevalence of catatonia signs, estimates the utility of diagnostic features, identifies core catatonia signs, and explores their underlying structure. METHOD We screened 339 acutely ill medical and psychiatric patients with the Bush Francis Catatonia Rating Scale (BFCRS). We examined prevalence and severity of catatonia signs and compared BFCRS, DSM-IV and DSM-5 diagnoses. We used principal component analysis (PCA) to examine the factorial validity of catatonia and item response theory (IRT) to estimate each sign's utility and reliability. RESULTS Out of the 339 patients, 300 were diagnosed with catatonia using the BFCRS and 232 catatonia diagnoses were validated by the treating provider based on selection for treatment with benzodiazepines or electroconvulsive therapy. Of the 232 validated catatonia cases, 211 (91%) met DSM-IV criteria but only 170 (73%) met DSM-5 criteria for catatonia. Staring was the most prevalent catatonia sign. PCA identified three components, interpretable as "Increased, Abnormal and Decreased Psychomotor Activity," although 63% of the variance was unexplained. IRT showed that Excitement, Waxy Flexibility and Immobility/Stupor were the best indicators of each factor. The BFCRS had many redundant items and as a whole had low reliability at low severity of catatonia, but good reliability at moderate-high severity of catatonia. CONCLUSIONS The structure of catatonia remains to be discovered.
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Affiliation(s)
- Jo Ellen Wilson
- Department of Psychiatry, Vanderbilt University, Nashville, TN, USA.
| | - Kathy Niu
- Department of Psychiatry, Vanderbilt University, Nashville, TN, USA.
| | | | - Stephen Z Levine
- Department of Community Mental Health, University of Haifa, Israel.
| | - Stephan Heckers
- Department of Psychiatry, Vanderbilt University, Nashville, TN, USA.
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Jouali T, Boukatta B, Bechri B, Houari N, Bouazzaoui A, Sbai H, Kanjaa N. [A neuroleptic malignant syndrome complicated by subarachnoid hemorrhage and revealing cerebral vasculitis]. Pan Afr Med J 2014; 19:247. [PMID: 25852790 PMCID: PMC4382063 DOI: 10.11604/pamj.2014.19.247.5293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/14/2014] [Indexed: 12/01/2022] Open
Abstract
Le syndrome malin des neuroleptiques est une complication du traitement par les neuroleptiques. Son incidence est estimée à 0,02% dans la population générale. Le traitement reste symptomatique et repose essentiellement sur l'arrêt immédiat du traitement antérieur. Nous rapportons l'observation clinique d'une patiente de 26 ans, schizophrénique sous Chlorpromazine, se présentant aux urgences pour la prise en charge d'un syndrome malin des neuroleptiques compliqué d'une hémorragie méningée et révélant une vascularite cérébrale.
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Affiliation(s)
- Toufik Jouali
- Service de Réanimation Polyvalente A4, CHU Hassan II des Fès, Fès, Maroc
| | - Brahim Boukatta
- Service de Réanimation Polyvalente A4, CHU Hassan II des Fès, Fès, Maroc
| | - Brahim Bechri
- Service de Réanimation Polyvalente A4, CHU Hassan II des Fès, Fès, Maroc
| | - Nawfel Houari
- Service de Réanimation Polyvalente A4, CHU Hassan II des Fès, Fès, Maroc
| | | | - Hicham Sbai
- Service de Réanimation Polyvalente A4, CHU Hassan II des Fès, Fès, Maroc
| | - Nabil Kanjaa
- Service de Réanimation Polyvalente A4, CHU Hassan II des Fès, Fès, Maroc
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Abstract
Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Osvaldo Fustinoni
- INEBA Institute of Neurosciences, Buenos Aires, Argentina; Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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Catatonia, neuroleptic malignant syndrome, and cotard syndrome in a 22-year-old woman: a case report. Case Rep Psychiatry 2013; 2013:452646. [PMID: 24093068 PMCID: PMC3777205 DOI: 10.1155/2013/452646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 08/07/2013] [Indexed: 11/24/2022] Open
Abstract
The following case study describes a 22-year-old woman with depression and symptoms of psychosis who developed neuroleptic malignant syndrome after using Risperidone, thus requiring life support equipment and Bromocriptine, later recovering after seven days. From a psychiatric and neurological point of view, however, the persistence of catatonic syndrome and Cotard syndrome delusions was observed, based on assertions such as “I do not have a heart,” “my heart is not beating,” “I can not breathe,” “I am breaking apart,” “I have no head” (ideas of negation) and statements about the patient being responsible for the “death of the whole world” (ideas of enormity). Brain NMR revealed leukoencephalopathy, interpreted as scar lesions caused by perinatal neurological damage, after discarding other pathologies. The patient responded well to electroconvulsive therapy after 11 sessions. Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed.
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Häßler F, Reis O, Weirich S, Höppner J, Pohl B, Buchmann J. A Case of Catatonia in a 14-Year-Old Girl with Schizophrenia Treated with Electroconvulsive Therapy. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013; 41:69-74. [DOI: 10.1024/1422-4917/a000211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.
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Affiliation(s)
- Frank Häßler
- Clinic for Child and Adolescent Psychiatry, Neurology and Psychotherapy, University of Rostock, Germany
| | - Olaf Reis
- Clinic for Child and Adolescent Psychiatry, Neurology and Psychotherapy, University of Rostock, Germany
| | - Steffen Weirich
- Clinic for Child and Adolescent Psychiatry, Neurology and Psychotherapy, University of Rostock, Germany
| | | | - Birgit Pohl
- Clinic for Anaesthesiology, University of Rostock, Germany
| | - Johannes Buchmann
- Clinic for Child and Adolescent Psychiatry, Neurology and Psychotherapy, University of Rostock, Germany
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