1
|
Patel RS, Hobart K, Wadhawan A, Chalia A, Youssef NA. Electroconvulsive Treatment Utilization for Inpatient Management of Catatonia in Adolescents With Schizophrenia Spectrum Disorders. J ECT 2022; 38:244-248. [PMID: 35623014 DOI: 10.1097/yct.0000000000000858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine rates of electroconvulsive therapy (ECT) use for catatonia in schizophrenia spectrum disorders, stratified by patient demographics and hospital characteristics, and its impact on inpatient length of stay and cost. METHODS We found 155 adolescents (aged 12-18 years) with principal discharge diagnosis of schizophrenia spectrum disorders with catatonia from the National Inpatient Sample. They were subgrouped into ECT (n = 20) and non-ECT (n = 135) groups. We used descriptive statistics to evaluate the utilization of ECT for catatonia and independent-sample t test for continuous variables with statistical significance at P ≤ 0.05. RESULTS The overall utilization rate of ECT in adolescents for catatonia was 12.9%. A high rate of ECT use was evident for Whites (30.8%) compared with the other race/ethnicities and also was seen in private health insurance beneficiaries (20%). The rate of ECT use varied by the region, with highest for the Northeast (20%), followed by the South (18.2%), and the West (14.3%). Adolescent inpatients with catatonia in public and teaching type, and large bed-size hospitals were more likely to receive ECT than their counterparts. The mean number of ECT sessions required during the inpatient stay was 5.2 (range, 1-15), and the mean number of days from admission to initial ECT was 2.5 (range, 0-6). CONCLUSIONS Electroconvulsive therapy is used for approximately only 13% of adolescents with catatonia when comorbid schizophrenia spectrum disorders are present, suggesting that many patients may not get evidence-based treatment. Future studies in this area are needed.
Collapse
Affiliation(s)
- Rikinkumar S Patel
- From the Department of Psychiatry, Oklahoma State University, Norman, OK
| | - Kelsey Hobart
- Department of Psychiatry, Saint Elizabeths Hospital, Washington, DC
| | | | - Ankit Chalia
- Department of Psychiatry, West Virginia University, Martinsburg, WV
| | - Nagy A Youssef
- Department of Psychiatry, The Ohio State University College of Medicine, Columbus, OH
| |
Collapse
|
2
|
Silva Gadelho L, Gama Marques J. Catatonia associated with epileptic seizures: A systematic review of case reports. Epilepsy Res 2022; 186:107016. [PMID: 36116265 DOI: 10.1016/j.eplepsyres.2022.107016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/13/2022] [Accepted: 08/30/2022] [Indexed: 11/03/2022]
Abstract
The association of catatonia with epileptic seizures is a rare phenomenon that is poorly understood and needs more clinical research. This systematic review included all published case reports of patients with catatonia meeting ICD-11 criteria associated with epileptic seizures, published until December 2021 in PubMed. Case reports were synthesized and results were expressed as percentages. In total, 42 articles with 52 case reports were included. Most patients were adults with a dispersed age (mean age 44.9 ± 19.3), slightly more males (59.6 %), with psychiatric history (76.9 %) of affective disorders (26.9 %) or psychotic episodes (13.5 %) and/or neurological history (61.5 %) of epileptic seizures (38.5 %) or head trauma (13.5 %). Their clinical presentation consisted mostly of decreased psychomotor activity (mutism: 94.2 %; stupor: 78.8 %; staring: 57.7 %; negativism: 36.5 %) with some abnormal psychomotor activity (catalepsy: 40.4 %; rigidity: 40.4 %; waxy flexibility: 23.1 %; posturing: 21.2 %) and half had clinical epileptic seizures (51.9 %), mostly generalized tonic-clonic (23.1 %). Almost all electroencephalograms (97.9 %) and half of brain imaging exams (47.4 %) performed had abnormal findings. The epileptic activity was mainly generalized (50 %) and associated with primary epilepsy (30.8 %), iatrogenesis (23.1 %), other secondary aetiologies (25 %) or unknown causes (21.2 %). Most improved with antiepileptic therapy (87.5 %) and had a complete remission (86.5 %). Catatonia secondary to epileptic seizures often has a nonspecific clinical presentation and appears in patients with previous psychiatric diagnoses, so any patient with catatonia should be properly investigated to avoid misdiagnosis and ineffective treatments.
Collapse
Affiliation(s)
- Luís Silva Gadelho
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Consulta de Esquizofrenia Resistente, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal.
| |
Collapse
|
3
|
Hinotsu K, Miyaji C, Yada Y, Kawai H, Sakamoto S, Okahisa Y, Tsutsui K, Kanbayashi T, Tanaka K, Takao S, Kishi Y, Takaki M, Yamada N. The validity of atypical psychosis diagnostic criteria to detect anti-NMDA receptor encephalitis with psychiatric symptoms. Schizophr Res 2022; 248:292-299. [PMID: 36130472 DOI: 10.1016/j.schres.2022.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/06/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022]
Abstract
Anti-NMDAR encephalitis has a psychotic presentation that is difficult to distinguish from primary psychosis. An atypical psychosis that is similar to schizophrenia, mood disorder, and epilepsy is unique, and the original diagnostic criteria exist only in Japan. The clinical symptoms and courses of anti-NMDAR encephalitis and atypical psychosis are very similar. We investigated whether the diagnostic criteria of atypical psychosis are useful to increase the detection rate of anti-NMDAR encephalitis with psychiatric symptoms. The presence of anti-NR1/NR2B IgG antibodies in the cerebrospinal fluid of 218 newly admitted inpatients initially diagnosed with schizophrenia (n = 151), mood disorder (n = 47), or epilepsy with psychiatric symptoms (n = 20) was assessed by cell-based assay. Of 218 patients, 123 (36.3 years ± SD 17.2, 69.9 % females) fulfilled the diagnostic criteria of category B for atypical psychosis. All 12 patients (9.8 %, 12/123) with anti-NR1/NR2B IgG antibodies fulfilled category B of atypical psychosis statistically better than the patients without anti-NR1/NR2B IgG antibodies (P = 0.0009). Of the 12 patients with anti-NMDAR antibodies, two did not fulfill either criteria of catatonia (DSM-5) or Graus' diagnostic criteria of anti-NMDAR encephalitis during the time course, and 11 patients showed good prognosis with early immunotherapies. In ROC analysis, abnormal electroencephalogram findings showed the highest sensitivity (0.833) for detection of anti-NR1/NR2B IgG antibodies, and 31.3 % of patients with category B atypical psychosis and abnormal electroencephalogram findings had anti-NMDAR antibodies. Lumbar puncture and detection of anti-NMDAR antibodies should be considered for patients who fulfill atypical psychosis diagnosis criteria with an abnormal electroencephalogram.
Collapse
Affiliation(s)
- Kenji Hinotsu
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Chikara Miyaji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuji Yada
- Okayama Psychiatric Medical Center, Japan
| | - Hiroki Kawai
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Shinji Sakamoto
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuko Okahisa
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Ko Tsutsui
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Japan; Kato Hospital, Japan
| | - Takashi Kanbayashi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Japan; Ibaraki Prefectural Medical Center of Psychiatry, Kasama, Japan
| | - Keiko Tanaka
- Brain Research Institute, Niigata University Graduate School of Medicine, Japan
| | - Soshi Takao
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | | | - Manabu Takaki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| |
Collapse
|
4
|
Jaimes-Albornoz W, Ruiz de Pellon-Santamaria A, Nizama-Vía A, Isetta M, Albajar I, Serra-Mestres J. Catatonia in older adults: A systematic review. World J Psychiatry 2022; 12:348-367. [PMID: 35317341 PMCID: PMC8900590 DOI: 10.5498/wjp.v12.i2.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/27/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated, even though its classification has evolved in recent years. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. The underrecognition of catatonia in older patients is also frequent, and research in this population is scarce.
AIM To conduct a systematic review of the literature on catatonia in older people to ascertain its clinical characteristics across settings.
METHODS Following the PRISMA guidelines, MEDLINE, EMBASE, and PsycINFO databases were searched from inception to December 2021, with a strategy aimed at identifying all articles published on catatonia in older adults. Titles and abstracts were scanned and selected independently by two authors. Papers investigating issues related to catatonia and/or catatonic symptoms in older people, with English abstracts available, were included. References of selected articles were revised to identify other relevant studies.
RESULTS In total, 1355 articles were retrieved. After removing duplicates, 879 remained. Of the 879 identified abstracts, 669 were excluded because they did not meet the inclusion criteria. A total of 210 articles underwent full text review, and 51 were eliminated for various reasons. Fourteen more articles were selected from the references. Overall, 173 articles were reviewed: 108 case reports, 35 case series, 11 prospective cohort studies, 6 case-control studies, 3 retrospective cohort studies and 10 reviews. We found several particular aspects of catatonia in this population. Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. Older patients, compared to younger patients, have a higher risk of developing catatonia with benzodiazepine (BZD) withdrawal, in bipolar disorder, and in the general hospital. Age, together with other risk factors, was significantly associated with the incidence of deep venous thrombosis, neuroleptic malignant syndrome poor outcome, other complications and mortality. Treatment with BZDs and electroconvulsive therapy is safe and effective. Prompt treatment of its cause is essential to ensure a good prognosis.
CONCLUSION Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. The risk of developing catatonia in some settings and conditions, as well as of developing complications, is high in this population. Symptomatic treatment is safe and effective, and timely etiologic treatment is fundamental.
Collapse
Affiliation(s)
- Walter Jaimes-Albornoz
- Psychiatry Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Angel Ruiz de Pellon-Santamaria
- Psychiatry Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Ayar Nizama-Vía
- Psychiatry Service “Virgen del Cisne” Mental Health Community Center, Regional Health Directorate, Tumbes 24002, Peru
| | - Marco Isetta
- Library and Knowledge Services, Central & North West London NHS Foundation Trust, St Charles’ Hospital, London W10 6DZ, United Kingdom
| | - Ines Albajar
- Neurology Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Jordi Serra-Mestres
- Old Age Psychiatry Service, Cardinal Clinic, Windsor SL4 5UL, United Kingdom
| |
Collapse
|
5
|
Jaimes-Albornoz W, Ruiz de Pellon-Santamaria A, Nizama-Vía A, Isetta M, Albajar I, Serra-Mestres J. Catatonia in older adults: A systematic review. World J Psychiatry 2022; 12:359-381. [DOI: 10.5498/wjp.v12.i2.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
6
|
Ogyu K, Kurose S, Uchida H, Kanemoto K, Mimura M, Takeuchi H. Clinical features of catatonic non-convulsive status epilepticus: A systematic review of cases. J Psychosom Res 2021; 151:110660. [PMID: 34768095 DOI: 10.1016/j.jpsychores.2021.110660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/24/2021] [Accepted: 10/24/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Non-convulsive status epilepticus (NCSE) can manifest as catatonia, although it is unclear how frequently such cases have been reported. The common clinical features of these two conditions are also unclear. METHODS Using the MEDLINE and Embase databases, we performed a systematic literature search to identify cases diagnosed with both catatonia, according to the Bush-Francis Catatonia Rating Scale, and NCSE, according to the Salzburg Consensus Criteria (last search: March 29, 2021). We extracted data on demographics, clinical features of catatonia, EEG findings, and treatments. RESULTS A total of 66 patients with catatonic NSCE (men, 49%; mean age, 42.0 years) were identified from our search. Of the 66 cases described: 30 (46%) showed motor symptoms; 35 (38%) occurred in patients with preceding episodes of epileptic seizures; 19 (29%) showed subtle ictal clinical phenomena, such as minor twitching of the mouth, periorbital region, and extremities; 22 (33%) presented with psychiatric symptoms prior to the onset of catatonia; 17 (26%) had a history of psychiatric diseases; and in 10 cases (15%), NSCE was confirmed by intentional or non-intentional long-term EEG monitoring. Benzodiazepines were used as the initial treatment for NCSE in 30 cases (49%), of which 20 cases (73%) improved with monotherapy. DISCUSSION A substantial number of cases included in the present review involved catatonia without any symptoms indicative of epilepsy, suggesting that NCSE may be misdiagnosed as a psychiatric disease, and highlighting the importance of the accurate diagnosis and treatment of NCSE in patients presenting with catatonia.
Collapse
Affiliation(s)
- Kamiyu Ogyu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba 266-0007, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan; Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga 326-0843, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kousuke Kanemoto
- Department of Neuropsychiatry, Aichi Medical University, Nagakute 480-1103, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan.
| |
Collapse
|
7
|
Somani A, Sharma A, Goyal N, Gulia M. Catatonia associated with seizures due to parietal cavernoma. Indian J Psychiatry 2021; 63:309-311. [PMID: 34211233 PMCID: PMC8221205 DOI: 10.4103/psychiatry.indianjpsychiatry_268_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/12/2020] [Accepted: 10/23/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aditya Somani
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India. E-mail:
| | - Ashish Sharma
- Department of Psychiatry, Adesh Medical College and Hospital, Mohri, Kurukshetra, Haryana, India
| | - Nitin Goyal
- Department of Radiology, Adesh Medical College and Hospital, Mohri, Kurukshetra, Haryana, India
| | - Manish Gulia
- Department of Radiology, Adesh Medical College and Hospital, Mohri, Kurukshetra, Haryana, India
| |
Collapse
|
8
|
Volle DC, Marder KG, McKeon A, Brooks JO, Kruse JL. Non-Convulsive Status Epilepticus in the Presence of Catatonia: A Clinically Focused Review. Gen Hosp Psychiatry 2021; 68:25-34. [PMID: 33276270 PMCID: PMC8262079 DOI: 10.1016/j.genhosppsych.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Catatonia is classically associated with psychiatric conditions but may occur in medical and neurologic disorders. Status epilepticus (SE) is a seizure lasting more than five minutes or two or more seizures within a five-minute period without interictal recovery of consciousness. Non-convulsive status epilepticus (NCSE) is SE without prominent motor activity that may present with catatonic symptoms. The relevance of NCSE as a potential etiology for catatonia is not clear in the literature. METHODS A systematic review was completed to evaluate the literature on NCSE presenting with catatonia. PubMed and PsycInfo databases were searched and articles were reviewed for the presence of catatonia and NCSE. RESULTS 15 articles describing 27 cases meeting inclusion criteria were identified. The authors add 1 case to the literature. The most common catatonic symptoms identified in NCSE were mutism and stupor. Clinical features frequent in NCSE presenting with catatonia included new catatonic symptoms, age over 50 years, comorbid neurological conditions, or a change in medications that affect seizure threshold. A documented psychiatric history was also common and may contribute to delayed diagnosis. DISCUSSION/CONCLUSION It is important to consider NCSE in the differential diagnosis of new catatonic symptoms. A suggested approach to diagnostic evaluation is provided.
Collapse
Affiliation(s)
- Dax C. Volle
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA,Corresponding author at: 760 Westwood Plaza, Room 37-384, Los Angeles, CA 90024-1759, USA. (D.C. Volle)
| | - Katharine G. Marder
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Andrew McKeon
- Departments of Neurology, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - John O. Brooks
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jennifer L. Kruse
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| |
Collapse
|
9
|
Fu R, Yanfang C, Shaohua C. Case of catatonia misdiagnosed with coma. Gen Psychiatr 2020; 33:e100059. [PMID: 32090193 PMCID: PMC7003369 DOI: 10.1136/gpsych-2019-100059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/05/2019] [Accepted: 09/10/2019] [Indexed: 11/04/2022] Open
Abstract
Catatonia is a state of high-degree psychomotor inhibition in which patients often maintain a constant fixed posture, and generally have unconscious obstacles and various reflex preservation. Patients suffering from severe catatonia will become stiff. Catatonia generally manifests unconsciousness while various reflexes are preserved. Patients show reticence, no food or drink intake, and immobility as signs of complete suppression of speech and movement, and even incontinence. Patients are often first diagnosed in non-psychiatric departments and are more likely to be misdiagnosed as having ‘coma’ or ‘epilepsy’, thus delaying treatment. This article reports a case of a 19-year-old female patient who was misdiagnosed with ‘catatonia’. A month ago, she was admitted to a general hospital of our city because of “intermittent attacks of nausea, vomiting, stupor for 15 years, with one week of exacerbation”. During her hospitalisation, she suddenly appeared was mute, had no food or drink intake, and showed immobility and incontinence, presenting a ‘coma state’. She was transferred to a general hospital in Wuhan to further investigate the cause of her “coma”. After 7 days in the hospital, no abnormal examination results were found and the symptoms were not alleviated. Later, she was transferred to the mental health centre for hospitalisation in this city. The patient was diagnosed as having (1) ‘epileptic psychosis’ and (2) ‘catatonic stupor’. After 3 days of treatment, the patient's recovered consciousness. She was clinically cured and discharged half a month later. We hereby report this case.
Collapse
Affiliation(s)
- Rui Fu
- Department of Sleep Disorders, Hubei Jingmen Oral Hospital (Jingmen Mental Health Center), Hubei Province, China
| | - Chen Yanfang
- Department of Psychiatry, Shandong Mental Health Center, Shandong, China
| | - Cao Shaohua
- Department of Hemodialysis, Hubei Jingmen No. 1 Hospital, Hubei Province, China
| |
Collapse
|
10
|
Verbraeken R, Luykx JJ. Persistent catatonia following epileptic seizures: a case report and systematic literature search. BMC Psychiatry 2018; 18:350. [PMID: 30373550 PMCID: PMC6206662 DOI: 10.1186/s12888-018-1935-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/22/2018] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Catatonia is frequently associated with mood and psychotic disorders as well as with general medical conditions, especially with seizures. In the case of the latter, catatonia mostly resolves when the seizures respond to the anticonvulsive treatment. We report, to our knowledge, the first case of a patient without affective or psychotic disorder, who developed catatonia in the postictum and whose catatonia did not resolve with anticonvulsive treatment, but did so with lorazepam. CASE PRESENTATION We describe a 36-year-old man, with no psychiatric history, except for a possible disorder in the use of cannabis, who developed catatonia after epileptic seizures. The catatonia did not respond to the anticonvulsant therapy, but did so to lorazepam 17 mg/d. Lorazepam could be tapered slowly and stopped without reemergence of catatonic signs. CONCLUSION Catatonia should be part of the differential diagnosis in patients with bradyphrenia and/or remarkable postictal behavior. This report shows that lorazepam should be taken into consideration (before moving to ECT), in cases of unresolved catatonia, even if the seizures are reduced with anticonvulsants.
Collapse
Affiliation(s)
| | - Jurjen J Luykx
- Department Of Psychiatry, Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
- Department of Translational Neuroscience, Rudolf Magnus Institute of Neuroscience, Utrecht University, Utrecht, The Netherlands
- SymforaMeander Hospital, Amersfoort, The Netherlands
- Department of Psychiatry, ZNA Hospitals, Antwerp, Belgium
| |
Collapse
|
11
|
Abstract
Hyperammonemic encephalopathy secondary to the use of valproate is rare without evidence of hepatotoxicity, and it usually presents with confusion, agitation, irritability, cognitive disturbances, lethargy, coma, and death. We present the case of a 21-year-old woman presenting with catatonia as a manifestation of hyperammonemic encephalopathy that resolved with the normalization of ammonia and suspension of valproate.
Collapse
|
12
|
Serra-Mestres J, Jaimes-Albornoz W. Recognizing Catatonia in Medically Hospitalized Older Adults: Why It Matters. Geriatrics (Basel) 2018; 3:geriatrics3030037. [PMID: 31011075 PMCID: PMC6319219 DOI: 10.3390/geriatrics3030037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 12/14/2022] Open
Abstract
Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral, emotional, and autonomic abnormalities caused by general medical, neurological, and psychiatric disorders, as well as by medications and drugs of abuse. Although there has been a plethora of research on catatonia over the last twenty years, it is still underdiagnosed. Studies of catatonia involving older adults have been sparse, despite its apparent high prevalence, higher risk of serious complications, and of association with non-psychiatric causes. This paper aims to provide an introduction to catatonia as a syndrome, as well as an account of its specificities in older adults, especially those in general hospitals, with the aim to raise awareness of catatonia amongst clinicians working with this age group in acute medical settings, so improvements in its diagnostic rates, treatment, and outcomes can be achieved.
Collapse
Affiliation(s)
- Jordi Serra-Mestres
- Department of Old Age Psychiatry, Central and North West London NHS Foundation Trust, Woodland Centre, Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN, UK.
| | - Walter Jaimes-Albornoz
- Psychiatry Service, Hospital Universitario Donostia, Osakidetza-Basque Health Service, E-20014 San Sebastian, Spain.
| |
Collapse
|
13
|
Taylor JB, Stern TA. Meeting Its Mission: Does Psychosomatics Align With the Mission of Its Parent Organization, the Academy of Psychosomatic Medicine? PSYCHOSOMATICS 2017; 58:375-385. [PMID: 28449827 DOI: 10.1016/j.psym.2017.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The vision and mission statements of the Academy of Psychosomatic Medicine (APM) indicate that the APM should promote excellence in clinical care for patients with comorbid psychiatric and general medical conditions by seeking to influence research, public policy, and interdisciplinary education. OBJECTIVE As the APM owns the journal, Psychosomatics, we sought to assess whether the APM's journal was fulfilling the vision and mission of its parent organization by reviewing the content of articles published in the journal to determine whether it sufficiently addresses the various clinical care knowledge areas it seeks to influence. METHODS We categorized content in all review articles, case reports, and original research articles published in Psychosomatics in 2015 and 2016. Each article was assigned to as many categories that it covered. RESULTS In the 163 articles reviewed, the most frequently covered fund of knowledge area was psychiatric morbidity in medical populations (44.2%); among psychiatric disorders, mood disorders (22.1%), psychiatric disorders due to a general medical condition or toxic substance (21.5%), anxiety disorders (14.7%), and delirium (13.5) were the most frequently covered. Of the medical and surgical topics, neurology (19.6%), coping with chronic illness/psychological response to illness (17.8%), toxicology (11.7%), outpatient medicine (10.4%), and cardiology (9.8%) appeared most often. CONCLUSIONS Psychosomatics appears to be successfully providing content relevant to the APM's vision and mission statements and to practitioners of psychosomatic medicine.
Collapse
Affiliation(s)
- John B Taylor
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
| | - Theodore A Stern
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| |
Collapse
|