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Zick JL, Wichser L. Idiopathic catatonic syndrome in a young male with no prior psychiatric history: a case report. J Med Case Rep 2023; 17:199. [PMID: 37138368 PMCID: PMC10155426 DOI: 10.1186/s13256-023-03903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Catatonia is a syndrome characterized by severe psychomotor disturbances such as hypomotility, bradykinesia, and unusual movements. The condition has been described in the context of a wide variety of primary disease processes, including psychotic and mood disorders and numerous general medical conditions. In the medical community, catatonia is misunderstood, under-recognized, and under-treated. There continues to be debate about whether catatonia is an independent syndrome or a secondary expression of other conditions. This is a unique case presentation, as there are few reports describing cases of isolated catatonic syndrome in the absence of any other psychiatric or medical condition. CASE PRESENTATION We present the case of a 20-year-old previously healthy Caucasian male whose initial presentation to psychiatric care was in the form of an acute catatonic syndrome dominated by mutism, blank staring, and poverty of movement. As the nature of the patient's symptoms precluded the collection of a complete psychiatric and medical history, we employed a broad differential diagnosis including catatonia due to another medical condition, catatonia as a specifier for a number of mental disorders, and catatonia not otherwise specified. CONCLUSIONS The presentation of an acute onset of psychomotor symptoms in the absence of a history of mental illness warrants extensive workup to rule out medical causes to ensure effective treatment of any underlying illness. Benzodiazepines are the first-line treatment for catatonic symptoms, and electroconvulsive therapy can be used to resolve symptoms in patients who do not respond to medical intervention.
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Affiliation(s)
- Jennifer L Zick
- Psychiatry Residency Program, University of Minnesota, Minneapolis, MN, 55455, USA.
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Lora Wichser
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, 55455, USA
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2
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Catatonia Due to General Medical Conditions in Psychiatric Patients: Implications for Clinical Practice. PSYCHIATRY INTERNATIONAL 2023. [DOI: 10.3390/psychiatryint4010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Catatonic syndrome is frequently observed over the course of severe mental disorders and general medical conditions, but when catatonia occurs in psychiatric patients with co-morbid medical or neurologic conditions, diagnosis and management may be challenging. Several medical conditions may cause catatonia in psychiatric patients, but some, such as brain injury, infections, hyponatremia and critical illness, may be most relevant in this population. Alongside appropriate etiologic treatment, benzodiazepines and electroconvulsive therapy in refractory cases are effective and safe, and may resolve catatonic syndrome rapidly. When newly-onset psychotic symptoms in catatonic patients with established psychotic disorders occur, delirium should be suspected and appropriately managed. An extensive clinical and laboratory diagnostic workup to determine the underlying etiology of catatonic syndrome should be carried out. In cases of acute multi-morbidity, the exact cause of catatonic syndrome in psychiatric patients may be unclear. It is recommended to avoid antipsychotic drugs in acutely catatonic patients, because they may exacerbate the catatonic symptoms. The akinetic type of catatonia should be differentiated from hypoactive delirium, as treatments for these syndromes differ substantially. When a psychiatric patient presents with symptomatology of both catatonia and delirium, treatment is particularly challenging.
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Johnson ET, Eraly SG, Aandi Subramaniyam B, Muliyala KP, Moirangthem S, Reddi VSK, Jain S. Complexities of cooccurrence of catatonia and autoimmune thyroiditis in bipolar disorder: A case series and selective review. Brain Behav Immun Health 2022; 22:100440. [PMID: 36118271 PMCID: PMC9475125 DOI: 10.1016/j.bbih.2022.100440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/15/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022] Open
Abstract
In recent years the neurobiological underpinnings of catatonia have been an emerging area of interest. Catatonia is frequently encountered in mood disorders, neurological disorders and systemic illnesses. Furthermore, the manifestation of catatonia in autoimmune disorders such as NMDA receptor antibody encephalitis and thyroiditis reinforces its neuropsychiatric nature. Irrespective of cause benzodiazepines and electroconvulsive therapy remain the standard treatments for catatonia, although a proportion fail to respond to the same. This report describes three women with pre-existing bipolar disorder presenting in catatonia. Interestingly in all three, while benzodiazepines and electroconvulsive therapy failed, a dramatic resolution of catatonia with corticosteroids was noted following the detection of Hashimoto's thyroiditis. Hashimoto's encephalopathy presenting as catatonia has been reported, but our patients' profile differed in having had an a priory diagnosis of bipolar disorder. Given that both catatonia and thyroid dysfunction are frequently encountered in bipolar disorder, Hashimoto's encephalopathy as a potential cause for this concurrent manifestation in bipolar disorder may be overlooked. Therefore, it is essential to suspect Hashimoto's encephalopathy when catatonia manifests in bipolar disorder. A timely evaluation would be prudent as they may fail to respond to standard treatments for catatonia but respond remarkably to corticosteroids, saving much time and angst. Recent evidence implicates immune system dysfunction, with neuroinflammation and peripheral immune dysregulation contributing to the pathophysiology of bipolar disorder as well as catatonia. Findings from this study reaffirm the role of immune system dysfunction common to the etiopathogenesis of all these disorders, highlighting the complex interplay between catatonia, thyroiditis and bipolar disorder. Catatonia is common in bipolar disorder and also noted in autoimmune disorders. Thyroiditis in bipolar disorder may be overlooked due to frequent occurrence of thyroid dysfunction. Catatonia in bipolar disorder may result from Hashimoto's encephalopathy. Hashimoto's related catatonia in bipolar disorder may poorly respond to standard treatment. Autoimmune thyroiditis and catatonia highlight the immune dysfunction hypothesis of bipolar disorder.
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Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges. Neurol Int 2021; 13:570-586. [PMID: 34842777 PMCID: PMC8628989 DOI: 10.3390/neurolint13040057] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/29/2022] Open
Abstract
Catatonia is a syndrome that has been associated with several mental illness disorders but that has also presented as a result of other medical conditions. Schizophrenia and other psychiatric disorders such as mania and depression are known to be associated with catatonia; however, several case reports have been published of certain medical conditions inducing catatonia, including hyponatremia, cerebral venous sinus thrombosis, and liver transplantation. Neuroleptic Malignant Syndrome and anti-NMDA receptor encephalitis are also prominent causes of catatonia. Patients taking benzodiazepines or clozapine are also at risk of developing catatonia following the withdrawal of these medications—it is speculated that the prolonged use of these medications increases gamma-aminobutyric acid (GABA) activity and that discontinuation may increase excitatory neurotransmission, leading to catatonia. The treatment of catatonia often involves the use of benzodiazepines, such as lorazepam, that can be used in combination therapy with antipsychotics. Definitive treatment may be found with electroconvulsive therapy (ECT). Aberrant neuronal activity in different motor pathways, defective neurotransmitter regulation, and impaired oligodendrocyte function have all been proposed as the pathophysiology behind catatonia. There are many clinical challenges that come with catatonia and, as early treatment is associated with better outcomes, it becomes imperative to understand these challenges. The purpose of this manuscript is to provide an overview of these challenges and to look at clinical studies regarding the pathophysiology, diagnosis, and treatment of as well as the complications and risk factors associated with catatonia.
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Peritogiannis V, Rizos DV. Catatonia Associated with Hyponatremia: Case Report and Brief Review of the Literature. Clin Pract Epidemiol Ment Health 2021; 17:26-30. [PMID: 34249136 PMCID: PMC8227445 DOI: 10.2174/1745017902117010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022]
Abstract
Background: Catatonia is a syndrome of altered motor behavior that is mostly associated with general medical, neurologic, mood and schizophrenia-spectrum disorders. The association of newly onset catatonic symptoms with hyponatremia has been rarely reported in the literature. Case Presentation: We present a rare case of a young female patient with schizophrenia, who presented with catatonic symptoms in the context of hyponatremia due to water intoxication. The symptoms were eliminated with the correction of hyponatremia. There are only a few reports of hyponatremia-associated catatonia in psychiatric and non-psychiatric patients. Sometimes, catatonic symptoms may co-occur with newly onset psychotic symptoms and confusion, suggesting delirium. In several cases, the catatonic symptoms responded to specific treatment with benzodiazepines or electroconvulsive therapy.
Conclusion:
Hyponatremia may induce catatonic symptoms in patients, regardless of underlying mental illness, but this phenomenon is even more relevant in patients with a psychotic or mood disorder, which may itself cause catatonic symptoms. It is important for clinicians not to attribute newly-onset catatonic symptoms to the underlying psychotic or mood disorder without measuring sodium serum levels. The measurement of sodium serum levels may guide treating psychiatrists to refer the patient for further investigation and appropriate treatment.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Dimitrios V Rizos
- Intensive Care Unit, "Hatzikosta" General Hospital, Ioannina, Greece
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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.
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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.
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Oldham MA. The Probability That Catatonia in the Hospital has a Medical Cause and the Relative Proportions of Its Causes: A Systematic Review. PSYCHOSOMATICS 2018; 59:333-340. [PMID: 29776679 DOI: 10.1016/j.psym.2018.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this review is to determine the probability that catatonia in the hospital has a secondary cause ("medical catatonia") and to calculate the relative proportions of these causes stratified by hospital setting. METHODS PRISMA systematic review of PubMed. RESULTS Eleven studies were included. Hospital-wide, 20% of catatonia was medical. In acute medical and surgical settings, medical catatonia comprised more than half of cases. At least 80% of older adults seen by consult psychiatry and critically ill patients had a medical cause. Two thirds of medical catatonia involved CNS-specific disease including encephalitis, neural injury, developmental disorders, structural brain pathology, or seizures. CONCLUSIONS Patients in acute medical and surgical settings with catatonia deserve a medical workup that prioritizes CNS etiologies.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry (M.A.O.), University of Rochester Medical Center, Rochester, NY.
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Das S, Srikanta MM, Thirthalli J. Severe extrapyramidal syndrome presenting as catatonia: A rare case report. Asian J Psychiatr 2018; 31:75-76. [PMID: 29447991 DOI: 10.1016/j.ajp.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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de Figueiredo NSV, Angst DBM, Lima Neto ADM, Machado MF, Rocha MSG, Brucki SMD. Catatonia, beyond a psychiatric syndrome. Dement Neuropsychol 2017; 11:209-212. [PMID: 29213514 PMCID: PMC5710691 DOI: 10.1590/1980-57642016dn11-020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although catatonia is a well-known psychiatric syndrome, there are many possible
systemic and neurological etiologies. The aim of this case report was to present
a case of a patient with cerebral venous sinus thrombosis and infarction in
which catatonia was the clinical manifestation of a possible nonconvulsive
status epilepticus. To our knowledge, only one such case has been reported in
the literature, which had a simplified diagnostic investigation. It is important
to correctly recognize the organic cause underlying catatonia in order to treat
the patient as soon as possible thereby improving outcome. Therefore, physicians
need to update their knowledge on catatonia, recognizing that it can be part of
a psychiatric or neurologic condition.
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Takács R, Asztalos M, Ungvari GS, Gazdag G. Catatonia in an inpatient gerontopsychiatric population. Psychiatry Res 2017; 255:215-218. [PMID: 28578181 DOI: 10.1016/j.psychres.2017.05.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/04/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023]
Abstract
There are limited data on the prevalence of catatonia in the elderly. The aim of this study was to determine the prevalence of catatonia in elderly patients (=/> 65 years) acutely admitted to the psychiatric unit of a general hospital. All patients aged 65 years and above admitted to a general hospital psychiatric unit over a 4-month period were screened for catatonia with the 14-item Bush-Francis Catatonia Screening Instrument (BFCSI). Patients with a minimum of 2 symptoms on the BFCSI were rated with the 23-item Bush-Francis Catatonia Rating Scale (BFCRS). Catatonia was simultaneously evaluated according to DSM-5 criteria. Clinical diagnoses were established using the validated Hungarian versions of the Structured Clinical Interview for DSM-IV Disorders, the Mini Mental State Examination and the Clock Drawing Test. Ninety-eight (28.1%) of the 342 patients admitted to the psychiatric unit during the study period were above 65 years of age; 11 (11.22%) and 6 (6.12%) patients were classified as having catatonia according to the BFCRS and DSM-5 criteria, respectively. The majority of the patients had catatonia due to a medical condition. A significant minority of gerontopsychiatric inpatients present with catatonia. Dementia was not a risk factor for catatonia.
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Affiliation(s)
- R Takács
- Centre for Psychiatry and Addiction Medicine, Szent István and Szent László Hospitals Budapest, Gyáli út 17-19, 1094 Budapest, Hungary; School of Doctoral Studies, Semmelweis University, Budapest, Hungary.
| | - M Asztalos
- School of Doctoral Studies, Semmelweis University, Budapest, Hungary.
| | - G S Ungvari
- University of Notre Dame, Australia/Marian Centre, 38 Henry Street, Fremantle, WA, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, 35 Stirling Highway Crawley, Perth, WA 6009, Australia.
| | - G Gazdag
- Centre for Psychiatry and Addiction Medicine, Szent István and Szent László Hospitals Budapest, Gyáli út 17-19, 1094 Budapest, Hungary; Department of Psychiatry and Psychotherapy, Semmelweis University Medical School, Balassa u 6, 1083 Budapest, Hungary.
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11
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Lin CC, Hung YY, Tsai MC, Huang TL. The Lorazepam and Diazepam Protocol for Catatonia Due to General Medical Condition and Substance in Liaison Psychiatry. PLoS One 2017; 12:e0170452. [PMID: 28114315 PMCID: PMC5256942 DOI: 10.1371/journal.pone.0170452] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 01/05/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The lorazepam-diazepam protocol had been proved to rapidly and effectively relieve catatonia in patients with schizophrenia or mood disorder. This study aims to investigate the efficacy of lorazepam-diazepam protocol in catatonia due to general medical conditions (GMC) and substance. METHOD Patients with catatonia that required psychiatric intervention in various settings of a medical center were included. The lorazepam-diazepam protocol had been used to treat the catatonia due to GMC or substance according to DSM-IV criteria. The treatment response had been assessed by two psychiatrists. RESULTS Eighteen (85.7%) of 21 catatonic patients due to GMC or substance became free of catatonia after the lorazepam-diazepam protocol. Five (23.8%) of the 21 patients had passed away with various causes of death and wide range of time periods after catatonia. CONCLUSION Our results showed that the lorazepam-diazepam protocol could rapidly and effectively relieve catatonia due to GMC and substance.
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Affiliation(s)
- Chin-Chuen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Yung Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chang Tsai
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tiao-Lai Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Lin CC, Hung YY, Tsai MC, Huang TL. Relapses and recurrences of catatonia: 30-case analysis and literature review. Compr Psychiatry 2016; 66:157-65. [PMID: 26995249 DOI: 10.1016/j.comppsych.2016.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/27/2015] [Accepted: 01/16/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Relieving catatonia helps identify the underlying etiology and its treatment. However, catatonia may reemerge after some time, but there are few data on the relapses and recurrences of catatonia. We aimed to investigate the characteristics of patients with relapses or recurrences of catatonia as well as the efficacy of the lorazepam-diazepam protocol on them. METHODS Patients with catatonia who had more than one episode of catatonia and were treated with the lorazepam-diazepam protocol were identified. Their medical charts were reviewed, and interview was conducted. RESULTS Thirty patients were identified. Nineteen (63.3%) were diagnosed with schizophrenia, five (16.7%) with major depressive disorder, two (6.7%) with bipolar disorder, and four (13.3%) with general medical conditions. In the 68 relapses and relapses the lorazepam-diazepam protocol was used, full response was reported in 54 (79.4%) of them. Twelve of 19 (63.2%) patients with schizophrenia were treated with clozapine. Twenty (66.7%) out of 30 patients were maintained on oral lorazepam by the time of discharge. Literature review showed similar prevalence of schizophrenia in patients with more than one episode of catatonia, and a wide variety of treatment options. CONCLUSION The lorazepam-diazepam protocol was mostly effective in managing relapses and recurrences of catatonia. Maintenance clozapine and oral lorazepam were beneficial in a significant number of patients.
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Affiliation(s)
- Chin-Chuen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Yung Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chang Tsai
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tiao-Lai Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Lalanne L, Meriot ME, Ruppert E, Zimmermann MA, Danion JM, Vidailhet P. Attempted infanticide and suicide inaugurating catatonia associated with Hashimoto's encephalopathy: a case report. BMC Psychiatry 2016; 16:13. [PMID: 26786766 PMCID: PMC4719733 DOI: 10.1186/s12888-016-0719-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/15/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Catatonia is a neuropsychiatric syndrome with motor and behavioural symptoms. Though usually occurring in patients with schizophrenia and mood disorders, this syndrome may also be associated with neurological diseases or general medical conditions. Few cases of catatonia associated with autoimmune disorders have been described. CASE PRESENTATION Here, we report the case of a 27-year-old woman diagnosed with Hashimoto's encephalitis (HE) who attempted suicide and infanticide by defenestration. As she presented risk factors for postpartum psychosis, she was treated principally with antipsychotics. Despite adequate treatment for psychosis, symptoms worsened and she developed catatonia. Complementary investigations showed elevated titres of anti-thyroglobulin and anti-thyroperoxidase antibodies (200 and 10 times, respectively, as compared to normal levels) and electroencephalography were suggestive of encephalopathy. In the presence of an otherwise unexplained neuropsychiatric condition, HE was suspected and oral prednisolone was introduced. Psychiatric symptoms improved dramatically within 72 h and the patient was still free of any symptom 3 years later. CONCLUSION Catatonia of organic aetiology should always be considered before a psychiatric aetiology especially in case of clinical worsening in spite of adequate psychotropic treatment. To our knowledge, this is the first description of catatonia associated with HE.
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Affiliation(s)
- Laurence Lalanne
- Department of Psychiatry, Fédération de Médecine Translationelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France. .,INSERM 1114, Fédération de Médecine Translationelle de Strasbourg, University Hospital of Strasbourg, Strasbourg, France. .,INSERM1114-Department of Psychiatry, University of Strasbourg- 1 place de l'hôpital, 67000, Strasbourg, France.
| | - Marie-Emmanuelle Meriot
- Department of Psychiatry, Fédération de Médecine Translationelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France.
| | - Elisabeth Ruppert
- Department of Neurology, Sleep and Electrophysiology Clinic, Fédération de Médecine Translationelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France. .,Institute for Cellular and Integrative Neurosciences, CNRS - UPR 3212, Fédération de Médecine Translationelle de Strasbourg (FMTS), 67084, Strasbourg, France.
| | - Marie-Agathe Zimmermann
- Department of Psychiatry, Fédération de Médecine Translationelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France.
| | - Jean-Marie Danion
- Department of Psychiatry, Fédération de Médecine Translationelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France. .,INSERM 1114, Fédération de Médecine Translationelle de Strasbourg, University Hospital of Strasbourg, Strasbourg, France.
| | - Pierre Vidailhet
- Department of Psychiatry, Fédération de Médecine Translationelle de Strasbourg (FMTS), University Hospital of Strasbourg, Strasbourg, France. .,INSERM 1114, Fédération de Médecine Translationelle de Strasbourg, University Hospital of Strasbourg, Strasbourg, France.
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Komatsu T, Nomura T, Takami H, Sakamoto S, Mizuno K, Sekii H, Hatta K, Sugita M. Catatonic Symptoms Appearing before Autonomic Symptoms Help Distinguish Neuroleptic Malignant Syndrome from Malignant Catatonia. Intern Med 2016; 55:2893-2897. [PMID: 27725556 PMCID: PMC5088557 DOI: 10.2169/internalmedicine.55.6613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 42-year-old Japanese woman with a 10-year history of schizophrenia was admitted due to a disturbance in consciousness that met the diagnostic criteria for both neuroleptic malignant syndrome (NMS) and malignant catatonia. Despite systemic supportive treatments, the catatonic symptoms preceding autonomic symptoms persisted. The symptoms improved after lorazepam administration, leading to a retrospective diagnosis of malignant catatonia. Catatonia is thought to be caused by a dysfunction of ganmma-aminobutyric acid type A receptors in the cortico-cortical networks of the frontal lobes, which causes hypoactivity of the dopaminergic transmission in the subcortical areas. Identifying the catatonic symptoms preceding autonomic symptoms could aid in distinguishing malignant catatonia from NMS.
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Affiliation(s)
- Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Japan
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Lin CC, Huang TL. Benzodiazepine treatment of catatonia. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The mechanisms of catatonia may involve the GABA system, dopamine system, glutamate/N-methyl-D-aspartate receptor system and brain-derived neurotrophic factor. In this article we will share our experiences in treating catatonia with benzodiazepines in Taiwan. We will look at catatonia and its association with anti-N-methyl-D-aspartate receptor encephalitis, and lastly, reports on predicting outcome of patients with catatonia will also be discussed.
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Affiliation(s)
- Chin-Chuen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tiao-Lai Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Oldham MA, Lee HB. Catatonia vis-à-vis delirium: the significance of recognizing catatonia in altered mental status. Gen Hosp Psychiatry 2015; 37:554-9. [PMID: 26162545 DOI: 10.1016/j.genhosppsych.2015.06.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 06/12/2015] [Accepted: 06/12/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Catatonia is seldom considered in evaluation of altered mental status (AMS) in medical settings. Furthermore, catatonia often meets delirium criteria due to incoherence, altered awareness and behavioral change. Catatonia may co-occur with or be preferentially diagnosed as delirium. METHODS We conducted a systematic literature review of MEDLINE, EMBASE and PsycINFO on the relationship between catatonia and delirium. We also juxtapose clinical features of these syndromes and outline a structured approach to catatonia evaluation and management in acute medical settings. RESULTS These syndromes share tremendous overlap: the historical catatonia-related terms "delirious mania" and "delirious depression" bespeak of literal confusion differentiating them. Only recently has evidence on their relationship progressed beyond case series and reports. Neurological conditions account for the majority of medical catatonia cases. CONCLUSIONS New-onset catatonia warrants a medical workup, and catatonic features in AMS may guide clinicians to a neurological condition (e.g., encephalitis, seizures or structural central nervous system disease). Lorazepam or electroconvulsive therapy (ECT) should be considered even in medical catatonia, and neuroleptics should be used with caution. Moreover, ECT may prove lifesaving in malignant catatonia. Further studies on the relationship between delirium and catatonia are warranted.
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Raffin M, Zugaj-Bensaou L, Bodeau N, Milhiet V, Laurent C, Cohen D, Consoli A. Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia. Eur Child Adolesc Psychiatry 2015; 24:441-9. [PMID: 25159089 DOI: 10.1007/s00787-014-0595-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/01/2014] [Indexed: 12/12/2022]
Abstract
We aimed to (1) describe the treatment used in a large sample of young inpatients with catatonia, (2) determine which factors were associated with improvement and (3) benzodiazepine (BZD) efficacy. From 1993 to 2011, 66 patients between the ages of 9 and 19 years were consecutively hospitalized for a catatonic syndrome. We prospectively collected sociodemographic, clinical and treatment data. In total, 51 (77%) patients underwent a BZD trial. BZDs were effective in 33 (65%) patients, who were associated with significantly fewer severe adverse events (p = 0.013) and resulted in fewer referrals for electroconvulsive therapy (ECT) (p = 0.037). Other treatments included ECT (N = 12, 18%); antipsychotic medications, mostly in combination; and treatment of an underlying medical condition, when possible. For 10 patients, four different trials were needed to achieve clinical improvement. When all treatments were combined, there was a better clinical response in acute-onset catatonia (p = 0.032). In contrast, the response was lower in boys (p = 0.044) and when posturing (p = 0.04) and mannerisms (p = 0.008) were present as catatonic symptoms. The treatment response was independent of the underlying psychiatric or systemic medical condition. As in adults, BZDs should be the first-line symptomatic treatment for catatonia in young patients, and ECT should be a second option. Additionally, the absence of an association between the response to treatment and the underlying psychiatric condition suggests that catatonia should be considered as a syndrome.
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Affiliation(s)
- Marie Raffin
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France,
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Rabello FDAPCJ, Luz DC, Figueiredo ECQD, Gaudêncio EDO, Coutinho LCQM, Azevedo WFD. Catatonia due to systemic lupus erythematosus. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives Discuss neuropsychiatric aspects and differential diagnosis of catatonic syndrome secondary to systemic lupus erythematosus (SLE) in a pediatric patient. Methods Single case report. Result A 13-year-old male, after two months diagnosed with SLE, started to present psychotic symptoms (behavioral changes, hallucinations and delusions) that evolved into intense catatonia. During hospitalization, neuroimaging, biochemical and serological tests for differential diagnosis with metabolic encephalopathy, neurological tumors and neuroinfections, among other tests, were performed. The possibility of neuroleptic malignant syndrome, steroid-induced psychosis and catatonia was also evaluated. A complete reversal of catatonia was achieved after using benzodiazepines in high doses, associated with immunosuppressive therapy for lupus, which speaks in favor of catatonia secondary to autoimmune encephalitis due to lupus. Conclusion Although catatonia rarely is the initial clinical presentation of SLE, the delay in recognizing the syndrome can be risky, having a negative impact on prognosis. Benzodiazepines have an important role in the catatonia resolution, especially when associated with parallel specific organic base cause treatment. The use of neuroleptics should be avoided for the duration of the catatonic syndrome as it may cause clinical deterioration.
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Lin CC, Huang TL. Lorazepam-diazepam protocol for catatonia in schizophrenia: a 21-case analysis. Compr Psychiatry 2013; 54:1210-4. [PMID: 23856388 DOI: 10.1016/j.comppsych.2013.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/06/2013] [Accepted: 06/09/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Catatonia is a unique clinical phenomenon characterized by concurrent motor, emotional, vegetative and behavioral signs. Benzodiazepines (BZD) and electroconvulsive therapy (ECT) can rapidly relieve catatonic signs. The lorazepam-diazepam protocol presented here has been proven to relieve catatonia in schizophrenia within a day. METHODS From July 2002 to August 2011, schizophrenic patients requiring psychiatric intervention for catatonia in Kaohsiung Chang Gung Memorial Hospital were studied by medical chart review. The study used the Bush-Francis Catatonia Rating Scale (BFCRS). Patients receiving the lorazepam-diazepam protocol were identified. RESULTS The survey included 21 patients (eight males and 13 females) with a mean age of 30.3 ± 12.6 years. Mean duration of schizophrenia was 4.7 ± 5.6 years. Thirteen (61.9%) patients responded within 2 h, 18 (85.7%) responded within one day, and all became catatonia-free within a week. Mean BFCRS score was 9.9 ± 3.0 before treatment. Patients that responded with a single intramuscular lorazepam injection had mean BFCRS score of 8.9 ± 2.8, significantly lower than the mean score (11.6 ± 2.5) of the rest of the patients (p = 0.034). CONCLUSIONS The lorazepam-diazepam protocol can rapidly relieve retarded catatonia in schizophrenia. Most patients became catatonia-free within one day but some may require up to a week. ECT should be considered if the protocol fails.
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Affiliation(s)
- Chin-Chuen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Hu HC, Chiu NM. Delayed Diagnosis in an Elderly Schizophrenic Patient with Catatonic State and Pulmonary Embolism. INT J GERONTOL 2013. [DOI: 10.1016/j.ijge.2012.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Sienaert P, Dhossche DM, Gazdag G. Adult catatonia: etiopathogenesis, diagnosis and treatment. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gross A, Altman M, Salvatore P, Baldessarini RJ, Chanoff M, Powers JP. An atypical, chronic psychotic disorder in a 55-year-old man. Harv Rev Psychiatry 2010; 17:329-43. [PMID: 19832047 DOI: 10.3109/10673220903299203] [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: 11/13/2022]
Affiliation(s)
- Anne Gross
- Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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Hung YY, Huang TL. Lorazepam and diazepam for relieving catatonic features in multiple sclerosis. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1537-8. [PMID: 17640789 DOI: 10.1016/j.pnpbp.2007.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 06/20/2007] [Accepted: 06/20/2007] [Indexed: 10/23/2022]
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Abstract
Neuropsychiatric disturbances are found in 50-70% of systemic lupus erythematosus (SLE) patients. However, there are rare cases of catatonia being described in SLE. Some studies have shown the effectiveness of high-dose steroid, plasma exchange and electroconvulsive therapy (ECT) in lupus catatonia. Herein are described two SLE patients with catatonia who had good response to i.v. diazepam (i.e. relief of catatonia symptoms). Patient 1, with mild cortical atrophy, had great improvement in catatonia symptoms on i.v. diazepam 150 mg during a period of 5 days. Patient 2, without cortical atrophy, had quick response to i.v. diazepam 10-20 mg. Both patients had no recurrence during 6-month follow up. In conclusion, benzodiazepines may play an important role in the treatment of catatonia associated with SLE if patients refuse ECT treatment.
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Affiliation(s)
- Hung-Yu Wang
- Department of Psychiatry, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Penland HR, Weder N, Tampi RR. The catatonic dilemma expanded. Ann Gen Psychiatry 2006; 5:14. [PMID: 16959040 PMCID: PMC1578553 DOI: 10.1186/1744-859x-5-14] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 09/07/2006] [Indexed: 02/20/2023] Open
Abstract
Catatonia is a common syndrome that was first described in the literature by Karl Kahlbaum in 1874. The literature is still developing and remains unclear on many issues, especially classification, diagnosis, and pathophysiology. Clinicians caring for psychiatric patients with catatonic syndromes continue to face many dilemmas in diagnosis and treatment. We discuss many of the common problems encountered in the care of a catatonic patient, and discuss each problem with a review of the literature. Focus is on practical aspects of classification, epidemiology, differential diagnosis, treatment, medical comorbidity, cognition, emotion, prognosis, and areas for future research in catatonic syndromes.
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Affiliation(s)
- Heath R Penland
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Natalie Weder
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rajesh R Tampi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Abstract
We have proved that a modified strategy (ie, lorazepam intramuscular injection [IMI] or diazepam intravenous drip [IVD] if lorazepam IMI fails) can rapidly relieve catatonic features in patients with schizophrenia. During a period of 3 years, we identified 7 major depressive patients with catatonic features in the emergency unit of a general hospital. The patients were treated with lorazepam IMI (dose, 2 mg/mL.per ampule) once or twice during the first 2 hours. If lorazepam IMI failed, diazepam IVD (dose, 10 mg/2 mL.per ampule) in 500 mL normal saline every 8 hours for 1 day would be administered. The total complete remission rate to lorazepam IMI within 2 hours was 6 (85.7%) per 7 patients, and the total complete remission rate to benzodiazepines (lorazepam IMI and diazepam IVD) within 1 day was 7 (100%) of all 7 patients. These results highly suggest that this modified strategy can also rapidly relieve catatonic features in major depression within 1 day and attain a high complete remission rate, even without electroconvulsive therapy.
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Affiliation(s)
- Yi-Yung Hung
- Department of Psychiatry, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Abstract
The uses of lorazepam and electroconvulsive therapy (ECT) have been proven to be effective in treating catatonia. In the present study a modified treatment strategy (i.e. lorazepam i.m. injection or diazepam infused i.v. if lorazepam failed, not with ECT) was proposed to rapidly relieve catatonic signs in patients with schizophrenia. During a 3-year period, 14 patients with catatonic schizophrenia in Chinese ethnic background Taiwanese were brought to the emergency unit of a general hospital. First, the patients were immediately treated with lorazepam 1 or 2 ampules (2 mg/mL per ampule) i.m. injection (IMI) during 2 h. Second, if the previous 2 ampules of lorazepam IMI failed, diazepam infused i.v. (10 mg/2 mL per ampule) in normal saline 500 mL every 8 h would be done during 1 day. The response rate of catatonic signs in these 14 patients with lorazepam IMI during the first 2 h was 85.7% (12/14). However, according to the results of this method, the total response rate to benzodiazepines during 1 day was 100%(14/14). These results suggested that this modified treatment strategy could rapidly and completely relieve catatonic signs, even without the use of ECT.
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Affiliation(s)
- Tiao-Lai Huang
- Department of Psychiatry, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
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Abstract
BACKGROUND Catatonic symptoms have been associated with mixed mania in the older psychiatric literature, however, to date no systematic studies have been performed to assess their frequency in these patients. METHOD Ninety-nine patients with bipolar disorder manic or mixed episode were assessed for the presence of catatonia. RESULTS Thirty-nine patients fulfilled criteria for mixed mania of whom 24 were catatonic. Among the patients with pure mania, only three were catatonic. Eighteen catatonic patients with mixed mania required admission to the acute care unit (ACU). LIMITATIONS Our findings only apply to severely ill patients with mixed mania who require ACU admission. Nevertheless, it is important to know, that the likelihood of overlooking catatonia in less severely ill patients with mixed mania is low and that it does not need to be routinely assessed on a general ward. CONCLUSIONS Catatonia is frequent in mania and linked to the mixed episode. Catatonia in mixed mania is likely to be found among the severely ill group of patients with mixed mania, who require emergency treatment.
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Affiliation(s)
- Stephanie Krüger
- Centre for Addiction and Mental Health, Clarke Institute of Psychiatry, Mood Disorders Program, University of Toronto, Toronto, Canada
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