1
|
Luccarelli J, McCoy TH, York T, Baldwin I, Fricchione G, Fuchs C, Smith JR. The effectiveness of the lorazepam challenge test in pediatric catatonia: A multisite retrospective cohort study. Schizophr Res 2024; 270:410-415. [PMID: 38986388 PMCID: PMC11323129 DOI: 10.1016/j.schres.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Catatonia is a neuropsychiatric disorder associated with changes in behavior and affect. In adults, catatonia can respond rapidly to treatment with benzodiazepines as part of the "lorazepam challenge test." The acute effectiveness of benzodiazepine treatment in pediatric catatonia, however, has received less study. This study reports catatonia severity as measured by the Bush Francis Catatonia Rating Scale (BFCRS) in pediatric patients before and after treatment with lorazepam. METHODS Multicenter retrospective cohort study from 1/1/2018 to 6/1/2023 of patients aged 18 and younger with a clinical diagnosis of catatonia and assessment using the BFCRS before and after treatment with lorazepam. RESULTS Among 54 patients, median age was 16, and 26 (48.1 %) were female. Neurodevelopmental disabilities were present in 24 (44.4 %) of patients. Prior to treatment, patients had a mean BFCRS score of 16.6 ± 6.1, which significantly reduced to 9.5 ± 5.3 following treatment with lorazepam (mean paired difference 7.1; t = 9.0, df = 53, p < 0.001), representing a large effect size (Hedges's g = 1.20; 95 % CI: 0.85 to 1.55). No significant association was found between lorazepam dose or route of administration and clinical response, nor were age, sex, study site, the presence of a neurodevelopmental disorder, the presence of hyperactive catatonic features, or the time between treatment and reassessment associated with post-treatment BFCRS. CONCLUSIONS Lorazepam resulted in a rapid improvement in BFCRS score in pediatric patients, with a large effect size. Further research is needed into optimal dosing and route of administration of the lorazepam challenge test in pediatric patients.
Collapse
Affiliation(s)
- James Luccarelli
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Thomas H McCoy
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN 37212, USA
| | - Gregory Fricchione
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA; Vanderbilt Kennedy Center, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA; Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN 37212, USA
| |
Collapse
|
2
|
Kristiansen K, Vernal DL, Hulgaard DR. Expanding the phenotype of NEDAMSS with a psychiatric perspective: analysis of a new case, and a systematic review of the literature. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02522-7. [PMID: 39031186 DOI: 10.1007/s00787-024-02522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
Pathogenic variants in the IRF2BPL gene are associated with neurodevelopmental disorders with varying degrees of regression, loss of speech and epilepsy. The phenotype is also known as Neurodevelopmental Disorder with regression, Abnormal Movements, loss of Speech, and Seizures (NEDAMSS). The motor symptoms of this disorder share significant phenotypical characteristics with catatonia, a severe neuropsychiatric psychomotor syndrome. The objective of this article is to expand the knowledge on the presentation of NEDAMSS with a focus on psychiatric symptoms including catatonia. A systematic review of 32 case presentations of NEDAMSS, and a novel case report of a patient with NEDAMSS, exhibiting multiple psychiatric symptoms, including catatonia are presented. Psychiatric symptoms and disorders including affective disorders, psychotic symptoms, catatonia, and developmental disorders are reported in one third of the reviewed cases. Reported effects of pharmacological treatment on motor symptoms of NEDAMSS are very limited. Our case presents improvement in motor symptoms originally attributed to NEDAMSS, after treatment with Lorazepam following diagnosis with catatonia. Patients with NEDAMSS may present with both neurological and psychiatric symptoms. The clinical presentation of NEDAMSS motor symptoms and catatonia have similarities and thus poses significant challenges to the diagnostic process, with risk of incorrect or delayed treatment. The limited experience and the complex phenotype of NEDAMSS complicates pharmacological treatment and encourages caution, especially with the use of antipsychotic drugs in the presence of possible catatonic symptoms.
Collapse
Affiliation(s)
- Kimmie Kristiansen
- Mental Health Services in the Region of Southern Denmark, Child- and Adolescent Psychiatry, Esbjerg, Denmark.
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ditte Roth Hulgaard
- Mental Health Services in the Region of Southern Denmark, Child- and Adolescent Psychiatry, Esbjerg, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Children and Youth department, Lillebaelt Hospital, Kolding, Danmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Phiri P, Delanerolle G, Hope O, Murugaiyan T, Dimba G, Rathod S, Zingela Z. Catatonia: A deep dive into its unfathomable depths. World J Psychiatry 2024; 14:210-214. [PMID: 38464767 PMCID: PMC10921292 DOI: 10.5498/wjp.v14.i2.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024] Open
Abstract
This editorial addresses catatonia, a complex neuropsychiatric syndrome characterised by a spectrum of psychomotor disturbances. The editorial seeks to clarify the ambiguous aspects of catatonia, integrating recent research findings, including global studies and diagnostic advancements. It discusses catatonia's clinical manifestations, prevalence, and associated psychiatric and medical conditions, with particular emphasis on its frequent co-occurrence with schizophrenia and mood disorders. The prevalence of catatonia, which varies across psychiatric populations, is illustrated by a significant study conducted in Nelson Mandela Bay, South Africa. This study provides valuable insights into the effectiveness of the Bush-Francis Screening Instrument compared to the Diagnostic and Statistical Manual 5 criteria in diagnosing catatonia. The editorial evaluates treatment approaches, primarily focusing on benzodiazepines and electroconvulsive therapy, and discusses emerging therapeutic strategies. It underscores the importance of robust diagnostic frameworks and early intervention in managing catatonia, as recommended by the latest evidence-based consensus guideline. Furthermore, it suggests future research directions, particularly in exploring the neurobiological and genetic factors of catatonia, to enhance our understanding and improve treatment outcomes. This editorial succinctly aims to demystify catatonia and provide valuable insights for clinicians and researchers in mental health care.
Collapse
Affiliation(s)
- Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, Hampshire, United Kingdom
| | - Gayathri Delanerolle
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Oliver Hope
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Tharangini Murugaiyan
- Acute Inpatients Services, Southern Health NHS Foundation Trust, Basingstoke RG24 9RH, United Kingdom
| | - Geoffrey Dimba
- Home Treatment Team, South West, Surrey and Borders Partnerships NHS Foundation Trust, Guildford GU2 7XL, Surrey, United Kingdom
| | - Shanaya Rathod
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Zukiswa Zingela
- Faculty of Health Sciences, Nelson Mandela University, Summerstrand 6001, Gqeberha, South Africa
| |
Collapse
|
4
|
Breit S, Meyer A, Schmitt W, Bracht T, Walther S. The Effect of Electroconvulsive Therapy on Specific Catatonia Symptoms and Predictors of Late Response. PHARMACOPSYCHIATRY 2024; 57:13-20. [PMID: 37995719 DOI: 10.1055/a-2195-1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is known to be effective in the treatment of catatonia, reaching response rates of about 80 to 100%. It is indicated in cases of treatment resistance to benzodiazepines and in life-threatening conditions such as malignant catatonia. Beneficial effects on specific symptoms or predictors of response are less clear. The objective of this retrospective study is to examine the ECT effect on specific catatonia symptoms in the acute phase of the illness and to identify predictors of response. METHODS A retrospective study examined data from 20 patients with catatonia, 18 associated with schizophrenia and 2 with bipolar disorder, who underwent ECT from 2008 to 2021. Ten subjects had more than one ECT-series, resulting in a total of 31 ECT-series. Catatonia symptom severity was assessed with the Bush Francis Catatonia Rating Scale (BFCRS). RESULTS ECT yielded excellent response. Nineteen of 20 patients and 30 of 31 ECT-series achieved response. The mean number of ECT sessions to response was 4.2. Response to ECT was more pronounced for motor inhibition symptoms such as stupor and mutism, while echophenomena, dyskinesia, stereotypy and perseveration responded less well. A predictor of late response was the presence of grasp reflex. DISCUSSION The present study corroborates the high and rapid effectiveness of ECT in the treatment of catatonia. Focus on single catatonia signs may help to identify those who are most likely to achieve remission quickly, as well as those who might need longer ECT-series.
Collapse
Affiliation(s)
- Sigrid Breit
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Agnes Meyer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wolfgang Schmitt
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Bracht
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
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.
Collapse
|
6
|
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
|
7
|
Zingela Z, Stroud L, Cronje J, Fink M, van Wyk S. The psychological and subjective experience of catatonia: a qualitative study. BMC Psychol 2022; 10:173. [PMID: 35841077 PMCID: PMC9287913 DOI: 10.1186/s40359-022-00885-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Catatonia is a severe psychomotor disorder that presents as abnormality of movement which may also be excessive or severely slowed. It often inhibits communication when protracted or severe. In this study we investigated the emotive and cognitive experience of patients with catatonia during a prevalence study in an acute mental health unit from August 2020 to September 2021. The value of this study is the addition of the inner and often unexplored cognitive and emotive experience of patients in the description of the catatonic state, which lends an additional dimension to complement the medical and psychopathological descriptors that have been the focus of most studies on catatonia. Methods Ethical approval was received from the Nelson Mandela University Human Research Committee and convenience sampling was undertaken to recruit participants admitted into an acute mental health unit with catatonia, four to eight weeks after discharge, following admission. The BFCSI and BFCRS and a pre-designed data collection sheet were used to assess n = 241 participants, and collect data on descriptions of thoughts, feelings, and behaviours they experienced during the catatonic episode. Results Forty-four (18.3%) of the total 241 participants who were assessed had catatonia. Thirty (68.2%) of the 44 participants with catatonia provided data on their experience of catatonia. Twenty-three were males (76.7% of 30) and seven were females (23.3% of 30). All were within the age range of 17 to 65 years. The dominant themes of thoughts, feelings, and behaviors described centered around yearning for or missing loved ones, heightened fear, intense anxiety, negative affect, aggression, obedience, and withdrawal. Conclusions The common themes that emerged from this study were overwhelming anxiety, fear, and depression. These were found to occur frequently in patients with catatonia when describing their psychological experience. These experiences may possibly relate to the flight, fight, freeze and fawn response, as described in prior studies on the subjective experience of catatonia. Trial registration: Not applicable.
Collapse
Affiliation(s)
- Zukiswa Zingela
- Executive Dean's Office, Nelson Mandela University, Gqeberha, South Africa.
| | - Louise Stroud
- Department of Psychology, Nelson Mandela University, Gqeberha, South Africa
| | - Johan Cronje
- Department of Psychology, Nelson Mandela University, Gqeberha, South Africa
| | - Max Fink
- Department of Psychiatry, Stony Brook University, New York, USA
| | - Stephan van Wyk
- Department of Psychiatry and Human Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa
| |
Collapse
|
8
|
Zingela Z, Stroud L, Cronje J, Fink M, van Wyk S. Management and outcomes of catatonia: A prospective study in urban South Africa. SAGE Open Med 2022; 10:20503121221105579. [PMID: 35756352 PMCID: PMC9218450 DOI: 10.1177/20503121221105579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Rapid intervention for catatonia with benzodiazepines and electroconvulsive therapy can prevent fatal complications. We describe the management and treatment response of 44 patients with catatonia in a psychiatric unit in urban South Africa. The objective was to screen admissions for catatonia and investigate management, treatment response, and treatment outcomes. Method We used a prospective, descriptive, observational study design and collected data using a data collection sheet, the Bush Francis Catatonia Screening Instrument, the Bush Francis Catatonia Rating Scale, and the Diagnostic Statistical Manual-5 to assess catatonia in new admissions from September 2020 to August 2021. Results Of the 241 participants screened on admission, 44 (18.3% of 241) screened positive for catatonia on the Bush Francis Catatonia Screening Instrument, while 197 (81.7% of 241) did not. Thirty-eight (86.4% of 44) received lorazepam, seven (15.9%) received clonazepam, and two (4.6%) received diazepam, implying that three (6.8%) of the 44 participants with catatonia received more than one benzodiazepine sequentially. Ten (22.7% of 44) patients received electroconvulsive therapy. Seven of those treated with electroconvulsive therapy (15.9% of 44 and 70% of 10) responded well and were discharged, whereas 22 (50% of 44 and 64.7% of 34) of those given lorazepam were discharged. Patients treated with electroconvulsive therapy had a higher initial Bush Francis Catatonia Rating Scale score. One patient (2.3%) relapsed within 4 weeks of discharge. Twenty (45.5%) of the 44 patients with catatonia had low average iron levels, 14 (31.8%) had low vitamin B12, and 24 (54.6%) had high creatinine kinase. Conclusion Both lorazepam and electroconvulsive therapy were found to be effective treatments for catatonia with good response and outcomes. The length of hospital stay of patients with catatonia was similar to that of patients without catatonia. Treatment guidelines for catatonia need to include the role and timing of electroconvulsive therapy to augment current treatment protocols for the use of lorazepam.
Collapse
Affiliation(s)
- Zukiswa Zingela
- Executive Dean’s Office, Nelson Mandela University, Gqeberha, South Africa
| | - Louise Stroud
- Department of Psychology, Nelson Mandela University, Gqeberha, South Africa
| | - Johan Cronje
- Department of Psychology, Nelson Mandela University, Gqeberha, South Africa
| | - Max Fink
- Stony Brook University, Stony Brook, NY, USA
| | - Stephan van Wyk
- Department of Psychiatry and Human Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa
- Nelson Mandela Academic Hospital, Mthatha, South Africa
| |
Collapse
|
9
|
Dawkins E, Cruden-Smith L, Carter B, Amad A, Zandi MS, Lewis G, David AS, Rogers JP. Catatonia Psychopathology and Phenomenology in a Large Dataset. Front Psychiatry 2022; 13:886662. [PMID: 35677876 PMCID: PMC9168075 DOI: 10.3389/fpsyt.2022.886662] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received little attention. This study aimed to use a large dataset to describe the clinical signs of catatonia; to assess whether these signs are associated with underlying diagnosis and prognosis; and to describe the phenomenology of catatonia, particularly with reference to fear. Methods A retrospective descriptive cross-sectional study was conducted using the electronic healthcare records of a large secondary mental health trust in London, United Kingdom. Patients with catatonia were identified in a previous study by screening records using natural language processing followed by manual validation. The presence of items of the Bush-Francis Catatonia Screening Instrument was coded by the investigators. The presence of psychomotor alternation was assessed by examining the frequency of stupor and excitement in the same episode. A cluster analysis and principal component analysis were conducted on catatonic signs. Principal components were tested for their associations with demographic and clinical variables. Where text was available on the phenomenology of catatonia, this was coded by two authors in an iterative process to develop a classification of the subjective experience of catatonia. Results Searching healthcare records provided 1,456 validated diagnoses of catatonia across a wide range of demographic groups, diagnoses and treatment settings. The median number of catatonic signs was 3 (IQR 2-5) and the most commonly reported signs were mutism, immobility/stupor and withdrawal. Stupor was present in 925 patients, of whom 105 (11.4%) also exhibited excitement. Out of 196 patients with excitement, 105 (53.6%) also had immobility/stupor. Cluster analysis produced two clusters consisting of negative and positive clinical features. From principal component analysis, three components were derived, which may be termed parakinetic, hypokinetic and withdrawal. The parakinetic component was associated with women, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders. 68 patients had phenomenological data, including 49 contemporaneous and 24 retrospective accounts. 35% of these expressed fear, but a majority (72%) gave a meaningful narrative explanation for the catatonia, which consisted of hallucinations, delusions of several different types and apparently non-psychotic rationales. Conclusion The clinical signs of catatonia can be considered as parakinetic, hypokinetic and withdrawal components. These components are associated with diagnostic and prognostic variables. Fear appears in a large minority of patients with catatonia, but narrative explanations are varied and possibly more common.
Collapse
Affiliation(s)
- Eleanor Dawkins
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Ben Carter
- Department of Biostatistics and Health Informatics, King’s College London, London, United Kingdom
| | - Ali Amad
- Department of Neuroimaging, King’s College London, London, United Kingdom
- University of Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, Lille, France
| | - Michael S. Zandi
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Anthony S. David
- Institute of Mental Health, University College London, London, United Kingdom
| | - Jonathan P. Rogers
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Division of Psychiatry, University College London, London, United Kingdom
| |
Collapse
|
10
|
Zingela Z, Stroud L, Cronje J, Fink M, Van Wyk S. A prospective descriptive study on prevalence of catatonia and correlates in an acute mental health unit in Nelson Mandela Bay, South Africa. PLoS One 2022; 17:e0264944. [PMID: 35259194 PMCID: PMC8903294 DOI: 10.1371/journal.pone.0264944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/20/2022] [Indexed: 12/29/2022] Open
Abstract
Catatonia is a psychomotor abnormality caused by neurological, medical or severe psychiatric disorders and substances. Its prevalence ranges from less than 10% to just above 60%. Diagnosis may be influenced by the screening tools used. Screening of new admissions to a mental health unit for catatonia was undertaken using three instruments to determine prevalence of catatonia. Participants ranged from age 16 years and over. Recruitment took place from September 2020 to August 2021. The setting was a mental health unit within a general hospital in Nelson Mandela Metro, South Africa. Five assessors were trained by the principal investigator to apply the Bush Francis Screening Instrument (BFCSI), the Bush Francis Catatonia Rating Scale (BFCRS), and the Diagnostic and Statistical Manual 5 (DSM-5), to assess participants. Clinical and demographic data were collected using a specially designed datasheet. Data analysis was performed to identify significant associations between presence or absence of catatonia and clinical and demographic data. Up to 241 participants were screened and 44 (18.3%) had catatonia. All 44 cases were identified through the BFCSI while the DSM-5 identified only 16 (6.6%%) of the 44 cases even though the remaining 28 (63.6%) participants still required treatment for catatonic symptoms. The DSM-5 diagnostic criteria excluded staring, which was the commonest sign of catatonia identified through the BFCSI [n = 33 (75%)]. Close to half (21; 47.7%) of those with catatonia on the BFCSI had schizophrenia. The rest had bipolar disorder (12; 27.3%), substance-induced psychotic disorder (7; 15.9%) and no specified diagnosis in one (1; 2.6%). The BFCSI was very effective at identifying catatonia while the DSM-5 was inadequate, missing close to 64% (28 of 44) of cases. Predictors of catatonia in this sample were a younger age and being male. A prevalence of 18.3%, indicates that assessment for catatonia should be routinely conducted in this and similar settings.
Collapse
Affiliation(s)
| | | | - Johan Cronje
- Nelson Mandela University, Gqeberha, South Africa
| | - Max Fink
- Stony Brook University, New York, NY, United States of America
| | - Stephan Van Wyk
- Department of Psychiatry and Human Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa
- Nelson Mandela Academic Hospital, Mthatha, South Africa
| |
Collapse
|