Methamphetamine-associated catatonia: Case series and systematic review of the literature from 1943-2020

BACKGROUND

Catatonia due to a general medical condition may result from a variety of causes, including substance intoxication and withdrawal. Stimulants are occasionally associated with catatonia, though there has been little investigation of methamphetamine's relationship to catatonia. Here we present 5 cases of catatonia associated with methamphetamine use and a systematic review of the associated literature from 1943 to 2020.

METHODS

We performed a systematic review of the literature and present 5 cases of catatonia evaluated using the Bush-Francis Catatonia Rating Scale and KANNER catatonia rating scale.

RESULTS

Methamphetamine use was associated with catatonia in a small number of cases in the literature. However, some of these reports included other possible etiologies. The patients in our case series met DSM-5 criteria for catatonia due to a general medical condition, with all reporting recent methamphetamine use and testing positive for amphetamines on urine drug screen.

CONCLUSIONS

Given the ongoing rise in methamphetamine use in the United States, it is important that clinicians understand that methamphetamine use can be associated with catatonia. Patients with methamphetamine-associated catatonia may respond favorably to lorazepam and require shorter hospital stays than other catatonic patients. Lastly, methamphetamine-associated catatonia highlights how alteration in dopamine function and projections may be a critical neural mechanism underlying catatonia in general.

Incontinence as a catatonic sign

BACKGROUND

Incontinence (urinary or fecal) is not included in DSM-5 criteria for catatonia or in most catatonia rating scales. However, there is a historical basis for the inclusion or consideration of incontinence as a catatonic sign.

METHODS

We performed a review of the literature and found references to urinary disturbances and fecal incontinence in 19th- and 20th-century literature. We did a computerized literature review using the terms "catatonia," "catatonic," and "incontinence."

RESULTS

We highlight 2 cases in which urinary or fecal incontinence was a presenting or predominant feature of catatonia. Clinical improvement was associated with improvement in incontinence.

CONCLUSIONS

These preliminary findings suggest that urinary and fecal incontinence may be an uncommon presentation of catatonia. Furthermore, incontinence may improve at the same time catatonia improves with treatment. The neural circuitry that controls micturition and the sphincter involves neural pathways and multiple neurotransmitters. Catatonia can cause a reemergence of involuntary or reflex maturation, leading to urinary incontinence. This may lead to the need for additional custodial care for patients. Thus, the detection and monitoring of urinary and fecal incontinence may help us better understand the pathophysiology and impairment associated with catatonia.

Review of antidepressants in the treatment of behavioral and psychiatric symptoms in dementia (BPSD)

Behavioral disturbances are commonplace among patients with dementia. Management of these symptoms has proved difficult.1,2 Currently, there are no FDA approved pharmacologic treatments for the treatment of BPSD.3 Traditionally, atypical antipsychotics have been used to treat behavioral disturbances despite modest efficacy and undesirable adverse effects.34,5 Because of the increase in mortality, there is a continued push to reduce antipsychotic utilization in this population.9,10 Thus, many clinicians are using alternative agents such as antidepressants and mood stabilizers to help treat BPSD, while avoiding using antipsychotics. The goal of this review is to review, analyze, and discuss the current literature available on the use of antidepressants to treat BPSD.