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Current Psychiatry Research and Reviews

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ISSN (Print): 2666-0822
ISSN (Online): 2666-0830

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Research Article

Clinical Presentation and Short Term Treatment Response in Catatonia: An Observational Study

Author(s): Kunal Surjan, Shivali Aggarwal, Mohit Sharma, Vishal Dhiman and Vijender Singh*

Volume 16, Issue 4, 2020

Page: [257 - 266] Pages: 10

DOI: 10.2174/2666082216999201209125637

Price: $65

Abstract

Background: Clinical features and treatment response in catatonia is unpredictable and needs to be studied further.

Objective: The aim of this research is to study clinical presentations of catatonia and its response to various modalities of treatment.

Methods: This study recruited 50 patients in the age group of 15-65 years, with a diagnosis of catatonia as per DSM 5 criteria, selected by a stepwise process of sample selection. Patients with significant medical or surgical illness warranting immediate intervention were excluded. A detailed history and clinical information was obtained following informed consent from patient’s caregivers and other significant relatives. Rating on the severity of symptoms as well as treatment response was done using the Bush-Francis Catatonia Rating Scale (BFCRS) on 1st, 3rd, 7th, and 14th day of admission. Modified Electro-Convulsive Therapy (MECT) was administered to patients who had an inadequate response to intravenous lorazepam.

Results: It was found that 32 (64%) patients had a psychotic disorder, and 18 (36%) patients had mood disorders as an underlying diagnosis in catatonic presentation. Mutism was the most common catatonic sign-on rating with BFCRS, found in 50 (100%) of the patients. Complete resolution of catatonia was observed in 26 (52%) of patients following the use of intravenous lorazepam, while 24 (48%) required MECT. Patients with a diagnosis of schizophrenia required higher doses of intravenous lorazepam (p=0.001) and showed a lesser response to intravenous lorazepam compared to patients with diagnoses of mood disorders and other psychotic disorders.

Conclusion: Most common diagnosis in patients of catatonia was found to be psychotic disorder. Retarded signs of catatonia were found to be the commonest presentation. MECT was required to achieve resolution of catatonic symptoms in around half (48%) of the cases. The patients with diagnoses of schizophrenia required higher doses and also showed a lesser response to intravenous lorazepam, hence MECT was required in a higher proportion of such cases.

Keywords: Catatonia, schizophrenia, electro convulsive therapy, intravenous lorazepam, mood disorders, mutism, staring.

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[1]
Achte KA. The course of schizophrenic and schizophreni-form psychoses. A comparative study of changes in disease pictures, prognoses and the patient-physician relationship during the years 1933-1935 and 1953-1955. Acta Psychiatr Scand Suppl 1961; 36(155): 1-273.
[PMID: 13681226]
[2]
Hogarty GE, Gross M. Preadmission symptom difference between first admitted schizophrenics in the pre-drug and post-drug era. Compr Psychiatry 1996; 7: 134-40.
[http://dx.doi.org/10.1016/S0010-440X(66)80024-X]
[3]
Morrison JR. Changes in subtype diagnosis of schizophrenia: 1920-1966. Am J Psychiatry 1974; 131(6): 674-7.
[http://dx.doi.org/10.1176/ajp.131.6.674] [PMID: 4597303]
[4]
Templer DI, Veleber DM. The decline of catatonic schizophrenia. J Orthomol Med 1981; 10: 156-8.
[5]
Stompe T, Ortwein-Swoboda G, Ritter K, Schanda H, Friedmann A. Are we witnessing the disappearance of catatonic schizophrenia? Compr Psychiatry 2002; 43(3): 167-74.
[http://dx.doi.org/10.1053/comp.2002.32352] [PMID: 11994832]
[6]
Carpenter WT Jr, Bartko JJ, Carpenter CL, Strauss JS. Another view of schizophrenia subtypes. A report from the international pilot study of schizophrenia. Arch Gen Psychiatry 1976; 33(4): 508-16.
[http://dx.doi.org/10.1001/archpsyc.1976.01770040068012] [PMID: 938187]
[7]
Rasmussen SA, Mazurek MF, Rosebush PI. Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology. World J Psychiatry 2016; 6(4): 391-8.
[http://dx.doi.org/10.5498/wjp.v6.i4.391] [PMID: 28078203]
[8]
Abrams R, Taylor MA. Catatonia. A prospective clinical study. Arch Gen Psychiatry 1976; 33(5): 579-81.
[http://dx.doi.org/10.1001/archpsyc.1976.01770050043006] [PMID: 1267574]
[9]
Banerjee A, Sharma LN. Catatonia incidence in acute psychiatric admissions. Indian J Psychiatry 1995; 37(1): 35-9.
[PMID: 21743713]
[10]
Payee H, Chandrasekaran R, Raju GVL. Catatonic syndrome: treatment response to Lorazepam. Indian J Psychiatry 1999; 41(1): 49-53.
[PMID: 21455353]
[11]
Seethalakshmi R, Dhavale S, Suggu K, Dewan M. Catatonic syndrome: importance of detection and treatment with lorazepam. Ann Clin Psychiatry 2008; 20(1): 5-8.
[http://dx.doi.org/10.1080/10401230701844786] [PMID: 18297580]
[12]
Dutt A, Grover S, Chakrabarti S, Avasthi A, Kumar S. Phenomenology and treatment of Catatonia: a descriptive study from north India. Indian J Psychiatry 2011; 53(1): 36-40.
[http://dx.doi.org/10.4103/0019-5545.75559] [PMID: 21431006]
[13]
Ramdurg S, Kumar S, Kumar M, Singh V, Kumar D, Desai NG. Catatonia: etiopathological diagnoses and treatment response in a tertiary care setting: a clinical study. Ind Psychiatry J 2013; 22(1): 32-6.
[http://dx.doi.org/10.4103/0972-6748.123612] [PMID: 24459371]
[14]
Chalasani P, Healy D, Morriss R. Presentation and frequency of catatonia in new admissions to two acute psychiatric admission units in India and Wales. Psychol Med 2005; 35(11): 1667-75.
[http://dx.doi.org/10.1017/S0033291705005453] [PMID: 16219124]
[15]
England ML, Ongür D, Konopaske GT, Karmacharya R. Catatonia in psychotic patients: clinical features and treatment response. J Neuropsychiatry Clin Neurosci 2011; 23(2): 223-6.
[http://dx.doi.org/10.1176/jnp.23.2.jnp223] [PMID: 21677256]
[16]
Taylor MA, Abrams R. Catatonia. Prevalence and importance in the manic phase of manic-depressive illness. Arch Gen Psychiatry 1977; 34(10): 1223-5.
[http://dx.doi.org/10.1001/archpsyc.1977.01770220105012] [PMID: 911221]
[17]
Pataki J, Zervas IM, Jandorf L. Catatonia in a university inpatient service (1985-1990). Convuls Ther 1992; 8(3): 163-73.
[PMID: 11941166]
[18]
Yassa R, Iskandar H, Lalinec M, Cleto L. Lorazepam as an adjunct in the treatment of catatonic states: an open clinical trial. J Clin Psychopharmacol 1990; 10(1): 66-8.
[http://dx.doi.org/10.1097/00004714-199002000-00024] [PMID: 2307736]
[19]
Rosebush PI, Hildebrand AM, Furlong BG, Mazurek MF. Catatonic syndrome in a general psychiatric inpatient population: frequency, clinical presentation, and response to lorazepam. J Clin Psychiatry 1990; 51(9): 357-62.
[PMID: 2211547]
[20]
Hawkins JM, Archer KJ, Strakowski SM, Keck PE. Somatic treatment of catatonia. Int J Psychiatry Med 1995; 25(4): 345-69.
[http://dx.doi.org/10.2190/X0FF-VU7G-QQP7-L5V7] [PMID: 8822386]
[21]
Benegal V, Hingorani S, Khanna S. Idiopathic catatonia: validity of the concept. Psychopathology 1993; 26(1): 41-6.
[http://dx.doi.org/10.1159/000284798] [PMID: 8511229]
[22]
Ungvari GS, Chiu HF, Chow LY, Lau BS, Tang WK. Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study. Psychopharmacology (Berl) 1999; 142(4): 393-8.
[http://dx.doi.org/10.1007/s002130050904] [PMID: 10229064]
[23]
Unal A, Bulbul F, Alpak G, Virit O, Copoglu US, Savas HA. Effective treatment of catatonia by combination of benzodiazepine and electroconvulsive therapy. J ECT 2013; 29(3): 206-9.
[http://dx.doi.org/10.1097/YCT.0b013e3182887a1a] [PMID: 23965606]
[24]
Bush G, Fink M, Petrides G, Dowling F, Francis A, Catatonia I. Rating scale and standardized examination. Acta Psychiatr Scand 1996; 93(2): 129-36.
[http://dx.doi.org/10.1111/j.1600-0447.1996.tb09814.x] [PMID: 8686483]
[25]
Oldham MA, Desan PH. Alcohol and sedative-hypnotic withdrawal catatonia: two case reports, systematic literature review, and suggestion of a potential relationship with alcohol withdrawal delirium. Psychosomatics 2016; 57(3): 246-55.
[http://dx.doi.org/10.1016/j.psym.2015.12.007] [PMID: 26949118]
[26]
Basu A, Jagtiani A, Gupta R. Catatonia in mixed alcohol and benzodiazepine withdrawal. J Pharmacol Pharmacother 2014; 5(4): 261-4.
[http://dx.doi.org/10.4103/0976-500X.142449] [PMID: 25422571]
[27]
Bestha DP, Padala P. A case of catatonia secondary to polysubstance abuse and acetaminophen overdose. Prim Care Companion J Clin Psychiatry 2010; 12(1)
[http://dx.doi.org/10.4088/PCC.09l00790ecr]]
[28]
Leff J. Psychiatry Around the Globe: A Transcultural View. New York: Marcel Dekker 1981.
[29]
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Press Inc 2013.
[30]
Lee JW, Schwartz DL, Hallmayer J. Catatonia in a psychiatric intensive care facility: incidence and response to benzodiazepinesAnn Clin Psychiatry 2000; 12(2): 89-96.
[http://dx.doi.org/10.3109/10401230009147094] [PMID: 10907800]

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