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Mahgoub Y, Hamlin D, Kindt H, Francis A. Catatonia and autism spectrum disorder: A common comorbid syndrome or a core feature? World J Psychiatry 2025; 15:103967. [DOI: 10.5498/wjp.v15.i5.103967] [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: 12/05/2024] [Revised: 02/27/2025] [Accepted: 03/28/2025] [Indexed: 04/30/2025] Open
Abstract
Autism spectrum disorder (ASD) is an early-onset neurodevelopmental disorder marked by persistent deficits in social communication and interaction, alongside restricted, repetitive patterns of behaviors (RRB), interests, or activities. It often co-occurs with various neuropsychiatric disorders, though their frequency varies widely due to unclear boundaries between the core features of ASD and common comorbidities. Catatonia, increasingly noted in neurodevelopmental conditions like ASD, shares striking similarities with ASD in symptomatology, brain mechanisms, and treatment responses, prompting the question of whether it is a core feature of ASD or a distinct condition. This paper delved into this overlap, exploring the relationship between catatonia and ASD through a narrative review of peer-reviewed literature from 1943 to 2024, sourced from PubMed and psychiatric journals. Focusing on ASD diagnostic evolution, symptom overlap with catatonia, and shared neurobiological and therapeutic characteristics, we used thematic analysis to synthesize findings into key areas such as historical nosology, phenomenological overlap, neurobiological parallels, and treatment response. The evidence revealed weak support for separating catatonia from overlapping RRB features of ASD, suggesting that some RRB might align more with comorbid catatonia than intrinsic ASD traits. However, this idea needs further validation through rigorous clinical trials. Clarifying this relationship could refine diagnostic approaches and open doors to targeted treatments, potentially improving outcomes for those affected.
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Affiliation(s)
- Yassir Mahgoub
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Dallas Hamlin
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Hailey Kindt
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Andrew Francis
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
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Luccarelli J, Clauss JA, York T, Baldwin I, Vandekar S, McGonigle T, Fricchione G, Fuchs C, Smith JR. Hospitalizations for pediatric catatonia in neurodivergent and neurotypical patients. Gen Hosp Psychiatry 2025; 95:133-139. [PMID: 40367741 DOI: 10.1016/j.genhosppsych.2025.05.003] [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: 09/16/2024] [Revised: 04/10/2025] [Accepted: 05/02/2025] [Indexed: 05/16/2025]
Abstract
INTRODUCTION Catatonia is a neuropsychiatric disorder that occurs in pediatric patients with a range of associated medical, psychiatric, and neurodevelopmental disorders (NDDs). This study describes hospital care of pediatric catatonia patients and compares treatments for neurotypical patients and those with NDDs. METHODS Retrospective cohort study from 1/1/2018 to 6/1/2023 of two academic medical centers of patients aged 18 and younger with catatonia. Patients were retrospectively assessed using the clinical global impressions-improvement (CGI-I) by two independent reviewers. RESULTS One hundred sixty-five patients were hospitalized for catatonia, of whom 50.3 % had an NDD. Median age was 15. One hundred sixty-four patients were treated with a benzodiazepine, with a median maximum 24-hour dose of 6 mg lorazepam-equivalents, which did not differ for patients with and without NDDs. Electroconvulsive therapy (ECT) was utilized in 14.5 % of patients. Median length of medical hospitalization was 5 days and hospitalizations were longer in neurotypical patients than in patients with NDDs. In an ordinal regression model, the probability of observing at least "much improvement" (CGI < 3) was 88.3 % (95 % CI: 82.4 % to 92.3 %), with patients with a non-medical primary diagnosis and an NDD having a lower odds of response than non-medical primary diagnosis without an NDD. CONCLUSIONS The probability of patients achieving a CGI-I score indicating at least "much improvement" was 88.3 %. Administered benzodiazepine dose and ECT treatment were similar for all patients, but neurotypical patients had longer hospitalizations than those with NDDs and had a higher odds of a more favorable clinical response for patients with non-medical primary diagnoses. Research under controlled conditions is needed to optimize and endure equitable catatonia treatment in youth.
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Affiliation(s)
- James Luccarelli
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Jacqueline A Clauss
- 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, Nashville, TN, USA
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 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, Nashville, TN, USA
| | - Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN 37203, USA
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Ilie G, Jaeggi AV. The modular mind and psychiatry: toward clinical integration with a focus on self-disorders. Front Psychol 2025; 16:1570049. [PMID: 40351589 PMCID: PMC12062109 DOI: 10.3389/fpsyg.2025.1570049] [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: 02/02/2025] [Accepted: 04/07/2025] [Indexed: 05/14/2025] Open
Abstract
One of the foundational tenets of evolutionary psychology, the modular view of the mind, offers promising applications for clinical psychiatry. This perspective conceptualizes the mind as a collection of specialized information-processing modules, shaped by natural selection to address adaptive challenges faced by our ancestors. In this paper, we propose several points of integration between the modularity framework and clinical psychiatric practice. First, we argue that the descriptive psychopathology of self-disorders provides evidence supporting the modular view, demonstrating how a dysfunctional minimal self may expose the mind's modular architecture to conscious awareness. Next, we will explore how the modular perspective can illuminate the nature of intrapsychic conflicts. Finally, we will discuss how evidence from neuropsychiatric syndromes supports the modular view of the mind and, in turn, how this perspective can provide a basis for classifying mental disorders.
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Affiliation(s)
- Gheorghe Ilie
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
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Rogers JP, Wilson JE, Oldham MA. Catatonia in ICD-11. BMC Psychiatry 2025; 25:405. [PMID: 40251508 PMCID: PMC12008857 DOI: 10.1186/s12888-025-06857-6] [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: 02/23/2024] [Accepted: 04/14/2025] [Indexed: 04/20/2025] Open
Abstract
In the International Statistical Classification of Diseases and Related Health Problems Version 11 (ICD-11), the diagnostic criteria for catatonia have been extensively revised. We provide context for these changes beginning with a brief history of how catatonia has been conceptualized and a description of how the criteria for catatonia have changed across ICD versions. We also compare ICD-11 with the criteria in the latest Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-5-TR), consider clinical implications of the changes in ICD-11, and highlight conceptual areas in need of further development.Described in 1874 by Karl Kahlbaum, catatonia was subsequently subsumed into the Kraepelinian concept of dementia praecox. This was reflected in versions of ICD up to ICD-9, which considered catatonia exclusively as a form of schizophrenia. ICD-10 introduced the diagnosis of organic catatonic disorder but did not incorporate the growing evidence that catatonia can occur in psychiatric conditions such as mood and autism-spectrum disorders.ICD-11 conceptualizes catatonia as an independent disorder with a common clinical phenotype regardless of associated condition, if present. In ICD-11, catatonia diagnosis requires at least three clinical features from the following categories: decreased, increased or abnormal psychomotor activity. These features may come from any combination of the categories, but only one from the increased psychomotor activity category should be counted. The four catatonia diagnoses in ICD-11 are catatonia associated with another mental disorder, catatonia induced by substances or medications, secondary catatonia syndrome and catatonia, unspecified. This expanded view of catatonia more closely resembles DSM-5-TR, which also recognizes catatonia associated with several psychiatric and general medical conditions. ICD-11 also offers guidance on distinguishing catatonia from similar behavioural features of other conditions, such as psychomotor retardation in depression, delirium, and factitious disorder.This new classification stands to improve recognition of catatonia and our hope is that it may lead to a growing awareness of the wide range of conditions associated with it. Ultimately, a better understanding of catatonia should contribute to improved outcomes as clinicians offer treatments both for catatonia itself as well as tailored treatments for its broad range of associated conditions.
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Affiliation(s)
| | - Jo Ellen Wilson
- Veterans Affairs, Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Wang YC, He Q, Wu YJ, Zhang L, Wu S, Fang XJ, Jia SS, Luo FG. Construction and validation of a machine learning-based nomogram model for predicting pneumonia risk in patients with catatonia: a retrospective observational study. Front Psychiatry 2025; 16:1557659. [PMID: 40160203 PMCID: PMC11951867 DOI: 10.3389/fpsyt.2025.1557659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 02/20/2025] [Indexed: 04/02/2025] Open
Abstract
Objective Catatonia was often complicated by pneumonia, and the development of severe pneumonia after admission posed significant challenges to its treatment. This study aimed to develop a Nomogram Model based on pre-admission characteristics of patients with catatonia to predict the risk of pneumonia after admission. Methods This retrospective observational study reviewed catatonia patients hospitalized at Hangzhou Seventh People's Hospital from September 2019 to November 2024. Data included demographic characteristics, medical history, maintenance medications, and pre-admission clinical presentations. Patients were divided into catatonia with and without pneumonia groups. The LASSO Algorithm was used for feature selection, and seven machine learning models: Decision Tree(DT), Logistic Regression(LR), Naive Bayes(NB), Random Forest(RF), K Nearest Neighbors(KNN), Gradient Boosting Machine(GBM), Support Vector Machine(SVM) were trained. Model performance was evaluated using AUC, Accuracy, Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, F1 Score, Cohen's Kappa, and Brier Score, and Brier score. The best-performing model was selected for multivariable analysis to determine the variables included in the final Nomogram Model. The Nomogram Model was further validated through ROC Curves, Calibration Curves, Decision Curve Analysis (DCA), and Bootstrapping to ensure discrimination, calibration, and clinical applicability. Results Among 156 patients, 79 had no pneumonia, and 77 had pneumonia. LASSO Algorithm identified 15 non-zero coefficient variables (LASSO 1-SEλ=0.076). The GBM showed the best performance (AUC = 0.954, 95% CI: 0.924-0.983, vs other models by DeLong's test: P < 0.05). Five key variables: Age, Clozapine, Diaphoresis, Intake Refusal, and Waxy Flexibility were used to construct the Nomogram Model. Validation showed good discrimination (AUC = 0.803, 95% CI: 0.735-0.870), calibration, and clinical applicability. Internal validation (Bootstrapping, n=500) confirmed model stability (AUC = 0.814, 95% CI: 0.743-0.878; Hosmer-Lemeshow P = 0.525). Conclusion This study developed a Nomogram Model based on five key factors, demonstrating significant clinical value in predicting the risk of pneumonia in hospitalized patients with catatonia.
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Esmaeelzadeh S, Mahmood R, Masood A. The effectiveness of repetitive transcranial magnetic stimulation (rTMS) in patients with catatonia associated with another mental disorder: A systematic review. Asian J Psychiatr 2025; 103:104311. [PMID: 39571330 DOI: 10.1016/j.ajp.2024.104311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 10/21/2024] [Accepted: 11/17/2024] [Indexed: 01/03/2025]
Abstract
BACKGROUND Catatonia is a rare but life-threatening condition characterized by a constellation of psychomotor disturbances. The most widely used treatments of catatonia include benzodiazepines and electroconvulsive therapy. Despite the widespread use of benzodiazepines and the high response rate of catatonia to ECT, there are instances where catatonia does not respond to first-line treatments. This study aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in managing catatonia. METHODS A systematic literature search was conducted on the following databases: Medline, PubMed, Cochrane Library, Embase, PsycINFO and ClinicalTrials.gov for registered but not yet published studies. RESULTS Out of 244 initially identified articles, there remained eight case reports and 1 case series eligible after screening. Of the twelve total cases, nine showed clinical improvement. However, there was significant heterogeneity in the complexity of the clinical situation, the severity of clinical features of catatonia, underlying causes, and rTMS treatment protocols between studies. CONCLUSION The results of this study are inconclusive. However, rTMS might be trialed for the management of catatonia when first-line treatment options fail, are unavailable, or need to be used with caution. Our review incorporating the most up to date evidence highlights the need for more extensive, standardized, randomized clinical trials to investigate the efficacy of rTMS for treating catatonia.
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Affiliation(s)
- Sarvenaz Esmaeelzadeh
- Department of Psychiatry, University of Saskatchewan, Royal University Hospital, Ellis Hall, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.
| | - Razi Mahmood
- AFG College with the University of Aberdeen, Building 98, Zone 40, Ali Bin Abi Talib Street, 820, Doha, Qatar.
| | - Altaf Masood
- Department of Psychiatry, University of Saskatchewan, Royal University Hospital, Ellis Hall, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.
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Wadhwa A, Cullinan JT, Sivaraman S. Use of Electroconvulsive Therapy on an Adolescent Inpatient Psychiatric Unit. Child Adolesc Psychiatr Clin N Am 2025; 34:119-128. [PMID: 39510644 DOI: 10.1016/j.chc.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment of psychiatric disorders in children and adolescents. The authors discuss brief history of this procedure, legal and ethical considerations, common indications and contraindications, appropriate referrals, details of the procedure, and adverse effects in this population. ECT is mainly used for treatment of treatment-resistant mood disorder/psychosis and catatonia although it has been effectively used for other conditions including neuroleptic malignant syndrome, refractory self-injurious behavior. A careful consideration of patient's medical and psychiatric history is important before considering ECT. Informed consent should involve patient and parents and patient's assent is crucial before initiating the procedure.
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Affiliation(s)
- Abhishek Wadhwa
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Neurobiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - James T Cullinan
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Neurobiology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soumya Sivaraman
- Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, 240C Center for Psychiatric Medicine| 1713 6th Avenue South, Birmingham, AL 35233, USA
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Morris SL. A Case Report of Psilocybin-induced Psychosis in a Predisposed Patient. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:684-687. [PMID: 39420616 PMCID: PMC11494431 DOI: 10.9758/cpn.24.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 10/19/2024]
Abstract
Psilocybin is gaining popularity as research shows potential benefits to those with anxiety, depression, and other mental health conditions. Individuals with risk factors for psychosis are typically excluded from such studies, limiting the empiric research of the risks and benefits in vulnerable populations. In the real-world setting, many individuals who seek treatment with psilocybin will have comorbid psychiatric conditions and other factors that predispose them to psychosis. We report a case of a patient with multiple predisposing risk factors, including a history of depression, personality disorder traits, and cannabis use, who experienced a psychotic episode with catatonic features and suicidality after several months of heavy psilocybin use. A review of similar previously published case reports demonstrates a pattern of psilocybin-induced psychosis occurring primarily in individuals with predisposing factors who have consumed either high or repeated doses of the drug. This case report furthers this pattern, which serves as both a warning that psilocybin use is not without risks and reassurance for researchers using much lower doses to treat mental illness.
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Affiliation(s)
- Sorsha Lee Morris
- Mental Health Service, San Francisco VA Health Care System, San Francisco, CA, USA
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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.
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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
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Hirjak D, Rogers JP, Wolf RC, Kubera KM, Fritze S, Wilson JE, Sambataro F, Fricchione G, Meyer-Lindenberg A, Ungvari GS, Northoff G. Catatonia. Nat Rev Dis Primers 2024; 10:49. [PMID: 39025858 DOI: 10.1038/s41572-024-00534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
Catatonia is a neuropsychiatric disorder characterized by motor, affective and cognitive-behavioural signs, which lasts from hours to days. Intensive research over the past two decades has led to catatonia being recognized as an independent diagnosis in the International Classification of Diseases, 11th Revision (ICD-11) since 2022. Catatonia is found in 5-18% of inpatients on psychiatric units and 3.3% of inpatients on medical units. However, in an unknown number of patients, catatonia remains unrecognized and these patients are at risk of life-threatening complications. Hence, recognizing the symptoms of catatonia early is crucial to initiate appropriate treatment to achieve a favourable outcome. Benzodiazepines such as lorazepam and diazepam, electroconvulsive therapy, and N-methyl-D-aspartate antagonists such as amantadine and memantine, are the cornerstones of catatonia therapy. In addition, dopamine-modulating second-generation antipsychotics (for example, clozapine and aripiprazole) are effective in some patient populations. Early and appropriate treatment combined with new screening assessments has the potential to reduce the high morbidity and mortality associated with catatonia in psychiatric and non-psychiatric settings.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
- German Centre for Mental Health (DZPG), Partner site Mannheim, Mannheim, Germany.
| | | | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Katharina Maria Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education and Clinical Center (GRECC), Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy
| | - Gregory Fricchione
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner site Mannheim, Mannheim, Germany
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Section of Psychiatry, School of Medicine, University Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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Jaimes-Albornoz W, Wu P, de Mendaza-Martínez de Icaya LG, Rozali F, Martínez-Querol M, Smith R, Isetta M, de Pellón Santamaria ÁR, Serra-Mestres J. Catatonia associated with pediatric postoperative cerebellar mutism syndrome. Childs Nerv Syst 2024; 40:2019-2032. [PMID: 38630268 DOI: 10.1007/s00381-024-06392-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/02/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To ascertain the presence of catatonia in cases of pediatric postoperative cerebellar mutism syndrome (PPCMS). METHOD A systematic review of PPCMS case reports of patients aged 0-17 years with sufficient clinical information to extract catatonic phenomena was undertaken following PRISMA guidelines. Standardized catatonia rating scales were applied to selected cases retrospectively to ascertain whether diagnostic criteria for catatonia were met. A case known to the authors is also presented. RESULTS Two hundred twenty-one suitable full-text articles were identified. Following screening and application of inclusion criteria, 51 articles were selected plus seven more from their references, reporting on 119 subjects. All cases met Bush and Francis (BF) diagnostic criteria for catatonia, 92.5% Pediatric Catatonia Rating Scale (PCRS), 52.9% ICD-11, and 44.5% DSM-5. All patients presented with mutism. The next most frequent signs were immobility/stupor (77.3%), withdrawal (35.3%), mannerisms (23.5%), and excitement/agitation (18.5%). Most cases presented with stuporous catatonia (75.6%). Catatonia most frequently occurred following resection of medulloblastoma (64.7%). Preoperative hydrocephalus occurred in 89 patients (74.8%). CONCLUSION Catatonia was frequent in this PPCMS sample, with a predominant stuporous variant; it should be considered in patients with PPCMS and assessed with reliable and validated instruments for prompt diagnosis and management.
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Affiliation(s)
- Walter Jaimes-Albornoz
- Psychiatry Service, Donostia University Hospital, Basque Health Service-Osakidetza, Paseo del Dr. Beguiristain 117, CP, 20014, San Sebastian, Spain
| | - Peter Wu
- Royal Hospital for Children & Young People, 50 Little France Crescent, Edinburgh, Scotland, UK, EH16 4TJ.
| | | | - Farah Rozali
- Queen Margaret Hospital, Whitefield Rd, Dunfermline, Scotland, UK, KY12 0SU
| | - María Martínez-Querol
- Psychiatry Service, Donostia University Hospital, Basque Health Service-Osakidetza, Paseo del Dr. Beguiristain 117, CP, 20014, San Sebastian, Spain
| | - Rowena Smith
- Royal Hospital for Children & Young People, 50 Little France Crescent, Edinburgh, Scotland, UK, EH16 4TJ
| | | | - Ángel Ruiz de Pellón Santamaria
- Psychiatry Service, Donostia University Hospital, Basque Health Service-Osakidetza, Paseo del Dr. Beguiristain 117, CP, 20014, San Sebastian, Spain
| | - Jordi Serra-Mestres
- ISEP Clinic Girona, Sta. Eugènia 85, 1er-1a, 17006, Girona, Catalunya, Spain
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Lapid MI, Merrill J, Mueller M, Hermida AP, Nykamp L, Andrus J, Azizi H, Bolton P, Bonsu N, Braga R, Dillon CR, Ecklesdafer D, Evans D, Harper D, Heintz H, Hussain-Krauter S, Holzgen O, Humphrey D, Jiwani S, Johnson EK, Kang S, Kassien J, Kim J, Knapp RG, Kung S, Kremen N, Le K, Mahdasian J, Marzouk T, Masrud JD, Mattingly J, Miller D, Pagali SR, Patrick R, Riva Posse P, Pritchett C, Rahman A, Rath S, Roczniak C, Rummans TA, Sanghani S, Seiner S, Smart L, Tomaschek E, Tsygankova V, VanderSchuur-White L, Walton MP, Wilkins J, Williams A, Williams SM, Petrides G, Forester BP. Electroconvulsive therapy for the acute management of severe agitation in dementia (ECT-AD): A modified study protocol. PLoS One 2024; 19:e0303894. [PMID: 38941338 PMCID: PMC11213353 DOI: 10.1371/journal.pone.0303894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVE This study began as a single-blind randomized controlled trial (RCT) to investigate the efficacy and safety of electroconvulsive therapy (ECT) for severe treatment-refractory agitation in advanced dementia. The aims are to assess agitation reduction using the Cohen-Mansfield Agitation Inventory (CMAI), evaluate tolerability and safety outcomes, and explore the long-term stability of agitation reduction and global functioning. Due to challenges encountered during implementation, including recruitment obstacles and operational difficulties, the study design was modified to an open-label format and other protocol amendments were implemented. METHODS Initially, the RCT randomized participants 1:1 to either ECT plus usual care or simulated ECT plus usual care (S-ECT) groups. As patients were enrolled, data were collected from both ECT and simulated ECT (S-ECT) patients. The study now continues in an open-label study design where all patients receive actual ECT, reducing the targeted sample size from 200 to 50 participants. RESULTS Study is ongoing and open to enrollment. CONCLUSION The transition of the ECT-AD study design from an RCT to open-label design exemplifies adaptive research methodologies in response to real-world challenges. Data from both the RCT and open-label phases of the study will provide a unique perspective on the role of ECT in managing severe treatment-refractory agitation in dementia, potentially influencing future clinical practices and research approaches.
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Affiliation(s)
- Maria I. Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Julia Merrill
- McLean Hospital, Belmont, Massachusetts, United States of America
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Adriana P. Hermida
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Louis Nykamp
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Jason Andrus
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States of America
| | - Heela Azizi
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Institute of Behavioral Science, Feinstein Institutes of Medical Research, Manhasset, New York, United States of America
| | - Paula Bolton
- McLean Hospital, Belmont, Massachusetts, United States of America
| | - Nana Bonsu
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Raphael Braga
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States of America
| | - Catherine R. Dillon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Donna Ecklesdafer
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Darci Evans
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - David Harper
- McLean Hospital, Belmont, Massachusetts, United States of America
- Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Hannah Heintz
- McLean Hospital, Belmont, Massachusetts, United States of America
| | - Sehba Hussain-Krauter
- Ican School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Olivia Holzgen
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Daniel Humphrey
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Salima Jiwani
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States of America
| | - Emily K. Johnson
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Simran Kang
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Institute of Behavioral Science, Feinstein Institutes of Medical Research, Manhasset, New York, United States of America
| | - Janelle Kassien
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Jonathan Kim
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Rebecca G. Knapp
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Neil Kremen
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States of America
| | - Kendra Le
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jack Mahdasian
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Taylor Marzouk
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Institute of Behavioral Science, Feinstein Institutes of Medical Research, Manhasset, New York, United States of America
| | - Jared D. Masrud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | | | - Dawn Miller
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Sandeep R. Pagali
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Regan Patrick
- McLean Hospital, Belmont, Massachusetts, United States of America
- Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - Patricio Riva Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Cristina Pritchett
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Aniqa Rahman
- McLean Hospital, Belmont, Massachusetts, United States of America
| | - Swapnil Rath
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Cara Roczniak
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Teresa A. Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sohag Sanghani
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States of America
| | - Steve Seiner
- Northwell, New Hyde Park, New York, United States of America
| | - LeAnn Smart
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Evan Tomaschek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Valeriya Tsygankova
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Lori VanderSchuur-White
- Pine Rest Christian Mental Health Services, Grand Rapids, Michigan, United States of America
| | - Monica P. Walton
- Oregon Health & Science University, Portland, Oregon, United States of America
| | - James Wilkins
- McLean Hospital, Belmont, Massachusetts, United States of America
- Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - April Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Sarah M. Williams
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - George Petrides
- Northwell, New Hyde Park, New York, United States of America
- Department of Psychiatry at the Zucker Hillside Hospital, Glen Oaks, New York, United States of America
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States of America
- RWJBarnabas Health System, Trinitas Regional Medical Center, Elizabeth, New Jersey, United States of America
| | - Brent P. Forester
- McLean Hospital, Belmont, Massachusetts, United States of America
- Harvard Medical School, Cambridge, Massachusetts, United States of America
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States of America
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Luccarelli J, Clauss JA, York T, Baldwin I, Vandekar S, McGonigle T, Fricchione G, Fuchs C, Smith JR. Exploring the Trajectory of Catatonia in Neurodiverse and Neurotypical Pediatric Hospitalizations: A Multicenter Longitudinal Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.06.24308554. [PMID: 38883751 PMCID: PMC11178013 DOI: 10.1101/2024.06.06.24308554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Objective Catatonia is a neuropsychiatric disorder that occurs in pediatric patients with a range of associated medical, psychiatric, and neurodevelopmental disorders (NDDs). This study describes hospital care of pediatric catatonia patients and compares treatments for neurotypical patients and those with NDDs. Methods Retrospective cohort study from 1/1/2018 to 6/1/2023 of two academic medical centers of patients aged 18 and younger with catatonia. Patients were retrospectively assessed using the clinical global impressions-improvement (CGI-I) by two independent reviewers. Results One hundred sixty-five patients were hospitalized for catatonia, of whom 50.3% had an NDD. Median age was 15. One hundred sixty-four patients were treated with a benzodiazepine, with a median maximum 24-hour dose of 6 mg lorazepam-equivalents, which did not differ for patients with and without NDDs. Electroconvulsive therapy (ECT) was utilized in 14.5% of patients. Median length of medical hospitalization was 5 days and hospitalizations were longer in neurotypical patients than in patients with NDDs. In an ordinal regression model, the probability of observing at least "much improvement" (CGI < 3) was 88.3% (95% CI: 82.4% to 92.3%), with NDD diagnosis associated with a lower odds of clinical response. Conclusions The probability of patients achieving a CGI-I score indicating at least "much improvement" was 88.3%. Administered benzodiazepine dose and ECT treatment were similar for all patients, but neurotypical patients had longer hospitalizations than those with NDDs and had a higher odds of a more favorable clinical response. Research under controlled conditions is needed to optimize and endure equitable catatonia treatment in youth.
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Affiliation(s)
- James Luccarelli
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jacqueline A. Clauss
- 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, Nashville, TN
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - 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, Nashville, TN
| | - Joshua R. Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, 37203
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Csihi L, Ungvari GS, Caroff SN, Gazdag G. First 150 years of catatonia: Looking back at its complicated history and forward to the road ahead. World J Psychiatry 2024; 14:600-606. [PMID: 38808080 PMCID: PMC11129151 DOI: 10.5498/wjp.v14.i5.600] [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: 01/27/2024] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
Karl Ludwig Kahlbaum (1828-1899) was the first to conceptualize and describe the main clinical features of a novel psychiatric illness, which he termed catatonia in his groundbreaking monograph published 150 years ago. Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course, a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions. In his classification system, Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox (schizophrenia) disease entity. Because of the substantial influence of Kraepelin's classification, catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century. However, with the advent of the psychopharmacotherapy era starting from the early 1950s, interest in catatonia in both clinical practice and research subsided until the early 2000s. The past two decades have witnessed a resurgence of interest in catatonia. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions. The introduction of an independent diagnostic category termed "Catatonia Not Otherwise Specified" significantly stimulated research in this field. The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.
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Affiliation(s)
- Levente Csihi
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Western Australia, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Western Australia, Australia
| | - Stanley N Caroff
- Behavioral Health Service, Corporal Michael J Cresencz, Veterans Affairs Medical Center, Philadelphia, PA 19104, United States
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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15
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Smith JR, York T, Baldwin I, Fuchs C, Fricchione G, Luccarelli J. Diagnostic features of paediatric catatonia: multisite retrospective cohort study. BJPsych Open 2024; 10:e96. [PMID: 38686558 PMCID: PMC11060083 DOI: 10.1192/bjo.2024.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Catatonia is a neuropsychiatric disorder characterised by psychomotor changes that can affect individuals across the lifespan. Although features of catatonia have been described in adults, the most common clinical symptoms among paediatric patients with catatonia are not well characterised. AIMS The goal of this study was to characterise the symptoms of catatonia demonstrated by paediatric patients, and to explore demographic and diagnostic factors associated with greater catatonia severity. METHOD We conducted a multicentre retrospective cohort study, from 1 January 2018 to 6 January 2023, of patients aged 18 and younger with a clinical diagnosis of catatonia and symptom assessment using the Bush Francis Catatonia Rating Scale (BFCRS). RESULTS A total of 143 patients met inclusion criteria. The median age was 15 (interquartile range: 13-16) years and 66 (46.2%) patients were female. Neurodevelopmental disabilities were present in 55 (38.5%) patients. Patients demonstrated a mean of 6.0 ± 2.1 signs of catatonia on the Bush Francis Catatonia Screening Item, with a mean BFCRS score of 15.0 ± 5.9. Among the 23 items of the BFCRS, six were present in >50% of patients (staring, mutism, immobility/stupor, withdrawal, posturing/catalepsy, rigidity), and four were present in <20% of cases (waxy flexibility, mitgehen, gegenhalten, grasp reflex). In an adjusted model, patients with neurodevelopmental disorders demonstrated greater BFCRS severity than those with other diagnoses. CONCLUSIONS Catatonia was diagnosed in a range of mental health conditions. Further research is needed to define optimal diagnostic criteria for catatonia in paediatric patients, and clarify the clinical course of the disorder.
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Affiliation(s)
- Joshua R. Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA; and Vanderbilt Kennedy Center, Vanderbilt University, Tennessee, USA
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Tennessee, USA
| | - Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA
| | - Gregory Fricchione
- Harvard Medical School, Massachusetts, USA; and Department of Psychiatry, Massachusetts General Hospital, Massachusetts, USA
| | - James Luccarelli
- Harvard Medical School, Massachusetts, USA; and Department of Psychiatry, Massachusetts General Hospital, Massachusetts, USA
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Santoro JD, Khoshnood MM, Jafarpour S, Nguyen L, Boyd NK, Vogel BN, Kammeyer R, Patel L, Manning MA, Rachubinski AL, Filipink RA, Baumer NT, Santoro SL, Franklin C, Tamrazi B, Yeom KW, Worley G, Espinosa JM, Rafii MS. Neuroimaging abnormalities associated with immunotherapy responsiveness in Down syndrome regression disorder. Ann Clin Transl Neurol 2024; 11:1034-1045. [PMID: 38375538 PMCID: PMC11021615 DOI: 10.1002/acn3.52023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To determine the prevalence of neuroimaging abnormalities in individuals with Down syndrome regression disorder (DSRD) and evaluate if neuroimaging abnormalities were predictive of therapeutic responses. METHODS A multicenter, retrospective, case-control study which reviewed neuroimaging studies of individuals with DSRD and compared them to a control cohort of individuals with Down syndrome (DS) alone was performed. Individuals aged 10-30 years and meeting international consensus criteria for DSRD were included. The presence of T1, T2/FLAIR, and SWI signal abnormalities was reviewed. Response rates to various therapies, including immunotherapy, were evaluated in the presence of neuroimaging abnormalities. RESULTS In total, 74 individuals (35%) had either T2/FLAIR and/or SWI signal abnormality compared to 14 individuals (12%) without DSRD (p < 0.001, 95%CI: 2.18-7.63). T2/FLAIR signal abnormalities were not appreciated more frequently in individuals with DSRD (14%, 30/210) than in the control cohort (9%, 11/119) (p = 0.18, OR: 1.63, 95%CI: 0.79-3.40). SWI signal abnormalities were appreciated at a higher frequency in individuals with DSRD (24%, 51/210) compared to the control cohort (4%, 5/119) (p < 0.001, OR: 7.31, 95%CI: 2.83-18.90). T2/FLAIR signal abnormalities were localized to the frontal (40%, 12/30) and parietal lobes (37%, 11/30). SWI signal abnormalities were predominantly in the bilateral basal ganglia (94%, 49/52). Individuals with DSRD and the presence of T2/FLAIR and/or SWI signal abnormalities were much more likely to respond to immunotherapy (p < 0.001, OR: 8.42. 95%CI: 3.78-18.76) and less likely to respond to benzodiazepines (p = 0.01, OR: 0.45, 95%CI: 0.25-0.83), antipsychotics (p < 0.001, OR: 0.28, 95%CI: 0.11-0.55), or electroconvulsive therapy (p < 0.001, OR: 0.12; 95%CI: 0.02-0.78) compared to individuals without these neuroimaging abnormalities. INTERPRETATION This study indicates that in individuals diagnosed with DSRD, T2/FLAIR, and SWI signal abnormalities are more common than previously thought and predict response to immunotherapy.
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Affiliation(s)
- Jonathan D. Santoro
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Department of NeurologyKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mellad M. Khoshnood
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Saba Jafarpour
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Lina Nguyen
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Natalie K. Boyd
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Benjamin N. Vogel
- Division of Neuroimmunology, Department of PediatricsChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Ryan Kammeyer
- Department of NeurologyChildren's Hospital ColoradoAuroraColoradoUSA
| | - Lina Patel
- Department of NeurologyChildren's Hospital ColoradoAuroraColoradoUSA
- Department of Pharmacology, Linda Crnic Institute for Down SyndromeUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Melanie A. Manning
- Department of GeneticsStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Angela L. Rachubinski
- Department of Pharmacology, Linda Crnic Institute for Down SyndromeUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Robyn A. Filipink
- Division of Child Neurology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Nicole T. Baumer
- Division of Developmental Medicine, Department of PediatricsBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Stephanie L. Santoro
- Genetics and Metabolism DivisionMassachusetts General Hospital for ChildrenBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Catherine Franklin
- Mater Research Institute‐UQThe University of QueenslandBrisbaneQueenslandAustralia
| | - Benita Tamrazi
- Department of RadiologyChildren's Hospital Los Angeles and Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kristen W. Yeom
- Department of RadiologyStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Gordon Worley
- Department of PediatricsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Joaquin M. Espinosa
- Department of Pharmacology, Linda Crnic Institute for Down SyndromeUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Michael S. Rafii
- Department of NeurologyKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
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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.
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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
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18
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Ungvari SG, Gazdag G. [The first concise description of catatonia, originating from Kahlbaum, is 150 years old]. Orv Hetil 2024; 165:197-198. [PMID: 38310521 DOI: 10.1556/650.2024.ho2774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Affiliation(s)
- S Gabor Ungvari
- 1 University of Notre Dame Australia Fremantle Australia
- 2 Division of Psychiatry, School of Medicine, University of Western Australia Perth Australia
| | - Gábor Gazdag
- 3 Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Pszichiátriai és Addiktológiai Centrum Budapest, Köves út 1., 1204 Magyarország
- 4 Semmelweis Egyetem, Általános Orvostudományi Kar, Pszichiátriai és Pszichoterápiás Klinika Budapest Magyarország
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Elmarasi O, Abdelhady S, Mahgoub Y. Thought Blocking as a Manifestation of Catatonia: A Case Report. J Nerv Ment Dis 2024; 212:120-121. [PMID: 38290105 DOI: 10.1097/nmd.0000000000001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
ABSTRACT Catatonia is an underrecognized disorder that has been widely described as a psychomotor syndrome, with little emphasis on its thought and cognitive dimensions. The current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision describes only motor and behavioral presentations, whereas a few catatonia scales describe only one form of thought disorders, which is thought perseveration. Thought blocking, a disorder of the thought process, is characterized by regular interruptions in the thought stream. It was described by several scholars as a sign of schizophrenia, with few reports describing thought blocking in association with catatonia. In this article, we describe the course of a patient with bipolar I disorder who presented with catatonia and demonstrated thought blocking. Her catatonic symptoms and thought blocking improved with the addition of lorazepam, recurred upon lorazepam discontinuation, and improved with resumption of lorazepam, demonstrating a clear on/off phenomenon. This report highlights the importance of recognizing thought and cognitive manifestations of catatonia, as it can enhance recognition and improve treatment.
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Affiliation(s)
- Omar Elmarasi
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Safaa Abdelhady
- Department of Psychiatry, Mansoura General Hospital, Ministry of Health and Population, Mansoura, Egypt
| | - Yassir Mahgoub
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, Pennsylvania
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20
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Brandt GA, Fritze S, Krayem M, Daub J, Volkmer S, Kukovic J, Meyer-Lindenberg A, Northoff G, Kubera KM, Wolf RC, Hirjak D. [German version of the Northoff scale for subjective experience in catatonia (NSSC-dv) : A validated instrument for examination of the subjective experience in catatonia]. DER NERVENARZT 2024; 95:10-17. [PMID: 38092982 PMCID: PMC10808566 DOI: 10.1007/s00115-023-01575-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 01/25/2024]
Abstract
Patients with catatonia often show serious motor, affective and behavioral symptoms, behind which the subjective experience often remains hidden. Therefore, this study disseminates our own systematic empirical investigation of the subjective experience of catatonia patients to a German-speaking audience of clinicians and researchers. Based on current evidence and the clinical experience of the authors, the self-report questionnaire Northoff Scale for Subjective Experience in Catatonia (NSSC) was modified, extended and validated and now consists of 26 items capturing the subjective experience of catatonia in its clinical diversity. A total of 46 patients with catatonia according to the International Classification of Diseases (11th revision, ICD-11) were asked about their subjective experience during the acute phase of the disease using the NSSC. The NSSC showed high internal consistency (Cronbach's alpha = 0.91). The NSSC total score was significantly associated with the Northoff Catatonia Rating Scale (NCRS; r = 0.46; p < 0.05), the total score of the Positive and Negative Syndrome Scale (PANSS; r = 0.30; p < 0.05), the Brief Psychiatric Rating Scale (BPRS; r = 0.33; p < 0.05), and Trait Anxiety (STAI; r = 0.64; p < 0.01), supporting its validity. Preliminary validation of the NSSC revealed good psychometric properties. The NSSC is a useful instrument for routine clinical use to assess the subjective experience of patients with catatonia in order to provide tailored psychotherapeutic interventions.
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Affiliation(s)
- Geva A Brandt
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Stefan Fritze
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Maria Krayem
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Jonas Daub
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Sebastian Volkmer
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Jacqueline Kukovic
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Andreas Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Kanada
| | - Katharina M Kubera
- Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universität Heidelberg, Heidelberg, Deutschland
| | - Robert Christian Wolf
- Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universität Heidelberg, Heidelberg, Deutschland
| | - Dusan Hirjak
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
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21
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Walther S, Nadesalingam N, Nuoffer M, Kyrou A, Wüthrich F, Lefebvre S. Structural alterations of the motor cortex and higher order cortical areas suggest early neurodevelopmental origin of catatonia in schizophrenia. Schizophr Res 2024; 263:131-138. [PMID: 36272843 DOI: 10.1016/j.schres.2022.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
The neurobiology of catatonia is still poorly understood. Particularly structural MRI studies yielded conflicting results. Heterogeneity of findings was suggested to stem from specifics of different rating scales. This study sought to test grey matter differences between patients with catatonia, patients without catatonia, and healthy controls using the two main instruments of catatonia rating. We included 98 patients with schizophrenia spectrum disorders and 42 healthy controls. Catatonia was measured using the Bush Francis Catatonia Rating Scale and the Northoff Catatonia Rating Scale. According to these scales, patients were classified into those with and those without catatonia. We tested whole brain grey matter volume, cortical thickness, and local gyrification across groups. Both catatonia rating scales correlated at tau = 0.65 but failed to classify identical subjects as catatonia patients. However, group differences in grey matter parameters were broadly similar with either rating scale to identify catatonia cases. Catatonia patients had reduced grey matter volume compared to controls in a large network including orbitofrontal cortex, cingulate, thalamus, and amygdala. While there was no group difference in cortical thickness, catatonia patients had increased local gyrification in premotor, motor, and parietal cortices compared to controls. Hypergyrification of the motor cortex and higher order cortical areas was found in catatonia patients compared to patients without catatonia. Both catatonia rating scales find similar symptom severity and group differences in grey matter indices. Catatonia is linked to reduced grey matter volume and increased local gyrification, suggesting some impact of early neurodevelopmental insults.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland
| | - Melanie Nuoffer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland
| | - Alexandra Kyrou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland
| | - Stephanie Lefebvre
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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22
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Hirjak D, Foucher JR, Ams M, Jeanjean LC, Kubera KM, Wolf RC, Northoff G. The origins of catatonia - Systematic review of historical texts between 1800 and 1900. Schizophr Res 2024; 263:6-17. [PMID: 35710511 DOI: 10.1016/j.schres.2022.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
Since January 1st 2022, catatonia is (again) recognized as an independent diagnostic entity in the 11th revision of the International Classification of Diseases (ICD-11). This is a relevant time to systematically review how the concept of catatonia has evolved within the 19th century and how this concept changed under the influence of a wide variety of events in the history of psychiatry. Here, we systematically reviewed historical and modern German and English texts focusing on catatonic phenomena, published from 1800 to 1900. We searched five different electronical databases (https://archive.org, www.hathitrust.org, www.books.google.de, https://link.springer.com and PubMed) and closely reviewed 60 historical texts on catatonic symptoms. Three main findings emerged: First, catatonic phenomena and their underlying mechanisms were studied decades before Karl Ludwig Kahlbaum's catatonia concept of 1874. Second, Kahlbaum not only introduced catatonia, but, more generally, also called for a new classification of psychiatric disorders based on a comprehensive analysis of the entire clinical picture, including the dynamic course and cross-sectional symptomatology. Third, the literature review shows that between 1800 and 1900 catatonic phenomena were viewed to be 'located' right at the interface of motor and psychological symptoms with the respective pathophysiological mechanisms being discussed. In conclusion, catatonia can truly be considered one of the most exciting and controversial entity in both past and present psychiatry and neurology, as it occupies a unique position in the border territory between organic, psychotic and psychogenic illnesses.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Jack R Foucher
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, CEMNIS (UF 4768) Non-invasive Neuromodulation Center, University Hospital Strasbourg, BP 426, 67 091 Strasbourg, France
| | - Miriam Ams
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ludovic C Jeanjean
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, CEMNIS (UF 4768) Non-invasive Neuromodulation Center, University Hospital Strasbourg, BP 426, 67 091 Strasbourg, France
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
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23
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Brandt GA, Fritze S, Krayem M, Daub J, Volkmer S, Kukovic J, Meyer-Lindenberg A, Northoff G, Kubera KM, Wolf RC, Hirjak D. Extension, translation and preliminary validation of the Northoff Scale for Subjective Experience in Catatonia (NSSC). Schizophr Res 2024; 263:282-288. [PMID: 37331880 DOI: 10.1016/j.schres.2023.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND In the last two decades, much neuroscientific research has been done on the pathomechanisms of catatonia. However, catatonic symptoms have mainly been assessed with clinical rating scales based on observer ratings. Although catatonia is often associated with strong affective reactions, the subjective domain of catatonia has simply been neglected in scientific research. METHODS The main objective of this study was to modify, extend and translate the original German version of the Northoff Scale for Subjective Experience in Catatonia (NSSC) and to examine its preliminary validity and reliability. Data were collected from 28 patients diagnosed with catatonia associated with another mental disorder (6A40) according to ICD-11. Descriptive statistics, correlation coefficients, internal consistency and principal component analysis were employed to address preliminary validity and reliability of the NSSC. RESULTS NSSC showed high internal consistency (Cronbach's alpha = 0.92). NSSC total scores were significantly associated with Northoff Catatonia Rating Scale (r = 0.50, p < .01) and Bush Francis Catatonia Rating Scale (r = 0.41, p < .05) thus supporting its concurrent validity. There was no significant association between NSSC total score and Positive and Negative Symptoms Scale total (r = 0.26, p = .09), Brief Psychiatric Rating Scale (r = 0.29, p = .07) and GAF (r = 0.03, p = .43) scores. CONCLUSION The extended version of the NSSC consists of 26 items and was developed to assess the subjective experience of catatonia patients. Preliminary validation of the NSSC revealed good psychometric properties. NSSC is a useful tool for everyday clinical work to assess the subjective experience of catatonia patients.
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Affiliation(s)
- Geva A Brandt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maria Krayem
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Daub
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sebastian Volkmer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jacqueline Kukovic
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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24
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Hirjak D, Brandt GA, Fritze S, Kubera KM, Northoff G, Wolf RC. Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types. Schizophr Res 2024; 263:93-98. [PMID: 36610862 DOI: 10.1016/j.schres.2022.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND A comprehensive assessment of catatonic symptoms is decisive for diagnosis, neuronal correlates, and evaluation of treatment response and prognosis of catatonia. Studies conducted so far used different cut-off criteria and clinical rating scales to assess catatonia. Therefore, the main aim of this study was to examine the frequency and distribution of diagnostic criteria and clinical rating scales for assessing catatonia that were used in scientific studies so far. METHODS We conducted a systematic review using PubMed searching for articles using catatonia rating scales/criteria published from January 1st 1952 (introduction of catatonic schizophrenia to first edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM]) up to December 5th, 2022. RESULTS 1928 articles were considered for analysis. 1762 (91,39 %) studies used one and 166 (8,61 %) used ≥2 definitions of catatonia. However, 979 (50,7 %) articles did not report any systematic assessment of catatonia. As for clinical criteria, DSM criteria were used by the majority of studies (n = 290; 14.0 %), followed by International Classification of Diseases (ICD) criteria (n = 61; 2.9 %). The Bush-Francis Catatonia Rating Scale (BFCRS) was found to be by far the most frequently utilized scale (n = 464; 22.4 % in the respective years), followed by Northoff Catatonia Rating Scale (NCRS) (n = 31; 1.5 % in the respective years). CONCLUSION DSM and ICD criteria as well as BFCRS and NCRS were most frequently utilized and can therefore be recommended as valid instruments for the assessment of catatonia symptomatology.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Geva A Brandt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
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25
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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.
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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
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Cattarinussi G, Gugliotta AA, Hirjak D, Wolf RC, Sambataro F. Brain mechanisms underlying catatonia: A systematic review. Schizophr Res 2024; 263:194-207. [PMID: 36404217 DOI: 10.1016/j.schres.2022.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Catatonia is a complex psychomotor disorder characterized by motor, affective, and behavioral symptoms. Despite being known for almost 150 years, its pathomechanisms are still largely unknown. METHODS A systematic research on PubMed, Web of Science, and Scopus was conducted to identify neuroimaging studies conducted on group or single individuals with catatonia. Overall, 33 studies employing structural magnetic resonance imaging (sMRI, n = 11), functional magnetic resonance imaging (fMRI, n = 10), sMRI and fMRI (n = 2), functional near-infrared spectroscopy (fNIRS, n = 1), single positron emission computer tomography (SPECT, n = 4), positron emission tomography (PET, n = 4), and magnetic resonance spectroscopy (MRS, n = 1), and 171 case reports were retrieved. RESULTS Observational sMRI studies showed numerous brain changes in catatonia, including diffuse atrophy and signal hyperintensities, while case-control studies reported alterations in fronto-parietal and limbic regions, the thalamus, and the striatum. Task-based and resting-state fMRI studies found abnormalities located primarily in the orbitofrontal, medial prefrontal, motor cortices, cerebellum, and brainstem. Lastly, metabolic and perfusion changes were observed in the basal ganglia, prefrontal, and motor areas. Most of the case-report studies described widespread white matter lesions and frontal, temporal, or basal ganglia hypoperfusion. CONCLUSIONS Catatonia is characterized by structural, functional, perfusion, and metabolic cortico-subcortical abnormalities. However, the majority of studies and case reports included in this systematic review are affected by considerable heterogeneity, both in terms of populations and neuroimaging techniques, which calls for a cautious interpretation. Further elucidation, through future neuroimaging research, could have great potential to improve the description of the neural motor and psychomotor mechanisms underlying catatonia.
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Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy
| | | | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert C Wolf
- Department of General Psychiatry at the Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
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27
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Waddington JL. From operational diagnostic to dimensional-continuum concepts of psychotic and non-psychotic illness: Embracing catatonia across psychopathology and intrinsic movement disorder in neural network dysfunction. Schizophr Res 2024; 263:99-108. [PMID: 36244867 DOI: 10.1016/j.schres.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 03/04/2023]
Abstract
Psychiatry is currently negotiating several challenges that are typified by (but are not unique to) schizophrenia: do periodic refinements in operational diagnostic algorithms (a) resolve intricacies and subtleties within and between psychotic and non-psychotic disorders that are authentic and impactful, or (b) constitute arbitrary and porous boundaries that should be complemented, or even replaced, by dimensional-continuum concepts of abnormality and dysfunction. Critically, these issues relate not only to apparent boundaries between diagnoses but also to those between 'health' and 'illness'. This article considers catatonia within evolving dimensional-continuum approaches to the description of impairment and dysfunction among psychotic and non-psychotic disorders. It begins by considering the definition and assessment of catatonia vis-à-vis other disorders, followed by its long-standing conjunction with schizophrenia, relationship with antipsychotic drug treatment, transdiagnostic perspectives and relationships, and pathobiological processes. These appear to involve dysfunction across elements in overlapping neural networks that result in a confluence of psychopathology and intrinsic hypo- and hyperkinetic motor dysfunction. It has been argued that while current diagnostic approaches can have utility in defining groups of cases that are closely related, contemporary evidence indicates categorical diagnoses to be arbitrary divisions of what is essentially a continuous landscape. Psychotic and non-psychotic diagnoses, including catatonia, may reflect arbitrary areas around points of intersection between orthogonal dimensions of psychopathology and intrinsic movement disorder in a poly-dimensional space that characterises this continuous landscape of mental health and dysfunction.
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Affiliation(s)
- John L Waddington
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Jiangsu Key Laboratory of Translational Research & Therapy for Neuropsychiatric Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.
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28
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Affiliation(s)
- Stephan Heckers
- From the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville (S.H., S.W.); and the Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland (S.W.)
| | - Sebastian Walther
- From the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville (S.H., S.W.); and the Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland (S.W.)
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29
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Serrat F, Cuevas-Esteban J, Baladon L, Rabaneda-Lombarte N, Díez-Quevedo C, Iglesias-González M. Factor analysis and validation of the Bush Francis catatonia rating scale-Spain version. THE EUROPEAN JOURNAL OF PSYCHIATRY 2023; 37:100221. [DOI: 10.1016/j.ejpsy.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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30
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Gandhi K, Nguyen K, Driscoll M, Islam Z, Maru S. Catatonia, Pregnancy, and Electroconvulsive Therapy (ECT). Case Rep Psychiatry 2023; 2023:9601642. [PMID: 37456983 PMCID: PMC10348863 DOI: 10.1155/2023/9601642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Background Catatonia is a neuropsychiatric syndrome, which typically occurs in the context of another psychiatric or medical condition, with a significant morbidity and mortality risk. Significant medical conditions resulting from catatonia include nutritional deficiencies, skin ulcerations, electrolyte disturbances, aspiration pneumonia, and venous thromboembolism. As a result, prompt treatment is required. Gold standard treatment consists of benzodiazepines, followed by electroconvulsive therapy (ECT) if pharmacotherapy alone is ineffective. With pregnancy and catatonia, there is a high risk of adverse maternal/fetal outcomes, and the risks/benefits of treatment must be carefully considered. Case Here, we present a case of a young pregnant woman with schizoaffective disorder whose catatonic state was not successfully resolved with lorazepam, therefore requiring ECT. Patient presented to the emergency department at 20 weeks of pregnancy, displaying symptoms of catatonia and psychosis. She was admitted to the inpatient behavioral health unit, where she was treated with lorazepam for catatonia. Treatment occurred in close collaboration with the obstetrics team. While initially, the patient appeared to have a positive response to lorazepam, she became increasingly catatonic with minimal oral intake, mutism, and urinary retention. As a result, she was transferred to the medical floor, where ECT was initiated due to the ineffectiveness of lorazepam. Her catatonia was successfully resolved with 12 total treatments of ECT; there were no adverse effects to the fetus. Patient delivered her baby at 39 weeks with no complications. She continued to receive inpatient psychiatric care until she was stable for discharge to an extended acute care unit. Objectives In this report, we will review relevant literature on catatonia in pregnancy, with focus on treatment with ECT. Conclusions Though the literature on these topics is limited and typically presented in case reports format, there appears to be a favorable view toward the use of ECT for pregnant catatonic patients. This case could be considered a vital contribution to the literature, as it provides a successful example of treating catatonia in pregnancy with no known adverse effects to the mother or child.
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Affiliation(s)
- Khushbu Gandhi
- Department of Psychiatry, Lehigh Valley Health Network, Bethlehem, PA, USA
| | - KieuHanh Nguyen
- Department of Psychiatry, Lehigh Valley Health Network, Bethlehem, PA, USA
| | - Maggie Driscoll
- Department of Psychiatry, Lehigh Valley Health Network, Bethlehem, PA, USA
| | - Zahid Islam
- Department of Psychiatry, Lehigh Valley Health Network, Bethlehem, PA, USA
| | - Siddhartha Maru
- Department of Psychiatry, Lehigh Valley Health Network, Bethlehem, PA, USA
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Ryazanova MA, Plekanchuk VS, Prokudina OI, Makovka YV, Alekhina TA, Redina OE, Markel AL. Animal Models of Hypertension (ISIAH Rats), Catatonia (GC Rats), and Audiogenic Epilepsy (PM Rats) Developed by Breeding. Biomedicines 2023; 11:1814. [PMID: 37509453 PMCID: PMC10376947 DOI: 10.3390/biomedicines11071814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Research into genetic and physiological mechanisms of widespread disorders such as arterial hypertension as well as neuropsychiatric and other human diseases is urgently needed in academic and practical medicine and in the field of biology. Nevertheless, such studies have many limitations and pose difficulties that can be overcome by using animal models. To date, for the purposes of creating animal models of human pathologies, several approaches have been used: pharmacological/chemical intervention; surgical procedures; genetic technologies for creating transgenic animals, knockouts, or knockdowns; and breeding. Although some of these approaches are good for certain research aims, they have many drawbacks, the greatest being a strong perturbation (in a biological system) that, along with the expected effect, exerts side effects in the study. Therefore, for investigating the pathogenesis of a disease, models obtained using genetic selection for a target trait are of high value as this approach allows for the creation of a model with a "natural" manifestation of the pathology. In this review, three rat models are described: ISIAH rats (arterial hypertension), GC rats (catatonia), and PM rats (audiogenic epilepsy), which are developed by breeding in the Laboratory of Evolutionary Genetics at the Institute of Cytology and Genetics (the Siberian Branch of the Russian Academy of Sciences).
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Affiliation(s)
- Marina A Ryazanova
- Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Vladislava S Plekanchuk
- Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Olga I Prokudina
- Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Yulia V Makovka
- Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630090, Russia
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk 630090, Russia
| | - Tatiana A Alekhina
- Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Olga E Redina
- Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Arcady L Markel
- Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630090, Russia
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk 630090, Russia
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Ungvari GS, Caroff SN, Csihi L, Gazdag G. Catatonia: “Fluctuat nec mergitur”. World J Psychiatry 2023; 13:131-137. [PMID: 37303935 PMCID: PMC10251365 DOI: 10.5498/wjp.v13.i5.131] [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: 01/21/2023] [Revised: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
In the beginning of the 1900s, the prevalence of catatonia in inpatient samples was reported to be between 19.5% and 50%. From the mid-1900s, most clinicians thought that catatonia was disappearing. Advances in medical sciences, particularly in the field of neurology, may have reduced the incidence of neurological diseases that present with catatonic features or mitigated their severity. More active pharmacological and psychosocial treatment methods may have either eliminated or moderated catatonic phenomena. Moreover, the relatively narrow descriptive features in modern classifications compared with classical texts and ascribing catatonic signs and symptoms to antipsychotic-induced motor symptoms may have contributed to an apparent decline in the incidence of catatonia. The application of catatonia rating scales introduced in the 1990s revealed significantly more symptoms than routine clinical interviews, and within a few years, the notion of the disappearance of catatonia gave way to its un-expected resurgence. Several systematic investigations have found that, on average, 10% of acute psychotic patients present with catatonic features. In this editorial, the changes in the incidence of catatonia and the possible underlying causes are reviewed.
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Affiliation(s)
- Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Western Australia, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Western Australia, Australia
| | - Stanley N Caroff
- Department of Psychiatric Service, Corporal Michael J Cresencz Veterans Affairs Medical Center, Philadelphia, PA 19104, United States
- Department of Psychiatric Service, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Levente Csihi
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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Petrescu C, Petrescu DM, Marian G, Focseneanu BE, Iliuta FP, Ciobanu CA, Papacocea S, Ciobanu AM. Neurological Soft Signs in Schizophrenia, a Picture of the Knowledge in the Last Decade: A Scoping Review. Healthcare (Basel) 2023; 11:1471. [PMID: 37239757 PMCID: PMC10217815 DOI: 10.3390/healthcare11101471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Neurological Soft Signs (NSS) are subtle neurological abnormalities that are more common in schizophrenia patients than in healthy individuals and have been regularly observed in neuroleptic-naive first-episode patients, supporting the hypothesis that they are an intrinsic component of schizophrenia. (2) Methods: a review of articles published in the last ten years (from January 2013 to January 2023) was carried out on articles published in ScienceDirect and PubMed, by following the PRISMA Statement extension for scoping reviews (PRISMA-ScR), which evaluated the impact of NSS in correlation with the symptomatology, neuroleptic treatment, and the cerebral structural changes of patients with schizophrenia. (3) Results: thirty articles were included, among them twelve included MRI structural evaluation and four studies with a longitudinal design. (4) Conclusions: interest in researching NSS has increased in recent years, but questions remain about their origin and relationship to schizophrenia symptoms, thus this study aims to fill in information gaps in the hope that future research will help provide individualized treatment. It is suggested that NSS in schizophrenia might have an inherited genetic relationship pattern, thus being in line with a trait viewpoint. Most of the research revealed that schizophrenia patients had higher NSS scores than healthy controls, however, they were rather similar to their first-degree relatives, thus, also arguing in favor of a trait perspective. The greatest improvement in scores is seen in those with a remitting course, as shown by declining NSS ratings concurrent with symptomatology.
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Affiliation(s)
- Cristian Petrescu
- Department of Psychiatry, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania;
| | - Diana M. Petrescu
- Neurology Clinic Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Gabriela Marian
- Academy of Romanian Scientists, 050045 Bucharest, Romania;
- Department of Psychiatry and Psychology, Titu Maiorescu University of Medicine, 040441 Bucharest, Romania
| | - Brindusa E. Focseneanu
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania;
- Department of Psychiatry and Psychology, Titu Maiorescu University of Medicine, 040441 Bucharest, Romania
| | - Floris Petru Iliuta
- Department of Psychiatry and Psychology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | | | - Serban Papacocea
- Department of Neurosurgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Adela M. Ciobanu
- Department of Psychiatry, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania;
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Palffy A, Ghaziuddin N. Letter to the Editor regarding "Unexplained regression in Down syndrome: Management of 51 patients in an international patient database" by Santoro et al. Am J Med Genet A 2023; 191:1474-1475. [PMID: 36598151 DOI: 10.1002/ajmg.a.63117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Alexander Palffy
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Neera Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Rogers JP, Oldham MA, Fricchione G, Northoff G, Ellen Wilson J, Mann SC, Francis A, Wieck A, Elizabeth Wachtel L, Lewis G, Grover S, Hirjak D, Ahuja N, Zandi MS, Young AH, Fone K, Andrews S, Kessler D, Saifee T, Gee S, Baldwin DS, David AS. Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2023; 37:327-369. [PMID: 37039129 PMCID: PMC10101189 DOI: 10.1177/02698811231158232] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.
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Affiliation(s)
- Jonathan P Rogers
- Division of Psychiatry, University College
London, London, UK
- South London and Maudsley NHS Foundation
Trust, London, UK
| | - Mark A Oldham
- Department of Psychiatry, University of
Rochester Medical Center, Rochester, NY, USA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research
Unit, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON,
Canada
| | - Jo Ellen Wilson
- Veterans Affairs, Geriatric Research,
Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Psychiatry and Behavioral
Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Andrew Francis
- Penn State Medical School, Hershey Medical
Center, PA, USA
| | - Angelika Wieck
- Greater Manchester Mental Health NHS
Foundation Trust, Manchester, UK
- Institute of Population Health, University
of Manchester, Manchester, UK
| | - Lee Elizabeth Wachtel
- Kennedy Krieger Institute, Baltimore,
Maryland, USA
- Department of Psychiatry, Johns Hopkins
School of Medicine, Baltimore, Maryland, USA
| | - Glyn Lewis
- Division of Psychiatry, University College
London, London, UK
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate
Institute of Medical Education and Research, Chandigarh, CH, India
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy,
Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg,
Mannheim, Germany
| | - Niraj Ahuja
- Regional Affective Disorders Service,
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Michael S Zandi
- Queen Square Institute of Neurology,
University College London, London, UK
- National Hospital for Neurology and
Neurosurgery, London, UK
| | - Allan H Young
- South London and Maudsley NHS Foundation
Trust, London, UK
- Department of Psychological Medicine,
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Kevin Fone
- School of Life Sciences, Queen’s Medical
Centre, The University of Nottingham, Nottingham, UK
| | | | - David Kessler
- Centre for Academic Mental Health,
University of Bristol, Bristol, UK
| | - Tabish Saifee
- National Hospital for Neurology and
Neurosurgery, London, UK
| | - Siobhan Gee
- Pharmacy Department, South London and
Maudsley NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine,
King’s College London, London, UK
| | - David S Baldwin
- Clinical Neuroscience, Clinical and
Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anthony S David
- Institute of Mental Health, University
College London, London, UK
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Peritogiannis V, Rizos DV. Catatonia Due to General Medical Conditions in Psychiatric Patients: Implications for Clinical Practice. PSYCHIATRY INTERNATIONAL 2023; 4:18-27. [DOI: 10.3390/psychiatryint4010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] 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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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 54 Pashidi Str., 45445 Ioannina, Greece
| | - Dimitrios V. Rizos
- Intensive Care Unit, “Hatzikosta” General Hospital, 45445 Ioannina, Greece
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Katzell L, Beydler E, dos Santos AS, Vijayvargiya R, Carr BR. Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy: A case report. Front Psychiatry 2023; 14:1143407. [PMID: 37032940 PMCID: PMC10076653 DOI: 10.3389/fpsyt.2023.1143407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Neuroleptic malignant syndrome (NMS), thought to arise through dopamine antagonism, is life-threatening. While prompt diagnosis of NMS is critical, it may be obscured by other diagnoses, such as malignant catatonia, with overlapping, life-threatening symptoms. Initiation of dopamine-blocking agents such as antipsychotics and abrupt cessation of dopaminergic medications such as amantadine can precipitate NMS. Once NMS is suspected, deft medical management should ensue. Multiple case reports detail electroconvulsive therapy's (ECT's) effectiveness in the treatment of NMS. While this relationship is well-documented, there is less literature regarding comparative efficacy of ECT in the acute treatment of NMS-like states precipitated by withdrawal of dopamine agonists, such as amantadine. Case We present a 52-year-old female with schizoaffective disorder bipolar type, with a history of a lorazepam-resistant catatonic episode the prior year that had responded to amantadine. She presented febrile with altered mental status, lead pipe rigidity, mutism, grasp reflex, stereotypy, autonomic instability, and a Bush-Francis Catatonia Rating Scale (BFCRS) of 24, suggesting malignant catatonia versus NMS. There was concern over a potentially abrupt cessation of her amantadine of which she had been prescribed for the past year. Interventions Organic etiologies were ruled out, and a presumptive diagnosis of NMS was made with central dopaminergic depletion from abrupt dopamine agonist (amantadine) withdrawal as the suspected underlying etiology. After intravenous lorazepam and reinduction of amantadine failed to alleviate her symptoms, urgent ECT was initiated. Our patient received an index series of ECT of seven treatments. After ECT #1 she was no longer obtunded, after treatment #2 her symptoms of mutism, rigidity, stereotypy, and agitation showed improvement, and by ECT #3, the NMS had rapidly dissipated as evidenced by stable vital signs, lack of rigidity, and coherent conversation. Conclusion Brisk identification of potentially life-threatening NMS and NMS-like states, including malignant catatonia, warrants a trial of ECT. ECT's theoretical mechanisms of action coincide with the theoretical pathophysiology of the conditions. It is a viable and safe treatment option for reducing mortality. With prompt initiation of ECT, we obtained rapid control of a condition with a potentially high mortality.
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Affiliation(s)
- Lauren Katzell
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Emily Beydler
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Amílcar Silva dos Santos
- Neuroscience Unit, CUF Tejo Hospital, Lisbon, Portugal
- Mental Health Department, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Universidade do Mindelo, Mindelo, São Vicente, Cape Verde
| | - Richa Vijayvargiya
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Brent R. Carr
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
- *Correspondence: Brent R. Carr,
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Weleff J, Barnett BS, Park DY, Akiki TJ, Aftab A. The State of the Catatonia Literature: Employing Bibliometric Analysis of Articles From 1965-2020 to Identify Current Research Gaps. J Acad Consult Liaison Psychiatry 2023; 64:13-27. [PMID: 35840002 DOI: 10.1016/j.jaclp.2022.07.002] [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: 09/27/2021] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since Kahlbaum's classic 19th-century description of catatonia, our conceptualization of this syndrome, as well treatment options for it, has advanced considerably. However, little is known about the current state of the catatonia literature since a comprehensive bibliometric analysis of it has not yet been undertaken. OBJECTIVE The purpose of this study was to conduct a bibliometric analysis, along with a content analysis of articles reporting new findings, to better understand the catatonia literature and how catatonia research is changing. METHODS Using the search term "Title(catatoni∗)" in Web of Science Core Collection for all available years (1965-2020), all available publications (articles, proceeding papers, reviews) pertaining directly to catatonia were identified, and metadata extracted. Semantic and coauthorship network analyses were conducted. A content analysis was also conducted on all available case reports, case series, and research articles written in English. RESULTS A total of 1015 articles were identified representing 2861 authors, 346 journals, and 15,639 references. The average number of publications per year over the last 20 years (31.3) more than doubled in comparison to that in the 20 years prior (12.8). The top 3 most common journals were Psychosomatics/Journal of the Academy of Consultation-Liaison Psychiatry, Journal of ECT, and Schizophrenia Research, which represented 12.6% of all publications. Content analysis revealed that catatonia articles are increasingly published in nonpsychiatric journals. There was a notable paucity of clinical trials throughout the study period. Since 2003, articles on catatonia secondary to a general medical condition, as well as articles including child/adolescent patients and patients with autism spectrum disorder or intellectual disability, have made up increasing shares of the literature, with a smaller proportion of articles reporting periodic or recurrent catatonia. We noted a decrease in the proportion of articles detailing animal/in vitro studies, genetic/heredity studies, and clinical trials, along with stagnation in the proportion of neuroimaging studies. CONCLUSIONS The catatonia literature is growing through contributions from authors and institutions across multiple countries. However, recent growth has largely been driven by increased case reports, with significant downturns observed in both clinical and basic science research articles. A dearth of clinical trials evaluating potential treatments remain a critical gap in the catatonia literature.
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Affiliation(s)
- Jeremy Weleff
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH; Department of Psychiatry, Yale University School of Medicine, New Haven, CT.
| | - Brian S Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, EC-10 Cleveland Clinic, Cleveland, OH
| | - Deborah Y Park
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, EC-10 Cleveland Clinic, Cleveland, OH
| | - Teddy J Akiki
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH; Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Awais Aftab
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH; Northcoast Behavioral Healthcare, Ohio Department of Mental Health and Addiction Services, Northfield, OH
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Luccarelli J, Kalinich M, McCoy TH, Fricchione G, Smith F, Beach SR. Co-Occurring Catatonia and COVID-19 Diagnoses Among Hospitalized Individuals in 2020: A National Inpatient Sample Analysis. J Acad Consult Liaison Psychiatry 2022; 64:209-217. [PMID: 36592693 PMCID: PMC9872966 DOI: 10.1016/j.jaclp.2022.12.010] [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: 10/07/2022] [Revised: 11/30/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND COVID-19 is associated with a range of neuropsychiatric manifestations. While case reports and case series have reported catatonia in the setting of COVID-19 infection, its rate has been poorly characterized. OBJECTIVE This study reports the co-occurrence of catatonia and COVID-19 diagnoses among acute care hospital discharges in the United States in 2020. METHODS The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients of any age discharged with a diagnosis of catatonia and COVID-19 in 2020. RESULTS Among 32,355,827 hospitalizations in the 2020 National Inpatient Sample, an estimated 15,965 (95% confidence interval: 14,992-16,938) involved a diagnosis of catatonia without COVID-19 infection, 1,678,385 (95% confidence interval: 1,644,738-1,712,022) involved a diagnosis of COVID-19 without a co-occurring catatonia diagnosis, and 610 (95% confidence interval: 578-642) involved both catatonia and COVID-19 infection. In an adjusted model, a diagnosis of COVID-19, but not a diagnosis of catatonia or the combination of catatonia and COVID-19, was associated with increased mortality. Patients with catatonia and COVID-19 were frequently diagnosed with encephalopathy and delirium codes. CONCLUSIONS Catatonia and COVID-19 were rarely co-diagnosed in 2020, and catatonia diagnosis was not associated with increased mortality in patients with COVID-19. Further research is needed to better characterize the phenomenology of catatonia in the setting of COVID-19 infection and its optimal treatment.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Send correspondence and reprint requests to James Luccarelli, MD, DPhil, Massachusetts General Hospital, 32 Fruit Street Yawkey 6A, Boston, MA 02114
| | - Mark Kalinich
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Thomas H. McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Felicia Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
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Styan T, Lee J, Wang J. A rare case of catatonia associated with COVID-19 infection. PSYCHIATRY RESEARCH CASE REPORTS 2022; 1:100054. [PMID: 36105919 PMCID: PMC9461279 DOI: 10.1016/j.psycr.2022.100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Tara Styan
- Department of Psychiatry, Royal Columbian Hospital, Mental Health and Substance Use Wellness Centre, 330 E Columbia St, New Westminster, BC V3L 3M2, Canada
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Julian Lee
- Department of Neurology, Royal Columbian Hospital, 330 E Columbia St, New Westminster, BC V3L 3M2, Canada
| | - Jay Wang
- Department of Psychiatry, Royal Columbian Hospital, Mental Health and Substance Use Wellness Centre, 330 E Columbia St, New Westminster, BC V3L 3M2, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
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Das S, Prasad S, Fichadia PA, Shrestha AB, Amuk Williams OC, Bachu A. Recurrent Catatonia due to Episodic Obsessive-Compulsive Disorder. Case Rep Psychiatry 2022; 2022:2022474. [PMID: 36425076 PMCID: PMC9681564 DOI: 10.1155/2022/2022474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 09/08/2024] Open
Abstract
Background Catatonia is regarded as a diverse type of motor dysregulation syndrome that includes mutism, immobility, catalepsy, negativism, stereotypies, and echo phenomena. Catatonia is known to coexist with a wide range of physical and mental health conditions, including mood disorders, schizophrenia, autoimmune disorders, and metabolic abnormalities. Albeit, the association between obsessive-compulsive disorder (OCD) and catatonia is underreported, and mechanisms are not well elucidated. Study. In this study, we present a case of a 36-year-old woman who developed episodes of catatonia during the course of her obsessive-compulsive disorder (OCD). Success rates have been recorded with both benzodiazepines and electroconvulsive therapy (ECT). Gauging the severity of her symptoms and poor drug compliance, the patient was opted for and successfully treated with ECT. She was also educated about OCD through a series of therapy sessions and exposure and response prevention (ERP) principles. She was maintained on ERP and adjunctive clonazepam upon discharge. On subsequent follow-ups, the patient seemed to be doing well and was eager to begin her job again. Conclusion Our study shows a possible link between OCD and catatonia. Additionally, robust studies are needed in order to determine the pathophysiology of catatonia and the mechanism of ECT so that more beneficial therapeutics can be developed. A combination of ECT and antidepressants with ERP therapy for recurrent catatonia with OCD could be effective as a therapeutic modality.
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Affiliation(s)
- Soumitra Das
- Emergency Mental Health, Sunshine Hospital, Melbourne, Australia
| | - Sakshi Prasad
- Faculty of Medicine, National Pirogov Memorial Medical University, 21018 Vinnytsya, Ukraine
| | | | | | | | - Anil Bachu
- Department of Psychiatry, Baptist Health-UAMS Combined Program, Little Rock, Arkansas, USA
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Andersson P, Wachtel LE, Lundberg J, Jamshidi E, Bring J, Rask-Andersen M, Jarbin H, Jokinen J, Desai Boström AE. Youth with severe mental illness and complex non-somatic motor abnormalities: conflicting conceptualizations and unequal treatment. NPJ MENTAL HEALTH RESEARCH 2022; 1:13. [PMID: 37521496 PMCID: PMC9533273 DOI: 10.1038/s44184-022-00013-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/11/2022] [Indexed: 11/08/2022]
Abstract
Two emerging diagnostic concepts promote distinct treatments for youth with acute-onset motor abnormalities and severe concurrent psychiatric symptoms: Pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric catatonia. Both have institutional approval in parts of Europe and in the USA, meriting an unconditional comparison of supporting evidence. Here we report results of qualitative and quantitative analyses of literature and Swedish National Registry Data suggesting that (1) catatonic patients are liable to fulfilling diagnostic criteria for PANS, (2) three conservatively assessed PANS case-reports present with possible unrecognized catatonia, (3) lithium and electroconvulsive therapy usage frequencies in Swedish minors (exclusively recommended for severe mental illness) are strongly intercorrelated and unequally distributed across Swedish counties, (4) established severe mental disorders are rarely overtly considered amongst PANS-specific research and (5) best-available evidence treatments appear markedly superior for pediatric catatonia compared to PANS in both childhood and adolescence. Prioritizing treatments for pediatric catatonia in concerned subjects could markedly improve treatment outcomes.
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Affiliation(s)
- Peter Andersson
- Department of Clinical Neuroscience/Psychology, Karolinska Institute, Stockholm, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Lee E. Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Esmail Jamshidi
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | | | - Mathias Rask-Andersen
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Håkan Jarbin
- Department of Clinical Sciences Lund, Section of Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
| | - Jussi Jokinen
- Department of Clinical Neuroscience/Psychology, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Adrian E. Desai Boström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
- Department of Women’s and Children’s Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden
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Ariza-Salamanca DF, Corrales-Hernández MG, Pachón-Londoño MJ, Hernández-Duarte I. Molecular and cellular mechanisms leading to catatonia: an integrative approach from clinical and preclinical evidence. Front Mol Neurosci 2022; 15:993671. [PMID: 36245923 PMCID: PMC9558725 DOI: 10.3389/fnmol.2022.993671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
This review aims to describe the clinical spectrum of catatonia, in order to carefully assess the involvement of astrocytes, neurons, oligodendrocytes, and microglia, and articulate the available preclinical and clinical evidence to achieve a translational understanding of the cellular and molecular mechanisms behind this disorder. Catatonia is highly common in psychiatric and acutely ill patients, with prevalence ranging from 7.6% to 38%. It is usually present in different psychiatric conditions such as mood and psychotic disorders; it is also a consequence of folate deficiency, autoimmunity, paraneoplastic disorders, and even autistic spectrum disorders. Few therapeutic options are available due to its complexity and poorly understood physiopathology. We briefly revisit the traditional treatments used in catatonia, such as antipsychotics, electroconvulsive therapy, and benzodiazepines, before assessing novel therapeutics which aim to modulate molecular pathways through different mechanisms, including NMDA antagonism and its allosteric modulation, and anti-inflammatory drugs to modulate microglia reaction and mitigate oxidative stress, such as lithium, vitamin B12, and NMDAr positive allosteric modulators.
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Affiliation(s)
- Daniel Felipe Ariza-Salamanca
- Medical and Health Sciences Education Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- *Correspondence: Daniel Felipe Ariza-Salamanca
| | - María Gabriela Corrales-Hernández
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - María José Pachón-Londoño
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Isabella Hernández-Duarte
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Parekh P, Gozi A, Reddi VSK, Saini J, John JP. Resting state functional connectivity and structural abnormalities of the brain in acute retarded catatonia: an exploratory MRI study. Eur Arch Psychiatry Clin Neurosci 2022; 272:1045-1059. [PMID: 34668026 DOI: 10.1007/s00406-021-01345-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 10/04/2021] [Indexed: 12/27/2022]
Abstract
In this first cross-sectional MRI study in acute catatonia, we compared the resting state whole-brain, within-network and seed (left precentral gyrus)-to-voxel connectivity, as well as cortical surface complexity between a sample of patients in acute retarded catatonic state (n = 15) diagnosed as per DSM-5 criteria and a demographically matched healthy control sample (n = 15). The patients had comorbid Axis-I psychiatric disorders including schizophrenia spectrum disorders and psychotic mood disorders, but did not have diagnosable neurological disorders. Acute retarded catatonia was characterized by reduced resting state functional connectivity, most robustly within the sensorimotor network; diffuse region of interest (ROI)-ROI hyperconnectivity; and seed-to-voxel hyperconnectivity in the frontoparietal and cerebellar regions. The seed (left precentral gyrus)-to-voxel connectivity was positively correlated to the catatonia motor ratings. The ROI-ROI as well as seed-to-voxel functional hyperconnectivity were noted to be higher in lorazepam responders (n = 9) in comparison to the non-responders (n = 6). The overall Hedges' g effect sizes for these analyses ranged between 0.82 and 3.53, indicating robustness of these results, while the average Dice coefficients from jackknife reliability analyses ranged between 0.6 and 1, indicating fair (inter-regional ROI-ROI connectivity) to perfect (within-sensorimotor network connectivity) reliability of the results. The catatonia sample showed reduced vertex-wise cortical complexity in the right insular cortex and contiguous areas. Thus, we have identified neuroimaging markers of the acute retarded catatonic state that may show an association with treatment response to benzodiazepines. We discuss how these novel findings have important translational implications for understanding the pathophysiology of catatonia as well as for the mechanistic understanding and prediction of treatment response to benzodiazepines.
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Affiliation(s)
- Pravesh Parekh
- Multimodal Brain Image Analysis Laboratory, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.,Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Anirban Gozi
- Multimodal Brain Image Analysis Laboratory, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.,Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | | | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - John P John
- Multimodal Brain Image Analysis Laboratory, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India. .,Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
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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: 2.3] [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.
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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
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Smulevich AB, Lobanova VM, Piskarev MV, Ilyina NA. Evolution of the Affective Catatonia Concept in XIX–XXI Centuries. PSIKHIATRIYA 2022; 20:97-108. [DOI: 10.30629/2618-6667-2022-20-2-97-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Affiliation(s)
- A. B. Smulevich
- FSBSI “Mental Health Research Centre”; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
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Malone K, Saveen S, Stevens CM, McNeil S. Successful Treatment of Catatonia: A Case Report and Review of Treatment. Cureus 2022; 14:e26328. [PMID: 35911277 PMCID: PMC9311495 DOI: 10.7759/cureus.26328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/13/2022] Open
Abstract
Herein, we report the case of a 20-year-old Caucasian male with a previous psychiatric history of schizophreniform, autism, unspecified intellectual disorder, and past medical history of hypertension, who presented after a suicidal attempt. One month prior to admission for the suicidal attempt, the patient had mutism. While admitted, the patient showed signs of mutism, posturing, negativism, and waxy flexibility. Treatment with both aripiprazole and lorazepam was effective and reversed the patient’s catatonia after low-dose titration. This case highlights the importance of reviewing patient history and presenting symptoms in the management of catatonia. Additionally, this case provides an opportunity to review the diagnostic approach and treatment type used for patients presenting with catatonia.
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Ramirez-Bermudez J, Medina-Gutierrez A, Gomez-Cianca H, Arias P, Pérez-Gonzalez A, Lebrija-Reyes PA, Espinola-Nadurille M, Aguilar-Venegas LC, Ojeda-López C, Restrepo-Martínez M, Bayliss L, Juárez-Jaramillo CA, Peñaloza G, Rivas-Alonso V, Flores-Rivera J, Gómez-Amador JL, Rios C, Sachdev PS. Clinical Significance of Delirium With Catatonic Signs in Patients With Neurological Disorders. J Neuropsychiatry Clin Neurosci 2022; 34:132-140. [PMID: 35040665 DOI: 10.1176/appi.neuropsych.18120364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE According to DSM-5, catatonia and delirium are mutually exclusive clinical syndromes. The investigators explored the co-occurrence of delirium and catatonia (i.e., catatonic delirium) and the clinical significance of this syndrome with a sample of neurological patients. METHODS This prospective study with consecutive sampling included patients diagnosed with delirium at the National Institute of Neurology and Neurosurgery of Mexico. DSM-5 criteria for delirium, the Confusion Assessment Method, and the Delirium Rating Scale-Revised-98 were used to select and characterize patients. Catatonia was assessed using the Bush-Francis Catatonia Rating Scale and DSM-5 diagnostic criteria. Logistic regression analysis was performed to identify etiological factors associated with catatonic delirium. RESULTS A total of 264 patients with delirium were included, 61 (23%) of whom fulfilled the criteria for catatonia and delirium simultaneously. Brain tumors, subarachnoid hemorrhage, acute hydrocephalus, and ischemic stroke were associated with delirium without catatonic signs. Catatonic delirium was observed among patients with encephalitis, epilepsy, brain neoplasms, and brain tuberculosis. After multivariate analysis, the association between catatonic delirium and encephalitis (both viral and anti-N-methyl-d-aspartate receptor [NMDAR]) was confirmed. CONCLUSIONS Delirium is a common complication of neurological diseases, and it can coexist with catatonia. The recognition of catatonic delirium has clinical significance in terms of etiology, as it was significantly associated with viral and anti-NMDAR encephalitis.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Angela Medina-Gutierrez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Heraclides Gomez-Cianca
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Patricia Arias
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Andres Pérez-Gonzalez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Paulina Angélica Lebrija-Reyes
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Luis Carlos Aguilar-Venegas
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Carmen Ojeda-López
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Miguel Restrepo-Martínez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Leo Bayliss
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Cynthia Areli Juárez-Jaramillo
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Guillermo Peñaloza
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Verónica Rivas-Alonso
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - José Flores-Rivera
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Juan Luis Gómez-Amador
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Camilo Rios
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Perminder S Sachdev
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
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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: 1.0] [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.
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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
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Luccarelli J, Fricchione G, Newton AW, Wozniak J. The diagnosis and treatment of catatonia via telemedicine: A case report and proposed diagnostic criteria. Schizophr Res 2022; 241:66-67. [PMID: 35086061 PMCID: PMC9040749 DOI: 10.1016/j.schres.2022.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 12/29/2022]
Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, McLean Hospital, Belmont, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
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