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Disturbances of the level of awareness are a frequent motive of attendance to emergency departments where the initial assessment and management will determine the direction of their outcome. The syndrome of catatonia must be taken into consideration and although it is normally associated with psychiatric diagnoses, it is also very often found in a great variety of neurological and medical conditions. Due to the clinical complexity of catatonia, there are still difficulties in its correct identification and initial management, something that leads to diagnostic delays and increased morbidity and mortality. In this article, a review of the literature on catatonia is presented with the aim of assisting emergency department doctors (and clinicians assessing patients in emergency situations) in considering this condition in the differential diagnosis of stupor due to its high frequency of association with organic pathology.

Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral, emotional, and autonomic abnormalities caused by general medical, neurological, and psychiatric disorders, as well as by medications and drugs of abuse. Although there has been a plethora of research on catatonia over the last twenty years, it is still underdiagnosed. Studies of catatonia involving older adults have been sparse, despite its apparent high prevalence, higher risk of serious complications, and of association with non-psychiatric causes. This paper aims to provide an introduction to catatonia as a syndrome, as well as an account of its specificities in older adults, especially those in general hospitals, with the aim to raise awareness of catatonia amongst clinicians working with this age group in acute medical settings, so improvements in its diagnostic rates, treatment, and outcomes can be achieved.

To determine the frequency and characteristics of catatonia in persons with dementia, all patients admitted to an old age psychiatry ward were screened for catatonia with the Bush-Francis Catatonia Screening Instrument (BFCSI) over a period of 6 months. Thirty-seven patients were admitted, and there were 14 patients with dementia. The rate of catatonia in these patients was 42.8% (6 out of 14). Five out of six of these patients received treatment for catatonia with lorazepam, all achieving complete remission. Catatonia occurred frequently in patients admitted with dementia.

BACKGROUND Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated, even though its classification has evolved in recent years. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. The underrecognition of catatonia in older patients is also frequent, and research in this population is scarce. AIM To conduct a systematic review of the literature on catatonia in older people to ascertain its clinical characteristics across settings. METHODS Following the PRISMA guidelines, MEDLINE, EMBASE, and PsycINFO databases were searched from inception to December 2021, with a strategy aimed at identifying all articles published on catatonia in older adults. Titles and abstracts were scanned and selected independently by two authors. Papers investigating issues related to catatonia and/or catatonic symptoms in older people, with English abstracts available, were included. References of selected articles were revised to identify other relevant studies. RESULTS In total, 1355 articles were retrieved. After removing duplicates, 879 remained. Of the 879 identified abstracts, 669 were excluded because they did not meet the inclusion criteria. A total of 210 articles underwent full text review, and 51 were eliminated for various reasons. Fourteen more articles were selected from the references. Overall, 173 articles were reviewed: 108 case reports, 35 case series, 11 prospective cohort studies, 6 case-control studies, 3 retrospective cohort studies and 10 reviews. We found several particular aspects of catatonia in this population. Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. Older patients, compared to younger patients, have a higher risk of developing catatonia with benzodiazepine (BZD) withdrawal, in bipolar disorder, and in the general hospital. Age, together with other risk factors, was significantly associated with the incidence of deep venous thrombosis, neuroleptic malignant syndrome poor outcome, other complications and mortality. Treatment with BZDs and electroconvulsive therapy is safe and effective. Prompt treatment of its cause is essential to ensure a good prognosis. CONCLUSION Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. The risk of developing catatonia in some settings and conditions, as well as of developing complications, is high in this population. Symptomatic treatment is safe and effective, and timely etiologic treatment is fundamental.

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Introduction: Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral and autonomic abnormalities that occurs in the context of general medical, neurological and psychiatric conditions. The complications of this syndrome have not been sufficiently studied in patients in this clinical setting. Objectives: To determine the rate and type of complications of catatonia in patients referred to a liaison psychiatry service. Aim: Prospective descriptive study. Method: All patients referred to liaison psychiatry were screened for catatonic phenomena with the Bush-Francis Catatonia Screening Instrument (BFCSI) between January and May 2012. Any complications of catatonia were recorded. Results: 236 patients were referred. Thirteen (5,5%) met research diagnostic criteria for catatonia and 10 (4,2%) DSM-IV criteria. Of these, six patients (46%) suffered from complications secondary to the catatonic syndrome. These patients were also those with the longer duration of catatonia (more than10 days). The complications observed were malnutrition, dehydration, hyponatremia, hypoglycaemia, and problems related to immobility such as pressure ulcers (the more frequent complication, present in all six patients), acute coronary syndrome, aspiration pneumonia, urinary retention and urinary infection. Three patients died as a result of these complications and their underlying conditions. Conclusions: Medical complications of catatonia were frequent (46%) and were more common in those patients with longer duration of catatonia. Death was also frequent (23%).

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