A Clinical Review of the Treatment of Catatonia

Sienaert, Pascal; Dhossche, Dirk M.; Vancampfort, Davy; Hert, Marc De; Gazdag, Gábor

doi:10.3389/fpsyt.2014.00181

Cited by 235 publications

(354 citation statements)

References 143 publications

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“…If the initial dose is ineffective, it should be repeated in 3 h and again after another 3 h. We have analyzed treatment response in 153 patients treated with lorazepam. In this group, we have observed a response in 132 (85.7%), 90 of whom experienced complete recovery within 3 h. This robust response to low-dose lorazepam has also been reported by others[46,53], but higher doses may be necessary in some cases[54,55]. If a patient responds adequately to benzodiazepine treatment, they should continue on the same dose (provided that this dose is not overly sedating or causing any other problematic side-effects) until treatment of any underlying disorder is underway.…”

Section: Treatmentsupporting

confidence: 84%

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Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

Rasmussen¹,

Mazurek²,

Rosebush³

2016

WJP

236

168

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Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is characterized by immobility, mutism, staring, rigidity, and a host of other clinical signs. Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. In many cases, the catatonia must be treated before any underlying conditions can be accurately diagnosed. Most patients with the syndrome respond rapidly to low-dose benzodiazepines, but electroconvulsive therapy is occasionally required. Patients with longstanding catatonia or a diagnosis of schizophrenia may be less likely to respond. The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors. Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome. Since 1989, we have systematically assessed patients presenting to our psychiatry service with signs of retarded catatonia. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated.

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Section: Treatmentsupporting

confidence: 84%

“…It should be noted that patients with long-standing catatonia may not respond as robustly or as rapidly to benzodiazepine treatment as those with acute catatonia[54,58]. We have reported the cases of two brothers, one of whom had been catatonic for 2 wk prior to treatment, while the other had been hospitalized with catatonia for 5 years[59].…”

Section: Treatmentmentioning

confidence: 99%

Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

Rasmussen¹,

Mazurek²,

Rosebush³

2016

WJP

236

168

View full text Add to dashboard Cite

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“…Benzodiazepines are the first‐choice treatment for catatonia, with a reported remission rate of about 70%–80% . However, the catatonic patients included in our study were resistant to benzodiazepines.…”

Section: Methodsmentioning

confidence: 80%

Catatonia in 26 patients with bipolar disorder: clinical features and response to electroconvulsive therapy

Medda

Toni²,

Luchini

et al. 2015

Bipolar Disorders

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“…While retarded catatonia is more common, excited catatonia may occasionally present as an acute behavioural disturbance. Catatonia should be treated with IV lorazepam or emergency ECT (Sienaert et al, 2014).…”

Section: The Management Of Acute Behavioural Disturbance In Schizophrmentioning

confidence: 99%

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders

Galletly

Castle

Dark

et al. 2016

Aust N Z J Psychiatry

648

672

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Objectives: This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. Methods:The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RANZCP GuidelinesGalletly et al. 411 Australian & New Zealand Journal of Psychiatry, 50(5)Results: The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. Conclusions:This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.

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A Clinical Review of the Treatment of Catatonia

Cited by 235 publications

References 143 publications

Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

Catatonia in 26 patients with bipolar disorder: clinical features and response to electroconvulsive therapy

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders

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