Alternative treatment strategies for catatonia: A systematic review

Beach, Scott R.; Gomez-Bernal, Federico; Huffman, Jeff C.; Fricchione, Gregory L.

doi:10.1016/j.genhosppsych.2017.06.011

Cited by 106 publications

(86 citation statements)

References 83 publications

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“…Aripiprazole is a partial agonist at the dopamine d2 receptor, decreasing catatonia symptoms, without increasing the risk of EPS and NMS. Low-potency SGAs, particularly olanzapine, are preferred for catatonia since serious risks are associated with high-potency antipsychotics like risperidone [12].…”

Section: Discussionmentioning

confidence: 99%

Mirtazapine Creating “Miracles” in Psychotic Depression With Catatonia

Patel¹,

Veluri²,

Verma³

2020

Cureus

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Catatonia is commonly seen in patients with mood disorders and schizophrenia. The treatment of catatonia requires immediate attention as delayed care resulted in malignant catatonia. The first-line treatment for catatonia is benzodiazepines (BZDs) with rapid improvement. Firstgeneration antipsychotics (FGAs) increase the risk of neuroleptic malignant syndrome and so are avoided in catatonic patients. Second-generation antipsychotics (SGAs) are recommended for treatment in catatonic patients. Treatment for catatonia due to depression includes serotonin reuptake inhibitors (SSRIs). When an individual manifests catatonia during an episode of depression with psychotic features, it is valid to administer both SSRIs and SGAs. Relatively very few studies have examined the use of atypical antidepressants, such as mirtazapine, and so we present a case of catatonia due to severe depression with psychotic features that improved significantly after the introduction of mirtazapine. Despite the beneficial effects of mirtazapine in psychotic depression and catatonia, it is underutilized due to the scarcity of literature. We recommend future clinical studies to evaluate mirtazapine's "miracle" effects, particularly in such patients presenting with psychotic depression and catatonia.

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Section: Discussionmentioning

confidence: 99%

Mirtazapine Creating “Miracles” in Psychotic Depression With Catatonia

Patel¹,

Veluri²,

Verma³

2020

Cureus

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“…However, in cases where BZD is ineffective, and ECT unavailable, patients may benefit from atypical antipsychotics, N-methyl-D-aspartate-receptor antagonists and antiepileptic drugs. 16,17 MDD patients with catatonia have a remission rate of 80% in adults and 65% in children and this is achieved in four to ten days on treatment with BZD. 18 Studies have suggested the use of repetitive transcranial magnetic stimulation (rTMS) as an alternative to ECT for the treatment of persistent severe catatonia for both acute treatment and maintenance.…”

Section: Discussionmentioning

confidence: 99%

Catatonia in major depressive disorder: diagnostic dilemma. A case report

Ojimba¹,

Isidahome²,

Odenigbo³

et al. 2019

JPCPY

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Catatonia is a complex neuropsychiatric syndrome that is often associated with psychiatric, neurological and/or medical conditions. In order to make a diagnosis of catatonia, the clinical picture must be dominated by three or more of the following symptoms; cataplexy, waxy flexibility, stupor, agitation, mutism, negativism, posturing, mannerisms, stereotypies, grimacing, echolalia, and echopraxia. We present a case of a 58-year-old female with no prior psychiatric history who presented to the psychiatric emergency room with a threeweek history of feeling depressed, anhedonic, hopeless, helpless, and worthless, associated with poor sleep, poor concentration, low energy, significant weight loss due to lack of appetite, and suicidal ideations after she saw her ex-boyfriend holding hands with another woman. Patient exhibited symptoms such as mutism, hyperextension of spine, clinching of jaw, psychomotor retardation which suggested probable diagnosis of catatonia at the background of major depressive disorder nonresponding to treatment. This case report demonstrates the need for a high index of suspicion and early screening for catatonia in psychiatric patients given the high morbidity and mortality that is associated with this condition if delayed or undiagnosed.

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“…The treatment of catatonia initially consists of benzodiazepines [ 4 , 5 , 7 , 9 , 13 , 14 , 18 , 32 – 35 ] (effective in 70–80% of all cases) and only when this is ineffective ECT. When ECT is of little help, transcranial magnetic stimulation [ 18 ] and NMDA antagonists such as amantadine and memantine [ 33 , 36 ] may be considered. When these are still ineffective, anticonvulsants can be tried.…”

Section: Discussionmentioning

confidence: 99%

“…When these are still ineffective, anticonvulsants can be tried. In some cases, atypical antipsychotics are combined with benzodiazepines [ 33 , 36 ]. Our patient was treated with valproic acid for epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Persistent catatonia following epileptic seizures: a case report and systematic literature search

Verbraeken¹,

Luykx

2018

BMC Psychiatry

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BackgroundCatatonia is frequently associated with mood and psychotic disorders as well as with general medical conditions, especially with seizures. In the case of the latter, catatonia mostly resolves when the seizures respond to the anticonvulsive treatment. We report, to our knowledge, the first case of a patient without affective or psychotic disorder, who developed catatonia in the postictum and whose catatonia did not resolve with anticonvulsive treatment, but did so with lorazepam.Case presentationWe describe a 36-year-old man, with no psychiatric history, except for a possible disorder in the use of cannabis, who developed catatonia after epileptic seizures. The catatonia did not respond to the anticonvulsant therapy, but did so to lorazepam 17 mg/d. Lorazepam could be tapered slowly and stopped without reemergence of catatonic signs.ConclusionCatatonia should be part of the differential diagnosis in patients with bradyphrenia and/or remarkable postictal behavior. This report shows that lorazepam should be taken into consideration (before moving to ECT), in cases of unresolved catatonia, even if the seizures are reduced with anticonvulsants.

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Alternative treatment strategies for catatonia: A systematic review

Cited by 106 publications

References 83 publications

Mirtazapine Creating “Miracles” in Psychotic Depression With Catatonia

Mirtazapine Creating “Miracles” in Psychotic Depression With Catatonia

Catatonia in major depressive disorder: diagnostic dilemma. A case report

Persistent catatonia following epileptic seizures: a case report and systematic literature search

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