Catatonia and Its Treatment

Abstract

Psychiatric diagnoses are currently categorized on a syndromic basis. The syndrome of catatonia, however, remains in a diagnostic limbo, acknowledged predominantly as a subtype of schizophrenia. Yet, catatonia is present in about 10% of acutely ill psychiatry patients, only a minority of whom have schizophrenia. Among those with comorbid affective disorders, who comprise the largest subgroup of catatonic patients, the catatonic signs typically resolve dramatically and completely with benzodiazepine therapy. Those with schizophrenia respond less reliably, suggesting that the underlying processes causing the catatonia may be different in this group. The majority of patients with catatonia have concurrent psychosis. Failure to treat the catatonia before institution of antipsychotic medication may increase the risk of inducing neuroleptic malignant syndrome. At this point of time, the pathobiology of catatonia is unknown; the major reason for considering catatonia as a separate diagnostic entity would be to increase recognition of this eminently treatable neuropsychiatric syndrome.

Catatonia in Psychotic Patients: Clinical Features and Treatment Response

“…Benzodiazepines at high doses and ECT have routinely beneficial effects in treating catatonia, as has been described by others in the literature. 5,8 For patients with malignant catatonia, investigations have shown that daily, bilateral ECT during the first week is most effective. 4,8 We also note that no significant difference in short-term outcome was observed between ECT, sham ECT and nonconvulsive stimulation in catatonia associated with chronic schizophrenia.…”

“…1,2,3 Recent literature suggests a 10-15% prevalence of catatonia among acute psychiatric inpatients. 4,5 While classic cases of catatonia are easily recognized, subtler signs and symptoms of catatonia are more prevalent and their recognition is more challenging for clinicians. 6,7 Catatonic presentations are often overlooked in the context of psychotic and/or mood episodes but the treatment for catatonia can be very different than that for psychotic and mood disorders.…”

“…6,7 Catatonic presentations are often overlooked in the context of psychotic and/or mood episodes but the treatment for catatonia can be very different than that for psychotic and mood disorders. 5,7,8 Since most patients present with catatonia and a mixture of psychotic/mood symptoms it is critical to treat each entity without adversely affecting the other. In this report, we examined the clinical characteristics and treatment response for patients with catatonia admitted to a psychiatric inpatient unit specializing in psychotic disorders, including mood disorders with psychotic features.…”

Use of Electroconvulsive Therapy In the Treatment of Catatonia

“…In either case, some families may not be able to adhere to the proscribed schedule of ECT making it less effective. In cases where there is a documented primary psychotic disorder, combination of secondgeneration antipsychotics and lorazepam may be recommended with careful monitoring for signs of MC or NMS [20].…”

“…Certain patient populations, such as the elderly, those with obstructive sleep apnea or history of paradoxical responses to BZPs, may not tolerate higher dosage of lorazepam or another agent from this class; therefore, ECT may be the best treatment option in these situations [20].…”