Catatonia in elderly psychiatric inpatients is not always associated with intense anxiety: Factor analysis and correlation with psychopathology

Cuevas‐Esteban, Jorge; Iglesias-González, María; Serra-Mestres, Jordi; Butjosa, Anna; Canal‐Rivero, Manuel; Serrano‐Blanco, Antoni; Baladón, Luisa

doi:10.1002/gps.5382

Cited by 15 publications

(14 citation statements)

References 39 publications

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“…Nevertheless, it has also been postulated that it is possible to differentiate between emotive and nonemotive subtypes of catatonia, suggesting that not all catatonia patients experience emotional distress[ 26 ]. This theory seems to be supported by the findings that catatonia in older adults is not always related to intense anxiety[ 27 ].…”

Section: Resultsmentioning

confidence: 84%

Catatonia in older adults: A systematic review

Jaimes-Albornoz¹,

Pellon-Santamaria²,

Nizama-Vía³

et al. 2022

WJP

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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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Section: Resultsmentioning

confidence: 84%

Catatonia in older adults: A systematic review

Jaimes-Albornoz¹,

Pellon-Santamaria²,

Nizama-Vía³

et al. 2022

WJP

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“…The thought is that catatonia could be an end state response to the feelings of imminent doom [ 21 ]. A study in an elderly population found that catatonic patients experienced more anxiety and hyperactivity [ 22 ]. This also may lend credibility to the notion that anxiety and fear can be part of the causes of catatonia, although catatonia is more complex and has more probable causes.…”

Section: Catatonia Causes Presentation and Pathophysiologymentioning

confidence: 99%

Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges

Edinoff

Kaufman

Hollier

et al. 2021

Neurology International

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Catatonia is a syndrome that has been associated with several mental illness disorders but that has also presented as a result of other medical conditions. Schizophrenia and other psychiatric disorders such as mania and depression are known to be associated with catatonia; however, several case reports have been published of certain medical conditions inducing catatonia, including hyponatremia, cerebral venous sinus thrombosis, and liver transplantation. Neuroleptic Malignant Syndrome and anti-NMDA receptor encephalitis are also prominent causes of catatonia. Patients taking benzodiazepines or clozapine are also at risk of developing catatonia following the withdrawal of these medications—it is speculated that the prolonged use of these medications increases gamma-aminobutyric acid (GABA) activity and that discontinuation may increase excitatory neurotransmission, leading to catatonia. The treatment of catatonia often involves the use of benzodiazepines, such as lorazepam, that can be used in combination therapy with antipsychotics. Definitive treatment may be found with electroconvulsive therapy (ECT). Aberrant neuronal activity in different motor pathways, defective neurotransmitter regulation, and impaired oligodendrocyte function have all been proposed as the pathophysiology behind catatonia. There are many clinical challenges that come with catatonia and, as early treatment is associated with better outcomes, it becomes imperative to understand these challenges. The purpose of this manuscript is to provide an overview of these challenges and to look at clinical studies regarding the pathophysiology, diagnosis, and treatment of as well as the complications and risk factors associated with catatonia.

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“…In terms of the objective psychopathology, some previous studies have endeavoured to apply principal component analysis to elucidate the structure of what is often displayed as a long list of rather disparate catatonic clinical signs ( 4 – 10 ). Sample sizes have varied between 106 and 2,703 and all have been in a mixed clinical population of patients with and without a diagnosis of catatonia.…”

Section: Introductionmentioning

confidence: 99%

“…These analyses have reduced the structure of catatonic signs to between two and six factors; this was often based on selecting factors with an eigenvalue greater than 1, but the method of model selection was not always clear. Models with fewer factors have tended to distinguish positive and negative (or hyperkinetic and hypokinetic) signs with or without a factor for qualitatively abnormal movements ( 4 – 7 ). Models with more factors have been more varied, including components such as excitement or agitation, volitional disturbance, abnormal movements, inhibition, automatic movements, repetitive movements or echophenomena, grimacing and autonomic disturbance ( 8 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…In terms of the subjective phenomenology of catatonia, several studies have found an association with an intense feeling of anxiety or fear ( 4 , 17 – 21 ), with some authors theorising the behaviours seen are akin to an evolutionary prey response to danger ( 21 ). Northoff and colleagues retrospectively asked 24 patients about their experience after recovering from an episode of catatonia and half reported uncontrollable and overwhelming emotions, in particular fear ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

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Catatonia Psychopathology and Phenomenology in a Large Dataset

et al. 2022

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BackgroundThe external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received little attention. This study aimed to use a large dataset to describe the clinical signs of catatonia; to assess whether these signs are associated with underlying diagnosis and prognosis; and to describe the phenomenology of catatonia, particularly with reference to fear.MethodsA retrospective descriptive cross-sectional study was conducted using the electronic healthcare records of a large secondary mental health trust in London, United Kingdom. Patients with catatonia were identified in a previous study by screening records using natural language processing followed by manual validation. The presence of items of the Bush-Francis Catatonia Screening Instrument was coded by the investigators. The presence of psychomotor alternation was assessed by examining the frequency of stupor and excitement in the same episode. A cluster analysis and principal component analysis were conducted on catatonic signs. Principal components were tested for their associations with demographic and clinical variables. Where text was available on the phenomenology of catatonia, this was coded by two authors in an iterative process to develop a classification of the subjective experience of catatonia.ResultsSearching healthcare records provided 1,456 validated diagnoses of catatonia across a wide range of demographic groups, diagnoses and treatment settings. The median number of catatonic signs was 3 (IQR 2–5) and the most commonly reported signs were mutism, immobility/stupor and withdrawal. Stupor was present in 925 patients, of whom 105 (11.4%) also exhibited excitement. Out of 196 patients with excitement, 105 (53.6%) also had immobility/stupor. Cluster analysis produced two clusters consisting of negative and positive clinical features. From principal component analysis, three components were derived, which may be termed parakinetic, hypokinetic and withdrawal. The parakinetic component was associated with women, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders. 68 patients had phenomenological data, including 49 contemporaneous and 24 retrospective accounts. 35% of these expressed fear, but a majority (72%) gave a meaningful narrative explanation for the catatonia, which consisted of hallucinations, delusions of several different types and apparently non-psychotic rationales.ConclusionThe clinical signs of catatonia can be considered as parakinetic, hypokinetic and withdrawal components. These components are associated with diagnostic and prognostic variables. Fear appears in a large minority of patients with catatonia, but narrative explanations are varied and possibly more common.

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Catatonia in elderly psychiatric inpatients is not always associated with intense anxiety: Factor analysis and correlation with psychopathology

Cited by 15 publications

References 39 publications

Catatonia in older adults: A systematic review

Catatonia in older adults: A systematic review

Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges

Catatonia Psychopathology and Phenomenology in a Large Dataset

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