Catatonia in older adults: A systematic review

Abstract

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.

Concurrent catatonia and COVID-19 infection in a demented patient: A case report

“…Some authors admit that COVID-19 infections may contribute to accelerating the development of or altering the course of pre-existing neuropsychiatric disorders which is in line with recent literature ( Quincozes-Santos et al, 2021 ). Additionally, as will be described below, NMDA receptor antagonists, such as memantine or amantadine, and benzodiazepines can be used as a treatment option for catatonia ( Jaimes-Albornoz et al, 2022 , Carroll et al, 2005 ), which might suggest that the abrupt suspension of these drugs, days before the admission to the inpatient unit, may also have favored the worsened of catatonia in our patient. This hypothesis is in line with the literature which suggest that abrupt discontinuation of certain drugs, namely benzodiazepines and NMDA receptor antagonists, may contribute to catatonia onset or worsening.…”

“…As in this case report, a multifactorial etiology to catatonia has been reported in various publications in the older adults' age group. ( Jaimes-Albornoz et al, 2022 ) We hypothesize that the COVID-19 infection is likely to have precipitated catatonia, particularly in a patient with a previous diagnosis of mixed dementia, a history of a previous major depressive episode and a recent abrupt suspension of memantine (NMDA receptor antagonist) and benzodiazepines. In fact, the available literature suggests that catatonia tends to be present in demented patients alongside with other disorders, be they medical or psychiatric ( Serra-Mestres and Jaimes-Albornoz, 2018 ).…”

“…It occurs in the context of general medical, neurological, and psychiatric conditions. It can also appear associated with medications and drugs of abuse ( Jaimes-Albornoz et al, 2022 ). The Diagnostic and Statistical Manual - Fifth Edition (DSM-5) classifies catatonia either as a specifier within all mental disorders, as secondary to a general medical condition, or as an unspecified catatonia, when the syndrome is identified but not yet its etiology ( American Psychiatric Association (APA) 2013 ).…”

“…The Diagnostic and Statistical Manual - Fifth Edition (DSM-5) classifies catatonia either as a specifier within all mental disorders, as secondary to a general medical condition, or as an unspecified catatonia, when the syndrome is identified but not yet its etiology ( American Psychiatric Association (APA) 2013 ). Depending on the predominant symptoms, catatonia can be divided into two variants: hypokinetic and hyperkinetic ( Jaimes-Albornoz et al, 2022 ).…”

“…Data on the prevalence of catatonia in the elderly is scarce ( Cuevas-Esteban et al, 2017 , Jaimes-Albornoz et al, 2022 , Takács et al, 2017 ), even more so in the case of catatonia in elderly with COVID-19 ( Vazquez-Guevara et al, 2021 ). Only a few reports specifically explore catatonia in older patients ( Cuevas-Esteban et al, 2017 ) .…”