Catatonia in the emergency department

Abstract

Disturbances of the level of awareness are a frequent motive of attendance to emergency departments where the initial assessment and management will determine the direction of their outcome. The syndrome of catatonia must be taken into consideration and although it is normally associated with psychiatric diagnoses, it is also very often found in a great variety of neurological and medical conditions. Due to the clinical complexity of catatonia, there are still difficulties in its correct identification and initial management, something that leads to diagnostic delays and increased morbidity and mortality. In this article, a review of the literature on catatonia is presented with the aim of assisting emergency department doctors (and clinicians assessing patients in emergency situations) in considering this condition in the differential diagnosis of stupor due to its high frequency of association with organic pathology.

Pernicious anemia presenting as catatonia: correlating vitamin B12 levels and catatonic symptoms

“…A strictly linear relationship between B12 levels and the patient's symptoms was unlikely, as catatonia has various etiologies and can break out under the influence of multifactorial stressors [3]. However, the absence of relapse after shortening the deadlines between the cyanocobalamin injections -therefore increasing the B12 levels over 200 pg/ml -supports the accountability of the B12 deficiency in the patient's catatonic symptoms.…”

“…Catatonia has been observed in a wide variety of general medical, neurological and psychiatric disorders, as well as associated with drugs and toxic substances, making it sometimes difficult to make the etiological diagnosis [3]. In this case, there is no supporting evidence for a neurological, toxic or psychiatric origin of this catatonic syndrome.…”

Catatonia as an internal medicine disease: infrequent or still underdiagnosed?

“…The syndrome is grouped under three forms of presentation: retarded (characterised by mutism, rigidity, immobility, negativism, catalepsy, posturing and echophenomena), excited (with restlessness, impulsivity and aggressivity presenting as the main symptoms) and malignant catatonia, a life-threatening form of which fever and autonomic instability are the warning signs 1 2. The underlying cause is important since it strongly influences prognosis.…”

Movement disorders in catatonia

“…Owing to the wide range of underlying diagnoses, patients with catatonia may present as a medical or psychiatric emergency13 or develop symptoms during hospitalisation, such as in the intensive care unit (ICU), which can be challenging from a diagnostic standpoint 13 14. Catatonia usually presents acutely but may present insidiously, and can be transient or chronic, and last for weeks, months and even years 15.…”

“…Catatonia usually presents acutely but may present insidiously, and can be transient or chronic, and last for weeks, months and even years 15. Catatonic patients are at risk for severe complications such as pneumonia, decubitus ulcers, malnutrition, dehydration, contractures and thrombosis and delays in diagnosis and management are associated with increased morbidity 13. Although it may become life-threatening,16 catatonia has an excellent prognosis if recognised and treated early.…”