Catatonia Under-Diagnosis in the General Hospital

Abstract

Catatonia is under-diagnosed in psychiatric settings. No studies have explored the under-diagnosis of catatonia in general hospitals. The authors conducted a retrospective chart review using DSM-5 criteria to diagnose catatonia in medical inpatients between 2011 and 2013. Of 133 case subjects meeting DSM-5 criteria for catatonia retrospectively, 79 had never been diagnosed and 54 had a documented diagnosis. Multiple logistic regression revealed that psychiatry consultation significantly decreased the odds of under-diagnosis of catatonia, whereas presence of agitation, grimacing, or echolalia increased the likelihood of under-diagnosis. Under-diagnosed case subjects received significantly lower doses of lorazepam, and increased mortality during admission and increased length of hospital stay both fell short of statistical significance in this group. Catatonia appears to be frequently under-diagnosed in the general hospital, and psychiatry consultation services play a crucial role in its detection and treatment. Strategies to improve recognition and treatment of catatonia should be implemented.

The Presentation and Treatment Response of Catatonia in Patients Admitted to the Psychiatric Inpatient Unit at Jimma University Medical Center, Ethiopia

“…The most common catatonic signs and symptoms in this study were mutism, posturing, and withdrawal, all of which were present in all 18 patients. This finding is in keeping with previous research [3,31]. In our study, most of the patients were younger than 30 years old and male.…”

“…In our study, there is no recorded catatonia sign of excitement, echopraxia/echolalia, stereotypy, mannerisms, verbigeration, stereotypy, impulsivity, grasp reflex, perseveration, and combativeness. It has also been argued that in comparison to classic psychiatric literature, modern research on catatonia has focused more on motor rather than verbal signs of catatonia, including echolalia and verbigeration [3,37].…”

“…Catatonia was first described by Kahlbaum as a state of psychomotor immobility and behavioral abnormality manifested by stupor, mutism, negativism, stereotypies, catalepsy, and verbigeration [1]. The prevalence of catatonia is 7-45% depending on the treatment setting [2][3][4]. Relevant studies have shown that up to 59% of patients with signs of catatonia are not recognized or underdiagnosed and 37% of these patients are not adequately treated [3].…”

“…The prevalence of catatonia is 7-45% depending on the treatment setting [ 2 – 4 ]. Relevant studies have shown that up to 59% of patients with signs of catatonia are not recognized or underdiagnosed and 37% of these patients are not adequately treated [ 3 ]. The mortality rate in patients who are underdiagnosed with malignant catatonia, a particularly severe form, and are therefore not adequately treated is 75-100% in ICU settings [ 4 , 5 ].…”

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

“…The prevalence of catatonia differs in different medical settings ranging from 5%-18% on inpatient psychiatric units, 12% in drug-naive patients with first-episode psychosis, 3.3 on a neurology/neuropsychiatric tertiary care inpatient units, 1.6% to 1.8% on psychiatry consultation-liaison services, 8.9% in elderly patients and 3.8% on intensive care units. 5 It has been reported that catatonia carries a high risk of morbidity and mortality, partly due to failure of timely recognition and initiation of appropriate treatment. 6 Catatonia appears to be a risk factor for developing neuroleptic malignant syndrome, which has a mortality rate of approximately 10% and may be clinically difficult to distinguish from malignant catatonia.…”