Comparative study of symptom profile of catatonia in patients with psychotic disorders, affective disorders and organic disorders

Grover, Sandeep; Sahoo, Swapnajeet; Chakravarty, Rahul; Chakrabarti, Subho

doi:10.1016/j.ajp.2019.05.024

Cited by 15 publications

(10 citation statements)

References 30 publications

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“…The median duration of catatonic episodes in both groups (10 and 12.5 days, respectively) was similar to the mean (4.6 days; SD: 6.7) duration of catatonia noted in the original study by Bush et al (1996b) from where the LCT was proposed. With respect to clinical diagnosis, non-affective disorders (63%) were overrepresented compared to affective disorders (37%) in both groups in our study, similar to that noted in a recent study from a different center in India (Grover et al, 2019). While consistent with the recent literature published from our center and other Indian studies as well (Grover et al, 2011;Ramdurg et al, 2013;Subramaniyam et al, 2019), the preponderance of psychosis in our sample is at variance with the view that catatonia is more frequently associated with affective disorder and that catatonia in schizophrenia is rare nowadays (Abrams and Taylor, 1976;Bush et al, 1996a;Rosebush et al, 1990).…”

Section: Discussionsupporting

confidence: 90%

Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting

Suchandra

Reddi

Subramaniyam

et al. 2020

Aust N Z J Psychiatry

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Objective: Catatonia can be life-threatening unless timely identified and treated. Lorazepam’s ubiquitous response has led to its universal acceptance as being the first-line management of catatonia and alludes to catatonia’s neurobiological underpinnings. Lorazepam challenge test (LCT) is widely used to either confirm a catatonia diagnosis or determine lorazepam sensitivity. It has a proposed schedule for administering lorazepam. However, efficacy of recommended LCT doses lack systematic evidence, resulting in variable LCT doses used in clinical and research settings contributing to findings that are challenging to generalize or assist with developing standardized lorazepam treatment protocols for catatonia. Given the same, this study aimed to objectively compare the response between two groups receiving different LCT doses and factors influencing the same. Methods: The 6-month study in a psychiatric emergency setting at a tertiary neuropsychiatric center in India evaluated 57 catatonia patients, before and after administration of single 2 mg ( n = 37; LCT-2) or 4 mg ( n = 20; LCT-4) lorazepam dose, applying Bush Francis Catatonia Rating Scale (BFCRS), Mini International Neuropsychiatric Interview (MINI 5.0) and obtaining sociodemographic, clinical data. Results: No between-group differences (LCT-2 vs LCT-4) for sociodemographic, clinical profiles or BFCRS severity score changes to lorazepam on Mann–Whitney U test were noted. Applying Wilcoxon signed rank test comparing individual sign severity demonstrated response variability, with significant response noted to both doses (stupor, mutism, staring, posturing, withdrawal, ambitendency, automatic obedience) and others selectively to 2 mg (echolalia, rigidity, negativism, mitgehen). Notably, sign resolution (present/absent) only to 2 mg was significant for stupor, mutism, staring, posturing, echolalia, rigidity, negativism and mitgehen. Conclusion: This study suggests 2 mg lorazepam may be an optimal LCT dose, given significant response to most catatonic signs thereby ensuring accurate detection and preventing misinterpretation of response. It offers future studies direction for standardizing lorazepam dosing schedules for catatonia management and exploring neurobiological underpinnings for individual catatonic signs that may be potentially different, given these findings.

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Section: Discussionsupporting

confidence: 90%

Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting

Suchandra

Reddi

Subramaniyam

et al. 2020

Aust N Z J Psychiatry

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“…12 Differences in the symptom profile of catatonia in patients with psychotic disorders and affective disorders has been a subject of debate with controversial results throughout history. 15,16 As catatonia presents with a wide range of signs, several studies have used factor analysis in order to identify its different clinical dimensions and to distinguish clinical presentations in affective and psychotic disorders. 17 Up to seven dimensions of catatonia have been described so far, being inhibition and excitement the most replicated findings, and 4.1 the mean number of reported factors.…”

mentioning

confidence: 99%

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

Cuevas‐Esteban

Iglesias-González

Serra-Mestres

et al. 2020

Int J Geriat Psychiatry

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Objective: Catatonic stupor has been linked to extreme fear. Whether the underlying phenomenology of every catatonic dimension is intense anxiety or fear remains unknown. Methods: One hundred and six patients aged ≥64 years were assessed for catatonia and clinical variables during the first 24 hours of admission. Two-sample t test were used to test for group differences. A principal component analysis was developed. Analysis of variance was performed to assess for differences in the diagnostic groups. Correlation coefficients were used to examine the association between catatonic dimensions and psychopathological variables. Results: There were statistically significant differences between catatonic and noncatatonic patients in the Hamilton and NPI scores. The three factor-model accounted for 52.23% of the variance. Factor 1 loaded on items concerned with "excitement," factor 2 on "inhibition" items, and factor 3 on "parakinetic" items. There was a significant effect for factor 1 (F [5.36] = 2.83, P = .02), and not significant for factor 2 and factor 3. Compared with patients with depression, patients with mania scored significantly higher on factor "excitement" (P < .05). Factor 2 showed a moderate correlation with Hamilton total score (r = .346, P = .031) and Hamilton psychic score (r = .380, P = .017). Conclusions: Catatonic patients experienced more anxiety and hyperactivity. A three-factor solution provided best fit for catatonic symptoms. Patients with mania scored highest on Excitement, patients with depression on Inhibition, and patients with schizophrenia on Parakinetic. The main finding in this study was a positive moderate correlation between the Hamilton psychic score and the Inhibition factor score, meaning that not every catatonic dimension is associated to intense anxiety.

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“…Catatonia in older people often presents acutely, but it can also have an insidious presentation. The duration can be transient or chronic, lasting for weeks, months or even years[ 37 , 38 ]. The total duration of illness could be significantly lower if the etiology is a GMC when compared with affective or psychotic disorders[ 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…The duration can be transient or chronic, lasting for weeks, months or even years[ 37 , 38 ]. The total duration of illness could be significantly lower if the etiology is a GMC when compared with affective or psychotic disorders[ 38 , 39 ]. Acute catatonia has a good prognosis if it is diagnosed early, its symptoms and etiology are treated in a timely fashion, and the necessary measures are taken to prevent complications.…”

Section: Resultsmentioning

confidence: 99%

“…The clinical presentation of catatonia is quite similar to that of adults under 65 years of age. In general, the most frequent signs are the same (immobility, staring, mutism, negativism, withdrawal, rigidity and posturing)[ 5 , 12 , 38 ]. Unlike what happens in patients under 65 years of age, excitement (41.8%), verbigeration (37.9%), perseveration (33%) and autonomic abnormalities (27.8%) seem to also be very frequent.…”

Section: Discussionmentioning

confidence: 99%

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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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Comparative study of symptom profile of catatonia in patients with psychotic disorders, affective disorders and organic disorders

Cited by 15 publications

References 30 publications

Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting

Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting

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

Catatonia in older adults: A systematic review

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