Concurrent catatonia and COVID-19 infection – An experiential account of challenges and management of cases from a tertiary care psychiatric hospital in India

Abstract

Catatonia has been reported as one among many neuropsychiatric manifestations associated with COVID-19 infection. Catatonia and COVID-19 co-occurrence remain clinical concerns often posing challenges pertaining to diagnosis, and especially management. Limited information is available regarding the appropriate approaches to the management of catatonia in COVID-19 infection, particularly with reference to the safety and efficacy of benzodiazepines and Electro-convulsive therapy (ECT). We present our experience of five patients with catatonia consequent to heterogeneous underlying causes and concurrent COVID-19 infection, who received care at the psychiatric COVID unit of our tertiary care psychiatric hospital. An interesting observation included varying underlying causes for catatonia and the potential role that COVID-19 infection may have played in the manifestation of catatonia. In our experience, new-onset catatonia with or without pre-existing psychiatric illness and concurrent COVID-19 can be safely and effectively managed with lorazepam and/or ECTs. However, critical to the same is the need to implement modified protocols that integrate pre-emptive evaluation for COVID-19 disease and proactive monitoring of its relevant clinical parameters, thereby permitting judicious and timely implementation of catatonia-specific treatment options.

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

“…Had this approach not been successful, we would have considered electroconvulsive therapy (ECT) after respiratory failure resolution. In a recent report of catatonia among COVID-19 patients ( Sakhardande et al, 2022 ), the authors emphasized that, in the absence of respiratory compromise, ongoing close monitoring of the COVID-19 disease can allow for concurrent administration of parenteral benzodiazepines, such as lorazepam, and ECT safely in catatonia.…”

Delayed onset catatonia after COVID-19

“…Given the morbidity and mortality associated with catatonia, it has been emphasized that inpatient providers should keep a high index of suspicion for catatonia when consulted for abnormal behavior or altered mental status in COVID-19 patients ( Scheiner et al, 2021 ), however it is equally important that outpatient providers also keep a high index of suspicion as catatonia is often underrecognized and misdiagnosed and that collaboration between primary care and psychiatry is vital. New-onset catatonia with or without pre-existing psychiatric illness and concurrent COVID-19 can be safely and effectively managed with lorazepam and/or ECTs ( Sakhardande et al, 2022 ). The vast majority of case reports so far reported catatonic symptoms related to COVID-19 infection that was diagnosed and acutely managed in an inpatient setting, and in general there is limited data on the prevalence and treatment of catatonia in the outpatient setting ( Solmi et al, 2018 ).…”

Molecular and cellular mechanisms leading to catatonia: an integrative approach from clinical and preclinical evidence

“…We consider neuroinflammation as a key process underlying catatonia as acute ill patients diagnosed with autoimmune diseases or infections sporadically present with catatonic symptoms (Cawkwell et al, 2021 ; Zain et al, 2021 ; Sakhardande et al, 2022 ). Microglia and astrocytes are sensitive to inflammation, its morphological change to M1-A1 respectively is known to cause connexins to decouple, neurons and oligodendrocytes injury by activation of complement and oxidative stress, and thus generating weak synaptic transmission, myelin destabilization, and excitatory-inhibitory imbalance (Orthmann-Murphy et al, 2008 ; Verkhratsky et al, 2009 ; Verkhratsky, 2010 ).…”