Guidelines for Preventing Common Medical Complications of Catatonia

Clinebell, Kimberly; Azzam, Pierre N.; Gopalan, Priya; Haskett, Roger F.

doi:10.4088/jcp.13r08870

Cited by 63 publications

(40 citation statements)

References 20 publications

(25 reference statements)

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“…Catatonia should be regarded as one of the hallmarks of ANMDARE. Efforts are needed to increase its recognition and to identify its signs and symptoms in order to start prompt specific immunomodulatory therapy …”

Section: Discussionmentioning

confidence: 99%

Catatonia in patients with anti‐NMDA receptor encephalitis

Espínola-Nadurille

Flores‐Rivera

Rivas‐Alonso

et al. 2019

Psychiatry Clin Neurosci

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Aim There is a lack of studies related to the frequency, phenomenology, and associated features of catatonic syndrome in patients with anti‐NMDA receptor encephalitis (ANMDARE). This study aimed to measure the frequency of catatonia in this condition and to delineate its particular symptoms. Methods A prospective study was done with all inpatients who fulfilled the criteria of definite ANMDARE admitted to the National Institute of Neurology and Neurosurgery of Mexico from January 2014 to September 2018. The Bush–Francis Catatonia Rating Scale and Braünig Catatonia Rating Scale were administered at admission. Results Fifty‐eight patients were included and catatonia was diagnosed in 41 of these patients (70.6%). Immobility, staring, mutism, and posturing were the most frequent catatonic signs. Catatonia was associated with delirium, hallucinations, psychomotor agitation, generalized electroencephalography dysfunction, and previous use of antipsychotics. Mortality was present in 10% of the total sample; it was associated with status epilepticus, and was less frequent in the catatonia group. After immunotherapy, all cases showed a complete recovery from catatonic signs. Conclusion This systematic assessment of catatonic syndrome shows that it is a frequent feature in patients with ANMDARE as part of a clinical pattern that includes delirium, psychomotor agitation, and hallucinations. The lack of recognition of this pattern may be a source of diagnostic and therapeutic errors, as most physicians associate catatonia with schizophrenia and affective disorders.

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Section: Discussionmentioning

confidence: 99%

Catatonia in patients with anti‐NMDA receptor encephalitis

Espínola-Nadurille

Flores‐Rivera

Rivas‐Alonso

et al. 2019

Psychiatry Clin Neurosci

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“…This has important implications for the treatment of catatonia in the context of psychosis, which will be discussed later in this review. Additionally, the immobility and refusal to eat or drink associated with catatonia can give rise to potentially serious medical complications, including dehydration[17], malnutrition[18,19], deep vein thrombosis and pulmonary embolism[20,21], pneumonia and other infections[17], pressure ulcers[19], and muscle contractures[18,19]. The very nature of catatonia can make it challenging, if not impossible, to carry out patient interviews and examinations, thereby interfering with the recognition of underlying diagnoses.…”

Section: Introductionmentioning

confidence: 99%

Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

Rasmussen¹,

Mazurek²,

Rosebush³

2016

WJP

235

168

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Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is characterized by immobility, mutism, staring, rigidity, and a host of other clinical signs. Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. In many cases, the catatonia must be treated before any underlying conditions can be accurately diagnosed. Most patients with the syndrome respond rapidly to low-dose benzodiazepines, but electroconvulsive therapy is occasionally required. Patients with longstanding catatonia or a diagnosis of schizophrenia may be less likely to respond. The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors. Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome. Since 1989, we have systematically assessed patients presenting to our psychiatry service with signs of retarded catatonia. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated.

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“…2 Understanding the pathophysiology of this severe disorder is crucial given its high rate of medical complications, including pressure ulcers, infections, and venous thromboembolism. 3 Moreover, such under standing might aid the comprehension of other neuro psychiatric disorders.…”

Section: Introductionmentioning

confidence: 99%

Catatonia and the immune system: a review

Rogers

Pollak

Blackman

et al. 2019

The Lancet Psychiatry

147

119

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Catatonia is a psychomotor disorder featuring stupor, posturing, and echophenomena. This Series paper examines the evidence for immune dysregulation in catatonia. Activation of the innate immune system is associated with mutism, withdrawal, and psychomotor retardation, which constitute the neurovegetative features of catatonia. Evidence is sparse and conflicting for acute-phase activation in catatonia, and whether this feature is secondary to immobility is unclear. Various viral, bacterial, and parasitic infections have been associated with catatonia, but it is primarily linked to CNS infections. The most common cause of autoimmune catatonia is N-methyl-D-aspartate receptor (NMDAR) encephalitis, which can account for the full spectrum of catatonic features. Autoimmunity appears to cause catatonia less by systemic inflammation than by the downstream effects of specific actions on extracellular antigens. The specific association with NMDAR encephalitis supports a hypothesis of glutamatergic hypofunction in catatonia.

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Guidelines for Preventing Common Medical Complications of Catatonia

Abstract: As medical complications are common with catatonia, implementation of preventive measures is imperative.

Cited by 63 publications

References 20 publications

Catatonia in patients with anti‐NMDA receptor encephalitis

Catatonia in patients with anti‐NMDA receptor encephalitis

Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

Catatonia and the immune system: a review

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