Systematic review of catatonia treatment

Abstract

ObjectiveTo investigate the evidence-based treatment of catatonia in adults. The secondary aim is to develop a treatment protocol.Materials and methodsA systematic review of published treatment articles (case series, cohort or randomized controlled studies) which examined the effects of particular interventions for catatonia and/or catatonic symptoms in adult populations and used valid outcome measures was performed. The articles for this review were selected by searching the electronic databases of the Cochrane Library, MEDLINE, EMBASE and PSYCHINFO.ResultsThirty-one articles met the inclusion criteria. Lorazepam and electroconvulsive therapy (ECT) proved to be the most investigated treatment interventions. The response percentages in Western studies varied between 66% and 100% for studies with lorazepam, while in Asian and Indian studies, they were 0% and 100%. For ECT, the response percentages are 59%–100%. There does not seem to be evidence for the use of antipsychotics in catatonic patients without any underlying psychotic disorder.ConclusionLorazepam and ECT are effective treatments for which clinical evidence is found in the literature. It is not possible to develop a treatment protocol because the evidence for catatonia management on the basis of the articles reviewed is limited. Stringent treatment studies on catatonia are warranted.

<p>Catatonia in Down syndrome: systematic approach to diagnosis, treatment and outcome assessment based on a case series of seven patients</p>

“…One plausible explanation for the catatonia’s chronicity in young people with neurodevelopmental disorders may be delayed diagnoses, which might render treatment more difficult. Based on this experience, Pelzer and colleagues recommend that patients with long term symptoms of catatonia be treated expediently with ECT, a recommendation our experience supports 22. At this time, we feel comfortable advising families that whereas we can’t promise recovery will be rapid, experience supports optimism that with standard of care treatments including lorazepam, ECT and possibly dextromethorphan/quinidine a return to baseline or close to baseline functioning is expected.…”

“…The preponderance of reports in DS, Autism and other neurodevelopmental disorders affirms their efficacy in these populations 6–9,11,14,53,63. A recent Cochrane report of 31 articles revealed lorazepam response rates of 66–100% in Western countries; ECT response rates varied 59–100% 22. Though, excellent response to ECT is generally acknowledged, including endorsement from the American Academy of Child and Adolescent Psychiatry, rigorous evidence including random controlled trials and meta-analyses have not been performed 62–65.…”

“…We present evidence that DS patients who have developed catatonia are relatively easy to diagnose utilizing the Bush-Francis Catatonia Rating Scale (BFCRS) and respond to acknowledged catatonia treatments 9,12–22. Use of this information by a medical team experienced in care of patients with genetic disorders and psychiatry allowed us to successfully treat seven young adults.…”

Early-Onset Alzheimer’s Disease Masquerading as Catatonia

“…Benzodiazepines are the mainstay of treatment in catatonia. [ 8 ] Furthermore, response to benzodiazepines validates the diagnosis of catatonia [ 9 ]. Some clinicians use the lorazepam challenge test in which 1–2 mg of lorazepam is infused, and the patient is reevaluated for improvement [ 9 ].…”

Mirtazapine Creating “Miracles” in Psychotic Depression With Catatonia

“…First-generation antipsychotics (FGAs) exhibit a higher potency on the dopamine d2 receptors, potentially increasing the risk for NMS and EPS, and so second-generation antipsychotics (SGAs) are preferred [ 2 ]. Pelzer et al conducted a systematic review of catatonia treatment and found that clozapine outperformed other SGAs by demonstrating an 85% positive response [ 11 ]. In catatonia caused by clozapine withdrawal, clozapine is the first-line treatment.…”