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Câmara Pestana P, Estibeiro MJ, Côrte-Real B, Cordeiro C, Simões I, Duarte G, Simões do Couto F, Novais F. Catatonia in Dementia: A Systematic Review of Case Reports and Case Series. Am J Geriatr Psychiatry 2024:S1064-7481(24)00407-X. [PMID: 39179430 DOI: 10.1016/j.jagp.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Catatonia is a neuropsychiatric syndrome characterized by motor, behavioral, and autonomic abnormalities. It is often underdiagnosed in geriatric patients with dementia despite established diagnostic criteria and treatment options. OBJECTIVE This systematic review investigates catatonia in the elderly, particularly those with dementia, to examine their clinical presentation, treatment response, and prognosis compared to elderly patients without dementia. METHODS We comprehensively searched MEDLINE and EMBASE, including case reports and series on catatonia in elderly patients. Reviewers independently performed data extraction and quality assessments. Statistical significance was set at a p value ≤0.05, and a multivariate logistic regression model was used to analyze differences between patients with and without dementia. RESULTS Our review included 182 articles with 225 cases. We found no significant differences in the clinical presentation of catatonia between patients with and without dementia, with both groups commonly exhibiting the hypokinetic variant. However, patients with dementia were more frequently treated with NMDA receptor antagonists (OR: 3.27; CI: 1.05-10.11; p = 0.040) and had a lower complete response rate to treatment (OR: 0.37; CI: 0.19-0.75; p = 0.006). Patients with dementia also exhibited fewer acute medical conditions (OR: 0.17; CI: 0.05-0.65; p = 0.009). CONCLUSIONS Catatonia in dementia does not have a different syndromic presentation. However, the diagnosis of dementia leads to varying preferences regarding the choice of symptomatic therapy and seems to be a predictor of a poorer therapeutic response. Actively treating catatonia, particularly in patients with dementia, addressing the characteristics of these patients is of paramount importance.
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Affiliation(s)
- Pedro Câmara Pestana
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, European Union, Portugal (PCP, IS, FN); Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Lisboa, European Union, Portugal (PCP, IS, FSDC, FN); Faculdade de Medicina, Universidade Católica Portuguesa, Sintra, European Union, Portugal (PCP, MJE, FSDC); PsyLab, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, European Union, Portugal (PCP, FN).
| | - Maria João Estibeiro
- Faculdade de Medicina, Universidade Católica Portuguesa, Sintra, European Union, Portugal (PCP, MJE, FSDC)
| | - Beatriz Côrte-Real
- Serviço de Psiquiatria, Hospital de Cascais Dr. José de Almeida, Lisboa, European Union, Portugal (BCR)
| | - Catarina Cordeiro
- Serviço de Psiquiatria, Hospital Garcia de Orta, Unidade Local de Saúde Almada-Seixal, Almada, European Union, Portugal (CC)
| | - Inês Simões
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, European Union, Portugal (PCP, IS, FN); Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Lisboa, European Union, Portugal (PCP, IS, FSDC, FN)
| | - Gonçalo Duarte
- Serviço de Farmacologia Clínica, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Lisboa, European Union, Portugal (GD); Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, European Union, Portugal (GD)
| | - Frederico Simões do Couto
- Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Lisboa, European Union, Portugal (PCP, IS, FSDC, FN); Faculdade de Medicina, Universidade Católica Portuguesa, Sintra, European Union, Portugal (PCP, MJE, FSDC)
| | - Filipa Novais
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, European Union, Portugal (PCP, IS, FN); Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Lisboa, European Union, Portugal (PCP, IS, FSDC, FN); PsyLab, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, European Union, Portugal (PCP, FN)
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Hirjak D, Rogers JP, Wolf RC, Kubera KM, Fritze S, Wilson JE, Sambataro F, Fricchione G, Meyer-Lindenberg A, Ungvari GS, Northoff G. Catatonia. Nat Rev Dis Primers 2024; 10:49. [PMID: 39025858 DOI: 10.1038/s41572-024-00534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
Catatonia is a neuropsychiatric disorder characterized by motor, affective and cognitive-behavioural signs, which lasts from hours to days. Intensive research over the past two decades has led to catatonia being recognized as an independent diagnosis in the International Classification of Diseases, 11th Revision (ICD-11) since 2022. Catatonia is found in 5-18% of inpatients on psychiatric units and 3.3% of inpatients on medical units. However, in an unknown number of patients, catatonia remains unrecognized and these patients are at risk of life-threatening complications. Hence, recognizing the symptoms of catatonia early is crucial to initiate appropriate treatment to achieve a favourable outcome. Benzodiazepines such as lorazepam and diazepam, electroconvulsive therapy, and N-methyl-D-aspartate antagonists such as amantadine and memantine, are the cornerstones of catatonia therapy. In addition, dopamine-modulating second-generation antipsychotics (for example, clozapine and aripiprazole) are effective in some patient populations. Early and appropriate treatment combined with new screening assessments has the potential to reduce the high morbidity and mortality associated with catatonia in psychiatric and non-psychiatric settings.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
- German Centre for Mental Health (DZPG), Partner site Mannheim, Mannheim, Germany.
| | | | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Katharina Maria Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education and Clinical Center (GRECC), Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy
| | - Gregory Fricchione
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner site Mannheim, Mannheim, Germany
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Section of Psychiatry, School of Medicine, University Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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Ramognino V, Fovet T, Horn M, Lebouvier T, Amad A. Catatonia in patients with dementia: A descriptive study of clinical profiles and treatment response. Asian J Psychiatr 2024; 96:104033. [PMID: 38564875 DOI: 10.1016/j.ajp.2024.104033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Catatonia is a highly prevalent syndrome in patients presenting with major neurocognitive disorders (dementia). In this study, we aim to provide a comprehensive description of the clinical and therapeutic aspects of catatonia in patients with dementia. METHOD This descriptive study, conducted between September 2015 and June 2022, collected data from 25 patients diagnosed with dementia, out of 143 patients treated for catatonia in our specialized psychiatry department. We collected sociodemographic, clinical and treatment data for each patient. RESULTS Dementia patients constituted 17% of the catatonic cases. Predominantly female, the cohort had a mean age of 65. Diagnoses included Alzheimer's (4 patients, 17%) and Parkinson's (1 patient, 4%) diseases, Lewy body dementia (5 patients, 21%), vascular dementia (4 patients, 17%) and frontotemporal lobar degeneration (10 patients, 41%). The mean Bush-Francis Catatonia Rating Scale score upon admission was 20/69. Overall, complete remission of catatonia was achieved in 75% of patients (n=18), with only 13% (n=3) responding to lorazepam alone, while others required additional interventions such as electroconvulsive therapy (ECT) and/or amantadine. Vascular dementia was predominantly observed in cases resistant to treatment. CONCLUSION The findings indicate a frequent co-occurrence of catatonia and dementia, highlighting treatability yet suggesting a potential for resistance to lorazepam, which varies by dementia diagnosis. Investigating the mechanisms underlying this resistance and the variability in treatment response is crucial for developing more precise therapeutic strategies.
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Affiliation(s)
- Vanina Ramognino
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France; EPSM des Flandres Bailleul, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Mathilde Horn
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Thibaud Lebouvier
- Univ. Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, CNRMAJ, LiCEND, DistAlz, Lille 59000, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France.
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Rogers JP, Oldham MA, Fricchione G, Northoff G, Ellen Wilson J, Mann SC, Francis A, Wieck A, Elizabeth Wachtel L, Lewis G, Grover S, Hirjak D, Ahuja N, Zandi MS, Young AH, Fone K, Andrews S, Kessler D, Saifee T, Gee S, Baldwin DS, David AS. Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2023; 37:327-369. [PMID: 37039129 PMCID: PMC10101189 DOI: 10.1177/02698811231158232] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.
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Affiliation(s)
- Jonathan P Rogers
- Division of Psychiatry, University College
London, London, UK
- South London and Maudsley NHS Foundation
Trust, London, UK
| | - Mark A Oldham
- Department of Psychiatry, University of
Rochester Medical Center, Rochester, NY, USA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research
Unit, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON,
Canada
| | - Jo Ellen Wilson
- Veterans Affairs, Geriatric Research,
Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Psychiatry and Behavioral
Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Andrew Francis
- Penn State Medical School, Hershey Medical
Center, PA, USA
| | - Angelika Wieck
- Greater Manchester Mental Health NHS
Foundation Trust, Manchester, UK
- Institute of Population Health, University
of Manchester, Manchester, UK
| | - Lee Elizabeth Wachtel
- Kennedy Krieger Institute, Baltimore,
Maryland, USA
- Department of Psychiatry, Johns Hopkins
School of Medicine, Baltimore, Maryland, USA
| | - Glyn Lewis
- Division of Psychiatry, University College
London, London, UK
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate
Institute of Medical Education and Research, Chandigarh, CH, India
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy,
Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg,
Mannheim, Germany
| | - Niraj Ahuja
- Regional Affective Disorders Service,
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Michael S Zandi
- Queen Square Institute of Neurology,
University College London, London, UK
- National Hospital for Neurology and
Neurosurgery, London, UK
| | - Allan H Young
- South London and Maudsley NHS Foundation
Trust, London, UK
- Department of Psychological Medicine,
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Kevin Fone
- School of Life Sciences, Queen’s Medical
Centre, The University of Nottingham, Nottingham, UK
| | | | - David Kessler
- Centre for Academic Mental Health,
University of Bristol, Bristol, UK
| | - Tabish Saifee
- National Hospital for Neurology and
Neurosurgery, London, UK
| | - Siobhan Gee
- Pharmacy Department, South London and
Maudsley NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine,
King’s College London, London, UK
| | - David S Baldwin
- Clinical Neuroscience, Clinical and
Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anthony S David
- Institute of Mental Health, University
College London, London, UK
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Malone K, Saveen S, Stevens CM, McNeil S. Successful Treatment of Catatonia: A Case Report and Review of Treatment. Cureus 2022; 14:e26328. [PMID: 35911277 PMCID: PMC9311495 DOI: 10.7759/cureus.26328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/13/2022] Open
Abstract
Herein, we report the case of a 20-year-old Caucasian male with a previous psychiatric history of schizophreniform, autism, unspecified intellectual disorder, and past medical history of hypertension, who presented after a suicidal attempt. One month prior to admission for the suicidal attempt, the patient had mutism. While admitted, the patient showed signs of mutism, posturing, negativism, and waxy flexibility. Treatment with both aripiprazole and lorazepam was effective and reversed the patient’s catatonia after low-dose titration. This case highlights the importance of reviewing patient history and presenting symptoms in the management of catatonia. Additionally, this case provides an opportunity to review the diagnostic approach and treatment type used for patients presenting with catatonia.
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Câmara-Pestana P, Cordeiro C, Raposo M, Sousa M, Estibeiro MJ, Peixoto L. Concurrent catatonia and COVID-19 infection in a demented patient: A case report. PSYCHIATRY RESEARCH CASE REPORTS 2022; 1:100011. [PMID: 36704771 PMCID: PMC9055781 DOI: 10.1016/j.psycr.2022.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 01/29/2023]
Abstract
Catatonia is a complex neuropsychiatric syndrome that comprises motor, behavioral and autonomic abnormalities. It occurs in the context of general medical, neurological, and psychiatric conditions. The study of catatonia in the elderly is particularly challenging due to the higher somatic and cognitive comorbidity, polymedication and the higher prevalence of delirium. Catatonia remains underdiagnosed in this population, especially in those with dementia. We describe a case of an 82-years-old patient with mixed dementia, who developed catatonia for the first time, during her admission to our general medical ward due to SARS-CoV-2 organizing pneumonia. Besides the specific treatment for SARS-CoV-2 organizing pneumonia, catatonia was treated symptomatically with benzodiazepines and memantine with success. In general, catatonia in older patients tends to have a good prognosis if detected early, its cause treated, the symptoms managed, and complications avoided. We report this case to alert clinicians in medical wards to this condition, to improve its overall diagnosis and treatment rates.
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Affiliation(s)
- Pedro Câmara-Pestana
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Psiquiatria e Saúde Mental, Lisboa 1649-028, Portugal,Faculdade de Medicina da Universidade de Lisboa, Clínica Universitária de Psiquiatria e Psicologia Médica, Lisboa, Portugal,Corresponding author at: Centro Hospitalar Universitário Lisboa Norte, Serviço de Psiquiatria e Saúde Mental, Lisboa 1649-028, Portugal
| | - Catarina Cordeiro
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Psiquiatria e Saúde Mental, Lisboa 1649-028, Portugal,Faculdade de Medicina da Universidade de Lisboa, Clínica Universitária de Psiquiatria e Psicologia Médica, Lisboa, Portugal
| | - Miguel Raposo
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Cardiologia, Lisboa, Portugal
| | - Mariana Sousa
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Medicina I C, Lisboa, Portugal
| | - Maria João Estibeiro
- Faculdade de Medicina da Universidade de Lisboa, Clínica Universitária de Psiquiatria e Psicologia Médica, Lisboa, Portugal
| | - Lígia Peixoto
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Medicina I C, Lisboa, Portugal
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Jaimes-Albornoz W, Ruiz de Pellon-Santamaria A, Nizama-Vía A, Isetta M, Albajar I, Serra-Mestres J. Catatonia in older adults: A systematic review. World J Psychiatry 2022; 12:348-367. [PMID: 35317341 PMCID: PMC8900590 DOI: 10.5498/wjp.v12.i2.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/27/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
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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Affiliation(s)
- Walter Jaimes-Albornoz
- Psychiatry Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Angel Ruiz de Pellon-Santamaria
- Psychiatry Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Ayar Nizama-Vía
- Psychiatry Service “Virgen del Cisne” Mental Health Community Center, Regional Health Directorate, Tumbes 24002, Peru
| | - Marco Isetta
- Library and Knowledge Services, Central & North West London NHS Foundation Trust, St Charles’ Hospital, London W10 6DZ, United Kingdom
| | - Ines Albajar
- Neurology Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Jordi Serra-Mestres
- Old Age Psychiatry Service, Cardinal Clinic, Windsor SL4 5UL, United Kingdom
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Jaimes-Albornoz W, Ruiz de Pellon-Santamaria A, Nizama-Vía A, Isetta M, Albajar I, Serra-Mestres J. Catatonia in older adults: A systematic review. World J Psychiatry 2022; 12:359-381. [DOI: 10.5498/wjp.v12.i2.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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de França GC, Barreto HCDB, Paranhos T, Nunes JC, de Oliveira-Souza R. Case Report: Catatonic Stupor in Behavioral Variant Frontotemporal Dementia. Front Neurol 2022; 12:798264. [PMID: 35115996 PMCID: PMC8805594 DOI: 10.3389/fneur.2021.798264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022] Open
Abstract
Catatonia is a psychomotor syndrome common to several medical and neuropsychiatric disorders. Here, we report on the case of a 95-year-old woman who underwent a radical change in personality characterized by sexual disinhibition, and physical and verbal aggressiveness. Over several months, she developed verbal stereotypies, gait deterioration, and double incontinence. She eventually developed mutism and an active opposition to all attempts to be fed or cared for. Benzodiazepines, olanzapine and electroconvulsive therapy were of no benefit. Magnetic resonance imaging revealed asymmetric (more severe on the right) frontotemporal, parietal, and upper brainstem atrophy. She died from sepsis without recovering from stupor seven years after the onset of symptoms. We believe that the initial behavioral disinhibition was related to the frontotemporal injury, whereas catatonic stupor reflected the progression of the degenerative process to the parietal cortices. Our case adds to the small number of cases of catatonia as a symptom of degenerative dementia. It also supports the idea that damage to the parietal cortex gives rise to pathological avoidance of which catatonic stupor represents an extreme form.
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Affiliation(s)
- Gustavo Campos de França
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil
| | - Henrique Carneiro de Barros Barreto
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil
| | - Thiago Paranhos
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of Rio de Janeiro, Clementino Fraga Filho Hospital, Rio de Janeiro, Brazil
| | - Julio Cesar Nunes
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil
| | - Ricardo de Oliveira-Souza
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil
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Grover S. Catatonia in the elderly: Does it require attention! JOURNAL OF GERIATRIC MENTAL HEALTH 2022. [DOI: 10.4103/jgmh.jgmh_33_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Catatonia: Back to the future of the neuropsychiatric syndrome. Med Clin (Barc) 2021; 158:369-377. [PMID: 34924197 DOI: 10.1016/j.medcli.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
Catatonia is an undertreated and underdiagnosed neuropsychiatric syndrome whose prognosis is benign if treated early, thus avoiding possible complications and compromising the health of patients. The latest epidemiological studies indicate a prevalence of catatonia of 9.2%, being frequent in medical pathologies (especially neurological ones), as well as in psychiatric pathologies. The use of validated scales is recommended for its diagnosis, to be able to measure the severity and response to treatment. Once catatonia has been identified, it is necessary to perform a protocolized diagnostic study of the underlying aetiology («Catatonia Workup»). Treatment of choice is benzodiazepines and electroconvulsive therapy. In recent years, new therapeutic alternatives such as non-invasive transcranial magnetic stimulation have emerged. In this review we propose several initiatives to promote the dissemination and knowledge of catatonia in the clinical setting.
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Vaquerizo-Serrano J, Salazar De Pablo G, Singh J, Santosh P. Catatonia in autism spectrum disorders: A systematic review and meta-analysis. Eur Psychiatry 2021; 65:e4. [PMID: 34906264 PMCID: PMC8792870 DOI: 10.1192/j.eurpsy.2021.2259] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Catatonic features can appear in autism spectrum disorders (ASDs). There can be overlap in symptoms across catatonia and ASD. The overall aim of this review is to provide evidence for the presence of catatonic features in subjects with ASD. METHODS A systematic literature search using the Web of Science database from inception to July 10, 2021 was conducted following PRISMA, MOOSE guidelines and the PROSPERO protocol. (CRD42021248615). Twelve studies with information about catatonia and ASD were reviewed. Data from a subset was used to conduct meta-analyses of the presence of catatonia in ASD. RESULTS The systematic review included 12 studies, seven of which were used for the meta-analysis, comprising 969 individuals. The mean age was 21.25 (7.5) years. Two studies (16.6%) included only children and adolescents. A total of 70-100% were males. Our meta-analysis showed that 10.4% (5.8-18.0 95%CI) of individuals with ASD have catatonia. Motor disturbances were common in ASD subjects with catatonia. No differences were found in comorbidity. Several treatments have been used in ASD with catatonic features, including benzodiazepines, antipsychotics, and electroconvulsive therapy (ECT). The findings of the systematic review showed that ECT might help manage catatonic symptoms. CONCLUSIONS Different features of catatonia can exist in individuals with ASD and core symptoms of catatonia are reported in ASD. Longitudinal and longer-term studies are required to understand the relationship between catatonia and ASD, and the response of catatonic symptoms to treatment.
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Affiliation(s)
- J. Vaquerizo-Serrano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases
(CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley
Hospital, LondonSE5 8AB, United Kingdom
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of
Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, LondonSE5 8AF, United Kingdom
- Institute of Psychiatry and Mental Health, Department of Psychiatry, Hospital
General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio
Maranón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental
(CIBERSAM), 28009Madrid, Spain
| | - G. Salazar De Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of
Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, LondonSE5 8AF, United Kingdom
- Institute of Psychiatry and Mental Health, Department of Psychiatry, Hospital
General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio
Maranón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental
(CIBERSAM), 28009Madrid, Spain
| | - J. Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases
(CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley
Hospital, LondonSE5 8AB, United Kingdom
| | - P. Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases
(CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley
Hospital, LondonSE5 8AB, United Kingdom
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Reduced functional connectivity in the prefrontal cortex of elderly catatonia patients: A longitudinal study using functional near-infrared spectroscopy. Neurosci Res 2020; 170:322-329. [PMID: 33316305 DOI: 10.1016/j.neures.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 12/31/2022]
Abstract
Catatonia is a syndrome that manifests in patients with mental disorders and general medical conditions. However, functional changes to the brain that cause catatonia remain unknown. In the present study, we used functional near-infrared spectroscopy (fNIRS) to assess spontaneous hemodynamic activities in the brain at the times of onset and resolution of catatonic symptoms in patients with catatonia. We used 22-channel and 49-channel fNIRS to examine hemodynamic activities in the prefrontal cortex (PFC), and both frontal and parietal cortices, respectively. A total of ten patients who were diagnosed with catatonia were included in the study. Resting state measurements were taken for five minutes at the time of the onset and resolution of catatonic symptoms. Analyses were performed for the prefrontal region and the motor cortex within the parietal-frontal region of the brain. Functional connectivity between the cerebral hemispheres was evaluated systematically based on spontaneous oscillation of Δ[HbO2]. In the PFC, the resting state functional connectivity (RSFC) was significantly lower in the catatonic state than in the eyes-closed non-catatonic state (p = 0.047). The study demonstrated that the RSFC in the PFC, measured using fNIRS, may be an objective indicator of the change in catatonic symptoms.
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Cuevas-Esteban J, Iglesias-González M, Serra-Mestres J, Butjosa A, Canal-Rivero M, Serrano-Blanco A, Baladon L. Catatonia in elderly psychiatric inpatients is not always associated with intense anxiety: Factor analysis and correlation with psychopathology. Int J Geriatr Psychiatry 2020; 35:1409-1417. [PMID: 32748453 DOI: 10.1002/gps.5382] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/22/2020] [Accepted: 07/21/2020] [Indexed: 12/29/2022]
Abstract
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 non-catatonic 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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Affiliation(s)
- Jorge Cuevas-Esteban
- Servicio Psiquiatría, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Departamento Psiquiatría, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Maria Iglesias-González
- Servicio Psiquiatría, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Departamento Psiquiatría, Universitat Autònoma de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Serra-Mestres
- Department of Old Age Psychiatry, Central & North West London NHS Foundation Trust, London, UK
| | - Anna Butjosa
- Sant Joan de Déu research foundation. Esplugues de Llobregat, Llobregat, Spain
| | - Manuel Canal-Rivero
- Servicio Psiquiatría, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antoni Serrano-Blanco
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Llobregat, Spain
| | - Luisa Baladon
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Llobregat, Spain
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15
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Hair cortisol in patients with a depressive episode treated with electroconvulsive therapy. J Affect Disord 2020; 274:784-791. [PMID: 32664015 DOI: 10.1016/j.jad.2020.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/05/2020] [Accepted: 05/10/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is substantial evidence showing changes in hypothalamic pituitary adrenal (HPA)-axis activity in patients with major depressive disorder (MDD). Also, there seem to be differences in HPA-axis functioning between MDD subgroups. It is however unclear whether hair cortisol concentrations (HCC), which are a stable marker of long-term cortisol levels, are suitable as a biomarker for identifying subgroups in MDD. METHODS We were able to attain valid HCC from a scalp hair sample of sixty-two patients with a major depressive episode right before electroconvulsive therapy (ECT). HCC were our main biological outcome measure. We created subgroups using depression severity as defined by the Hamilton Depression Rating Scale, the presence/absence of psychotic symptoms, the presence of melancholia as defined by the CORE and catatonia as defined by the Bush-Francis Catatonia Rating Scale. RESULTS Our analyses of the total group showed a median HCC of 4.4 pg/mg. We found patients with catatonia (N = 10) to have substantially higher median HCC (8.3 pg/mg) than patients without catatonia (3.8 pg/mg). Although presence of melancholia and depression severity were not significantly associated with HCC, more severe psychomotor agitation was associated with higher HCC. Pre-treatment HCC was not associated with ECT outcome. STRENGTHS AND LIMITATIONS A complicating factor in interpretation of our results was the large variability in HCC. This could be related to potential confounders such as cardiometabolic and other comorbidities, that were however addressed to the extent possible. CONCLUSIONS HCC is a potential biomarker for MDD patients with severe agitation and/or catatonia. CLINICALTRIALS.GOV: Identifier: NCT02562846.
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Agüera-Ortiz L, Claver-Martín MD, Franco-Fernández MD, López-Álvarez J, Martín-Carrasco M, Ramos-García MI, Sánchez-Pérez M. Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association. Front Psychiatry 2020; 11:380. [PMID: 32508684 PMCID: PMC7251154 DOI: 10.3389/fpsyt.2020.00380] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. METHODS A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed. RESULTS After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate. DISCUSSION AND CONCLUSIONS Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María Isabel Ramos-García
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Sánchez-Pérez
- Unidad de Psiquiatría Geriátrica, Hospital Sagrat Cor. Martorell, Barcelona, Spain
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17
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Subramaniyam BA, Muliyala KP, Hari Hara S, Kumar Reddi VS. Prevalence of catatonic signs and symptoms in an acute psychiatric unit from a tertiary psychiatric center in India. Asian J Psychiatr 2019; 44:13-17. [PMID: 31302436 DOI: 10.1016/j.ajp.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of catatonia varies with the setting and type of rating scale used to measure catatonia. Catatonia, initially subsumed under schizophrenia, now is increasingly recognized in association with affective disorders. AIM We aimed to examine the prevalence of catatonia in an acute psychiatric inpatient unit in a tertiary center in India. METHODS Study subjects (n = 300) were randomly selected from amongst the inpatients over one year and evaluated within 24 h of admission using BFCRS and NCS, besides a sociodemographic and clinical proforma. During the inpatient stay MINI PLUS 5.0 was applied. RESULTS Among 300 inpatients recruited, 88 (29.3%) demonstrated at least one catatonic sign in either of the rating scales. As per the diagnostic cut-offs defined by BFCRS and NCS, the prevalence of catatonia syndrome was 49 (16.3%) and 32 (10.6%) respectively. The prevalence rates as per ICD-10 criteria and DSM-5 criteria were 19% and 5.3% respectively. The two most frequently noted signs - staring and withdrawal, were not listed as signs in either the ICD-10 or DSM V. The prevalence of catatonic symptoms was different in psychotic disorders in contrast to affective disorders. Severity of catatonia was associated with younger age, lesser duration of primary illness and prior episodes of catatonia. CONCLUSIONS The prevalence of catatonia varies from 5.3% to 19% based on the criteria used. Identification warrants use of structured instruments. Catatonia is more severe in the initial years of illness, those with prior episodes of catatonia and in the younger age group.
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Affiliation(s)
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Suchandra Hari Hara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - V Senthil Kumar Reddi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
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18
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Solmi M, Pigato GG, Roiter B, Guaglianone A, Martini L, Fornaro M, Monaco F, Carvalho AF, Stubbs B, Veronese N, Correll CU. Prevalence of Catatonia and Its Moderators in Clinical Samples: Results from a Meta-analysis and Meta-regression Analysis. Schizophr Bull 2018; 44:1133-1150. [PMID: 29140521 PMCID: PMC6101628 DOI: 10.1093/schbul/sbx157] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Catatonia is an independent syndrome that co-occurs with several mental and medical conditions. We performed a systematic literature review in PubMed/Scopus until February 2017 and meta-analyzed studies reporting catatonia prevalence. Across 74 studies (cross-sectional = 32, longitudinal = 26, retrospective = 16) providing data collected from 1935 to 2017 across all continents, mean catatonia prevalence was 9.0% (k = 80, n = 110764; 95% CI = 6.9-11.7, I2 = 98%, publication bias P < .01), decreasing to 7.8% (k = 19, n = 7612, 95% CI = 7-8.7, I2 = 38.9%) in a subgroup with low heterogeneity. Catatonia prevalence was 23.9% (k = 8, n = 1168, 95% CI = 10-46.9, I2 = 96%) in patients undergoing ECT/having elevated creatinine phosphokinase. Excluding ECT samples, the catatonia prevalence was 8.1% (k = 72, n = 109606, 95% CI = 6.1-10.5, I2 = 98%, publication bias P < .01), with sensitivity analyses demonstrating that country of study origin (P < .001), treatment setting (P = .003), main underlying condition (P < .001), and sample size (P < .001)moderated catatonia prevalence, being highest in Uganda (48.5%, k = 1) and lowest in Mexico (1.9%, 95% CI = 0.4-8.8, I2 = 67%, k = 2), highest in nonpsychiatric out- or inpatient services (15.8%, 95% CI = 8.1-28.4, I2 = 97%, k = 15)and lowest in psychiatric outpatients services (3.2%, 95% CI = 1.7-6.1, I2 = 50%, k = 3), highest in presence of medical or neurological illness with no comorbid psychiatric condition (20.6%, 95% CI = 11.5-34.2, I2 = 95%, k = 10)and lowest in mixed psychiatric samples (5.7%, 95% CI = 4.2-7.7, I2 =98%, k = 43), highest in studies with sample sizes <100 (20.7%, 95% CI = 12.8-31.6, I2 = 90%, k = 17) and lowest in studies with sample sizes >1000 (2.3%, 95% CI = 1.3-3.9, I2 = 99%, k = 16). Meta-regression showed that smaller sample size (P < .01) and less major depressive disorder (P = .02) moderated higher catatonia prevalence. Year of data collection did not significantly moderate the results. Results from this first meta-analysis of catatonia frequencies across time and disorders suggest that catatonia is an epidemiologically and clinically relevant condition that occurs throughout several mental and medical conditions, whose prevalence has not decreased over time and does not seem to depend on different rating scales/criteria. However, results were highly heterogeneous, calling for a cautious interpretation.
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Affiliation(s)
- Marco Solmi
- Psychiatry Unit, Neuroscience Department, University of Padua, Padua, Italy,Institute for Clinical Research and Education in Medicine, Padua, Italy,To whom correspondence should be addressed; Psychiatry Unit, Neuroscience Department, University of Padua, via Giustiniani 2, Padua, Italy 35124; tel: +39-0498213831, fax: +39-0498218256, e-mail:
| | - G Giorgio Pigato
- Psychiatry Unit, Azienda Ospedaliera di Padova, Padua Hospital, Padua, Italy
| | - Beatrice Roiter
- Psychiatry Unit, Neuroscience Department, University of Padua, Padua, Italy
| | | | - Luca Martini
- Psychiatry Unit, Neuroscience Department, University of Padua, Padua, Italy
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Francesco Monaco
- Institute for Clinical Research and Education in Medicine, Padua, Italy
| | - Andrè F Carvalho
- Institute for Clinical Research and Education in Medicine, Padua, Italy,Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Brendon Stubbs
- Institute for Clinical Research and Education in Medicine, Padua, Italy,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicola Veronese
- Institute for Clinical Research and Education in Medicine, Padua, Italy,National Research Council, Ageing Branch, Padua, Italy
| | - Christoph U Correll
- Institute for Clinical Research and Education in Medicine, Padua, Italy,Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
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Serra-Mestres J, Jaimes-Albornoz W. Recognizing Catatonia in Medically Hospitalized Older Adults: Why It Matters. Geriatrics (Basel) 2018; 3:geriatrics3030037. [PMID: 31011075 PMCID: PMC6319219 DOI: 10.3390/geriatrics3030037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 12/14/2022] Open
Abstract
Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral, emotional, and autonomic abnormalities caused by general medical, neurological, and psychiatric disorders, as well as by medications and drugs of abuse. Although there has been a plethora of research on catatonia over the last twenty years, it is still underdiagnosed. Studies of catatonia involving older adults have been sparse, despite its apparent high prevalence, higher risk of serious complications, and of association with non-psychiatric causes. This paper aims to provide an introduction to catatonia as a syndrome, as well as an account of its specificities in older adults, especially those in general hospitals, with the aim to raise awareness of catatonia amongst clinicians working with this age group in acute medical settings, so improvements in its diagnostic rates, treatment, and outcomes can be achieved.
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Affiliation(s)
- Jordi Serra-Mestres
- Department of Old Age Psychiatry, Central and North West London NHS Foundation Trust, Woodland Centre, Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN, UK.
| | - Walter Jaimes-Albornoz
- Psychiatry Service, Hospital Universitario Donostia, Osakidetza-Basque Health Service, E-20014 San Sebastian, Spain.
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20
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Mason DP, Tan M, Lee J, Wolstencroft P, Sanborn K, Ballon JS. Verbigeration: An overlooked symptom of a "forgotten syndrome"? Bipolar Disord 2017; 19:710-712. [PMID: 29268005 DOI: 10.1111/bdi.12574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel P Mason
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - Megan Tan
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - Jonathan Lee
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | | | | | - Jacob S Ballon
- Department of Psychiatry, Stanford University, Stanford, CA, USA
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