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Wu Y, He Q, Zhang L, Li T, Luo F. Successful Recovery of a Catatonic Patient with Severe Pneumonia and Respiratory Failure: Modified Electroconvulsive Therapy Following Tracheotomy. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:183-188. [PMID: 38622014 PMCID: PMC11015835 DOI: 10.62641/aep.v52i2.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUD Catatonia encompasses a group of severe psychomotor syndromes affecting patients' motor, speech, and complex behaviors. Common features include rigidity, reduced mobility, speech, sputum production, defecation, and eating. Risks associated with catatonia, such as increased muscle tension and reduced swallowing and coughing reflexes, along with risks from therapeutic approaches like prolonged bed rest and sedative drugs, can elevate the risk of aspiration pneumonia, severe pneumonia, and acute respiratory failure. These complications significantly impede catatonia treatment, leading to poor prognosis and jeopardizing patient safety. CASE DESCRIPTION In this report, we present a case of catatonia complicated by severe pneumonia and respiratory failure, successfully managed with modified electroconvulsive therapy alongside tracheotomy. We hope this case provides valuable insights for psychiatrists encountering similar scenarios, facilitating the development of rational therapeutic strategies for prompt improvement of patient condition.
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Affiliation(s)
- Yuejing Wu
- Intensive Care Unit, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 310058 Hangzhou, Zhejiang, China
| | - Qian He
- Intensive Care Unit, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 310058 Hangzhou, Zhejiang, China
| | - Li Zhang
- Intensive Care Unit, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 310058 Hangzhou, Zhejiang, China
| | - Tao Li
- Intensive Care Unit, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 310058 Hangzhou, Zhejiang, China
| | - Fugang Luo
- Intensive Care Unit, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, 310058 Hangzhou, Zhejiang, China
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Hegewald C, Guthrie D, LeFay SM. Pharmacologic Treatment of Malignant Catatonia Without Electroconvulsive Therapy: A Case Report. Cureus 2024; 16:e58071. [PMID: 38737995 PMCID: PMC11088471 DOI: 10.7759/cureus.58071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Malignant catatonia is a rare, life-threatening variant of catatonia requiring prompt treatment. Malignant catatonia is characterized by typical catatonia symptoms of psychomotor, neurologic, and behavioral changes complicated by autonomic instability, with an estimated mortality rate of 50% or more when untreated. Electroconvulsive therapy (ECT) is considered the definitive and most effective treatment for malignant catatonia, with minimal literature on the efficacy of pharmacological interventions alone. Timely access to life-saving ECT may be limited in some hospitals due to restrictive laws on the use of ECT when the patient is incapacitated or due to lack of treatment availability. This case report describes the successful pharmacologic treatment of a patient with malignant catatonia where ECT was unobtainable due to legal restrictions and lack of access to treatment. The patient was initially commenced on lorazepam but continued to deteriorate, subsequently developing complications of aspiration pneumonia and Clostridium difficile colitis. The patient's malignant catatonia resolved with a combination of lorazepam, memantine, and a one-time dose of dantrolene. This complex case highlights the challenges of treating malignant catatonia in under-resourced systems or jurisdictions with restrictive ECT laws and adds additional data on the successful use of pharmacologic interventions for malignant catatonia where ECT is impractical or delayed.
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Affiliation(s)
| | | | - Sydney M LeFay
- Psychiatry, Salem Health, Salem, USA
- Psychiatry, Oregon Health & Science University, Portland, USA
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Wadi L, Mandge V. Electroconvulsive therapy for catatonia in anti-NMDA receptor encephalitis: A case series. J Neuroimmunol 2024; 386:578271. [PMID: 38155066 DOI: 10.1016/j.jneuroim.2023.578271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Anti-NMDAR encephalitis is the most common cause of immune-mediated catatonia. CASE SERIES Three females presented with neuropsychiatric symptoms and were empirically treated with first-line immunotherapy and ovarian teratoma resection for suspected autoimmune encephalitis, preceding diagnostic confirmation via NMDAR antibody positivity. They required escalating large doses of benzodiazepines for refractory malignant catatonia resulting in ICU level care. ECT treatments were initiated, and patients were gradually noted to have clinical improvement as was measured by the Bush-Francis Catatonia Rating Scale. CONCLUSIONS Clinicians should recognize catatonia among patients with suspected anti-NMDAR encephalitis and consider the early implementation of ECT into treatment algorithms.
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Affiliation(s)
- Lara Wadi
- Duke University Hospital, 2301 Erwin Road, Durham, NC 27705, United States of America.
| | - Vishal Mandge
- Duke University Hospital, 2301 Erwin Road, Durham, NC 27705, United States of America; Duke Regional Hospital, 3643 N Roxboro St, Durham, NC 27704, United States of America.
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Saini A, Begum N, Matti J, Ghanem DA, Fripp L, Pollak TA, Zandi MS, David A, Lewis G, Rogers J. Clozapine as a treatment for catatonia: A systematic review. Schizophr Res 2024; 263:275-281. [PMID: 36117082 DOI: 10.1016/j.schres.2022.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/29/2022]
Abstract
Catatonia is a neuropsychiatric disorder characterised by altered movement, speech, and behaviour. Clozapine is an established therapy for treatment-resistant schizophrenia, but its role in catatonia has not been systematically examined. In this systematic review, we aimed to assess the evidence for clozapine as a treatment for catatonia. Full text original research articles in English where at least one patient with catatonia was treated with clozapine were included, provided catatonia did not occur solely in the context of neuroleptic malignant syndrome. Results were tabulated with calculations of summary statistics presented. Risk of bias was assessed with the Tool for Evaluating the Methodological Quality of Case Reports and Case Series. 182 patients were included, 81 from cohort studies and 101 from case reports or case series. 119/182 patients (65 %) had a specified underlying diagnosis of schizophrenia. Over 80 % of reported patients with catatonia had at least partial remission following treatment with clozapine across both cohort studies and case reports and case series. Among the case reports and series, 24/101 patients (23.8 %) followed clozapine withdrawal. Overall, 25 studies were of low quality, 60 of moderate quality and 8 of high quality. Our findings should be interpreted with caution, as the reliance on case reports, case series and small cohort studies is susceptible to reporting biases, regression to the mean and confounding by other treatments. Future research could use large healthcare databases to ascertain outcomes in those on clozapine with a history of catatonia given the difficulty and expense of conducting randomised controlled trials.
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Affiliation(s)
- Aman Saini
- Medical School, University College London, London, UK.
| | | | - James Matti
- Medical School, University College London, London, UK
| | | | - Laurie Fripp
- Medical School, University College London, London, UK
| | - Thomas A Pollak
- Department of Psychosis Studies, King's College London, London, UK
| | - Michael S Zandi
- UCL Queen Square Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Anthony David
- Institute of Mental Health, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Jonathan Rogers
- Division of Psychiatry, University College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Mastellari T, Saint-Dizier C, Fovet T, Geoffroy PA, Rogers J, Lamer A, Amad A. Exploring seasonality in catatonia diagnosis: Evidence from a large-scale population study. Psychiatry Res 2024; 331:115652. [PMID: 38071881 DOI: 10.1016/j.psychres.2023.115652] [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: 07/29/2023] [Revised: 11/12/2023] [Accepted: 11/29/2023] [Indexed: 01/02/2024]
Abstract
Catatonia is a severe psychomotor syndrome mainly associated with psychiatric disorders, such as mood disorders and schizophrenia. Seasonal patterns have been described for these psychiatric disorders, and a previous study conducted in South London showed for the first time a seasonal pattern in the onset of catatonia. In this study, we aim to extend those findings to a larger national sample of patients admitted to French metropolitan hospitals, between 2015 and 2022, and to perform subgroup analyses by the main associated psychiatric disorder. A total of 6225 patients diagnosed with catatonia were included. A seasonal pattern for catatonia diagnosis was described, using cosinor models. Two peaks of diagnoses for catatonic cases were described in March and around September-October. Depending on the associated psychiatric disorder, the seasonality of catatonia diagnosis differed. In patients suffering with mood disorders, peaks of catatonia diagnosis were found in March and July. For patients suffering with schizophrenia, no seasonal pattern was found.
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Affiliation(s)
- Tomas Mastellari
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France.
| | - Chloé Saint-Dizier
- Fédération Régionale de Recherche en Santé Mentale et Psychiatrie, Hauts-de-France, France; Univ. Lille, Faculté Ingénierie et Management de la Santé, Lille F-59000, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Pierre-Alexis Geoffroy
- Département de Psychiatrie et d'Addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, F-75018 Paris, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, F-75019 Paris, France; GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France
| | - Jonathan Rogers
- Division of Psychiatry, University College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Antoine Lamer
- Fédération Régionale de Recherche en Santé Mentale et Psychiatrie, Hauts-de-France, France; Univ. Lille, Faculté Ingénierie et Management de la Santé, Lille F-59000, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
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Miyakoshi M, Arai T, Kurose S, Kaji M, Nakane J, Onaya M, Koreki A. Spontaneous Bladder Rupture in a Catatonic Schizophrenia Patient. Case Rep Psychiatry 2023; 2023:4277372. [PMID: 38033476 PMCID: PMC10684317 DOI: 10.1155/2023/4277372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Catatonia is a psychiatric emergency in schizophrenia that often leads to excessive activation of the sympathetic nervous system. Urinary retention in catatonia is often underestimated but has potentially detrimental consequences. Herein, we present the case of a woman in her 40s with schizophrenia treated for catatonia during a relapse. When treated as an inpatient, the patient suddenly complained of severe abdominal pain. Computed tomography revealed a spontaneous rupture of the posterior wall of the bladder, requiring emergency repair surgery in the urology department. The patient was readmitted to our hospital following surgery and ultimately discharged 1 month later. Bladder rupture is life-threatening, and delayed diagnosis and treatment can be fatal. This case report serves as a warning that psychiatrists should not overlook urinary retention in patients with catatonia and should consider bladder rupture in the differential diagnosis when these patients have abdominal pain.
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Affiliation(s)
- Megumi Miyakoshi
- Department of Psychiatry, National Hospital Organisation Shimofusa Psychiatric Medical Centre, 578 Hetacho Midori-ku, Chiba 266-0007, Japan
| | - Takayuki Arai
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shin Kurose
- Department of Psychiatry, National Hospital Organisation Shimofusa Psychiatric Medical Centre, 578 Hetacho Midori-ku, Chiba 266-0007, Japan
| | - Masataka Kaji
- Department of Psychiatry, National Hospital Organisation Shimofusa Psychiatric Medical Centre, 578 Hetacho Midori-ku, Chiba 266-0007, Japan
| | - Jun Nakane
- Department of Psychiatry, National Hospital Organisation Shimofusa Psychiatric Medical Centre, 578 Hetacho Midori-ku, Chiba 266-0007, Japan
| | - Mitsumoto Onaya
- Department of Psychiatry, National Hospital Organisation Shimofusa Psychiatric Medical Centre, 578 Hetacho Midori-ku, Chiba 266-0007, Japan
| | - Akihiro Koreki
- Department of Psychiatry, National Hospital Organisation Shimofusa Psychiatric Medical Centre, 578 Hetacho Midori-ku, Chiba 266-0007, Japan
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Abstract
Catatonia is a severe neuropsychiatric syndrome that affects emotion, speech, movement and complex behaviour. It can occur in a wide range of psychiatric and neurological conditions, including depression, mania, schizophrenia, autism, autoimmune encephalitis (particularly NMDAR encephalitis), systemic lupus erythematosus, thyroid disease, epilepsy and medication-induced and -withdrawal states. This concise guideline highlights key recommendations from the British Association for Psychopharmacology (BAP) Catatonia Guideline, published in April 2023. Important investigations may include neuroimaging, electroencephalography and assessment for neuronal autoantibodies in serum and cerebrospinal fluid. First-line treatment comprises benzodiazepines and/or electroconvulsive therapy. The benzodiazepine of choice is lorazepam, which is sometimes used in very high doses. Multidisciplinary working between psychiatrists and physicians is often essential. The main limitation of the guidelines is the low quality of the underlying evidence, comprising mainly small observational studies and case reports or series.
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Affiliation(s)
- Jonathan P Rogers
- University College London, London, UK, and specialty registrar in general adult and old age psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - Michael S Zandi
- National Hospital for Neurology and Neurosurgery, London, UK, and honorary associate professor, Queen Square Institute of Neurology, University College London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
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Rogers JP, Pollak TA, Begum N, Griffin A, Carter B, Pritchard M, Broadbent M, Kolliakou A, Ke J, Stewart R, Patel R, Bomford A, Amad A, Zandi MS, Lewis G, Nicholson TR, David AS. Catatonia: demographic, clinical and laboratory associations. Psychol Med 2023; 53:2492-2502. [PMID: 35135642 PMCID: PMC10123832 DOI: 10.1017/s0033291721004402] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Catatonia, a severe neuropsychiatric syndrome, has few studies of sufficient scale to clarify its epidemiology or pathophysiology. We aimed to characterise demographic associations, peripheral inflammatory markers and outcome of catatonia. METHODS Electronic healthcare records were searched for validated clinical diagnoses of catatonia. In a case-control study, demographics and inflammatory markers were compared in psychiatric inpatients with and without catatonia. In a cohort study, the two groups were compared in terms of their duration of admission and mortality. RESULTS We identified 1456 patients with catatonia (of whom 25.1% had two or more episodes) and 24 956 psychiatric inpatients without catatonia. Incidence was 10.6 episodes of catatonia per 100 000 person-years. Patients with and without catatonia were similar in sex, younger and more likely to be of Black ethnicity. Serum iron was reduced in patients with catatonia [11.6 v. 14.2 μmol/L, odds ratio (OR) 0.65 (95% confidence interval (CI) 0.45-0.95), p = 0.03] and creatine kinase was raised [2545 v. 459 IU/L, OR 1.53 (95% CI 1.29-1.81), p < 0.001], but there was no difference in C-reactive protein or white cell count. N-Methyl-d-aspartate receptor antibodies were significantly associated with catatonia, but there were small numbers of positive results. Duration of hospitalisation was greater in the catatonia group (median: 43 v. 25 days), but there was no difference in mortality after adjustment. CONCLUSIONS In the largest clinical study of catatonia, we found catatonia occurred in approximately 1 per 10 000 person-years. Evidence for a proinflammatory state was mixed. Catatonia was associated with prolonged inpatient admission but not with increased mortality.
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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
| | - Thomas A. Pollak
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, King's College London, London, UK
| | - Nazifa Begum
- GKT School of Medical Education, King's College London, London, UK
| | - Anna Griffin
- GKT School of Medical Education, King's College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | | | | | - Anna Kolliakou
- Department of Psychological Medicine, King's College London, London, UK
| | - Jessie Ke
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Rashmi Patel
- Department of Psychosis Studies, King's College London, London, UK
| | - Adrian Bomford
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Ali Amad
- Department of Neuroimaging, King's College London, London, UK
- Univ. Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Michael S. Zandi
- UCL Queen Square Institute of Neurology, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | | | - Anthony S. David
- UCL Queen Square Institute of Neurology, University College London, London, UK
- Institute of Mental Health, University College London, London, UK
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Hosseini P, Whincup R, Devan K, Ghanem DA, Fanshawe JB, Saini A, Cross B, Vijay A, Mastellari T, Vivekananda U, White S, Brunnhuber F, Zandi MS, David AS, Carter B, Oliver D, Lewis G, Fry C, Mehta PR, Stanton B, Rogers JP. The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracy. EClinicalMedicine 2023; 56:101808. [PMID: 36636294 PMCID: PMC9829703 DOI: 10.1016/j.eclinm.2022.101808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Catatonia is a psychomotor syndrome that has a wide range of aetiologies. Determining whether catatonia is due to a medical or psychiatric cause is important for directing treatment but is clinically challenging. We aimed to ascertain the performance of the electroencephalogram (EEG) in determining whether catatonia has a medical or psychiatric cause, conventionally defined. METHODS In this systematic review and meta-analysis of diagnostic test accuracy (PROSPERO CRD42021239027), Medline, EMBASE, PsycInfo, and AMED were searched from inception to May 11, 2022 for articles published in peer-reviewed journals that reported EEG findings in catatonia of a medical or psychiatric origin and were reported in English, French, or Italian. Eligible study types were clinical trials, cohort studies, case-control studies, cross-sectional studies, case series, and case reports. The reference standard was the final clinical diagnosis. Data extraction was conducted using individual patient-level data, where available, by two authors. We prespecified two types of studies to overcome the limitations anticipated in the data: larger studies (n ≥ 5), which were suitable for formal meta-analytic methods but generally lacked detailed information about participants, and smaller studies (n < 5), which were unsuitable for formal meta-analytic methods but had detailed individual patient level data, enabling additional sensitivity analyses. Risk of bias and applicability were assessed with the QUADAS-2 tool for larger studies, and with a published tool designed for case reports and series for smaller studies. The primary outcomes were sensitivity and specificity, which were derived using a bivariate mixed-effects regression model. FINDINGS 355 studies were included, spanning 707 patients. Of the 12 larger studies (5 cohort studies and 7 case series), 308 patients were included with a mean age of 48.2 (SD = 8.9) years. 85 (52.8%) were reported as male and 99 had catatonia due to a general medical condition. In the larger studies, we found that an abnormal EEG predicted a medical cause of catatonia with a sensitivity of 0.82 (95% CI 0.67-0.91) and a specificity of 0.66 (95% CI 0.45-0.82) with an I 2 of 74% (95% CI 42-100%). The area under the summary ROC curve offered excellent discrimination (AUC = 0.83). The positive likelihood ratio was 2.4 (95% CI 1.4-4.1) and the negative likelihood ratio was 0.28 (95% CI 0.15-0.51). Only 5 studies had low concerns in terms of risk of bias and applicability, but a sensitivity analysis limited to these studies was similar to the main analysis. Among the 343 smaller studies, 399 patients were included, resulting in a sensitivity of 0.76 (95% CI 0.71-0.81), specificity of 0.67 (0.57-0.76) and AUC = 0.71 (95% CI 0.67-0.76). In multiple sensitivity analyses, the results were robust to the exclusion of reports of studies and individuals considered at high risk of bias. Features of limbic encephalitis, epileptiform discharges, focal abnormality, or status epilepticus were highly specific to medical catatonia, but features of encephalopathy had only moderate specificity and occurred in 23% of the cases of psychiatric catatonia in smaller studies. INTERPRETATION In cases of diagnostic uncertainty, the EEG should be used alongside other investigations to ascertain whether the underlying cause of catatonia is medical. The main limitation of this review is the differing thresholds for considering an EEG abnormal between studies. FUNDING Wellcome Trust, NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust.
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Affiliation(s)
- Paris Hosseini
- Department of Neuropsychiatry, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Karrish Devan
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Aman Saini
- Medical School, University College London, London, UK
| | | | - Apoorva Vijay
- GKT School of Medical Education, King's College London, London, UK
| | - Tomas Mastellari
- Division of Psychiatry, University College London, London, UK
- Inserm U1172, CHU de Lille, Lille Neuroscience & Cognition (LilNCog), Université de Lille, Lille, France
| | - Umesh Vivekananda
- Department of Clinical and Experimental Epilepsy, Institute of Neurology UCL, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven White
- Department of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Franz Brunnhuber
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Michael S. Zandi
- National Hospital for Neurology and Neurosurgery, London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Anthony S. David
- Institute of Mental Health, University College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Dominic Oliver
- Department of Psychosis Studies, King's College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Charles Fry
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Puja R. Mehta
- Queen Square Institute of Neurology, University College London, London, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
- Neuropsychiatry Service, South London and Maudsley NHS Trust, St. Thomas' Hospital, London, UK
| | - Jonathan P. Rogers
- South London and Maudsley NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
- Corresponding author. UCL Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Rd, Bloomsbury, London W1T 7NF, UK.
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10
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Feasibility and usefulness of brain imaging in catatonia. J Psychiatr Res 2023; 157:1-6. [PMID: 36427412 DOI: 10.1016/j.jpsychires.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/25/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
Catatonia is a well characterized psychomotor syndrome that has recognizable motor, affective, behavioural and vegetative manifestations. Despite recent demonstration that catatonia is often associated with brain imaging abnormalities, there is currently no consensus or guidelines about the role of brain imaging. In this study, we assessed the feasibility of brain imaging in a series of patients with catatonia in a routine clinical setting and estimated the prevalence of clinically relevant radiological abnormalities. Sixty patients with catatonia were evaluated against sixty non-healthy controls subjects with headache. The MRI reports were reviewed, and MRI scans were also interpreted by neuroradiologists using a standardised MRI assessment. In this cohort, more than 85% of brain scans of patients with catatonia revealed abnormalities. The most frequently reported abnormalities in the catatonic group were white matter abnormalities (n = 44), followed by brain atrophy (n = 27). There was no evidence for significant differences in the frequency of abnormalities found in radiology reports and standardised neuroradiological assessments. The frequency of abnormalities was similar to that found in a population of non-healthy controls subjects with headache. This study shows that MRI is feasible in patients with catatonia and that brain imaging abnormalities are common findings in these patients. Most frequently, white matter abnormalities and diffuse brain atrophy are observed.
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Barnett BS, Balaji D, Weleff J, Carroll BT. Catatonia and Neuroleptic Malignant Syndrome in Patients With Cerebral Palsy: Two Case Reports and a Systematic Review of the Literature. J Acad Consult Liaison Psychiatry 2022; 64:277-293. [PMID: 36586471 DOI: 10.1016/j.jaclp.2022.12.008] [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: 10/19/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with cerebral palsy, a group of movement disorders with motor, communication, and behavioral features that can mimic catatonic signs, could benefit from efforts to improve the detection and treatment of comorbid catatonia. Given that cerebral palsy frequently co-occurs with conditions associated with catatonia, such as autism spectrum disorder, epilepsy, intellectual disability, and mood and psychotic disorders, lifetime prevalence of catatonia in this population may be high. OBJECTIVE This study aimed to systematically review the literature on catatonia and the related condition of neuroleptic malignant syndrome (NMS) in patients with cerebral palsy while presenting 2 additional cases of catatonia. METHODS We used the terms "cerebral palsy" in combination with "catatoni∗," related terms for catatonia, and "neuroleptic malignant syndrome" to query Ovid MEDLINE (1948 to November 28, 2022), PsycINFO, Cumulative Index to Nursing, and Allied Health Literature, and Embase for applicable case reports. The Neuroleptic Malignant Syndrome Information Service database was also manually searched. RESULTS In addition to our 2 catatonia reports, we identified 10 reports of catatonia in patients with cerebral palsy, as well as 8 reports of NMS. Patients with both conditions responded well, and sometimes rapidly, to treatment. Notably, of the 5 patients with catatonia and cerebral palsy who received electroconvulsive therapy, 2 developed recurrent self-limited hyperthermia posttreatment. We also identified several cases of baclofen withdrawal, which can be life threatening because of seizure risk, presenting with NMS-like features in patients with cerebral palsy who had malfunctioning intrathecal baclofen pumps for spasticity management. CONCLUSIONS Given frequent comorbidity of conditions associated with catatonia in patients with cerebral palsy, as well as routine treatment with medications that can induce NMS, such as metoclopramide and anticholinergics, catatonia and NMS may be underreported in the cerebral palsy patient population, despite being highly treatable. Possible underdiagnosis of catatonia in patients with cerebral palsy may be because of misattribution of overlapping features between the 2 conditions to cerebral palsy. Clinicians should be aware of possible recurrent self-limited fever when using electroconvulsive therapy to treat patients with catatonia and cerebral palsy while also being vigilant for intrathecal baclofen withdrawal when encountering NMS-like features in patients with cerebral palsy.
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Affiliation(s)
- Brian S Barnett
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH.
| | - Dhiksha Balaji
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jeremy Weleff
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH; Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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12
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Post-traumatic catatonia in a teenaged patient. Am J Emerg Med 2022; 62:146.e1-146.e2. [PMID: 36117015 DOI: 10.1016/j.ajem.2022.08.057] [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: 08/13/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
Catatonia is a poorly understood and underrecognized psychomotor condition characterized by three or more catatonic symptoms, commonly including abnormalities in speech, affect, and movement. Catatonia is generally associated with psychiatric disorders such as bipolar disorder and schizophrenia, but may be seen in general medical conditions and rarely after physical trauma. Here, we present the first pediatric case of catatonia following traumatic brain injury as well as the first case of catatonia in any patient following minor traumatic brain injury.
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13
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Correll CU, Solmi M, Croatto G, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J. Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry 2022; 21:248-271. [PMID: 35524619 PMCID: PMC9077617 DOI: 10.1002/wps.20994] [Citation(s) in RCA: 168] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
People with schizophrenia die 15-20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random-effects meta-analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators. Primary outcome was all-cause mortality risk ratio (RR); key secondary outcomes were mortality due to suicide and natural causes. Other secondary outcomes included any other specific-cause mortality. Publication bias, subgroup and meta-regression analyses, and quality assessment (Newcastle-Ottawa Scale) were conducted. Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all-cause mortality was increased in people with schizophrenia versus any non-schizophrenia control group (RR=2.52, 95% CI: 2.38-2.68, n=79), with the largest risk in first-episode (RR=7.43, 95% CI: 4.02-13.75, n=2) and incident (i.e., earlier-phase) schizophrenia (RR=3.52, 95% CI: 3.09-4.00, n=7) versus the general population. Specific-cause mortality was highest for suicide or injury-poisoning or undetermined non-natural cause (RR=9.76-8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79-7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4), to alcohol or gastrointestinal or renal or nervous system or cardio-cerebrovascular or all natural causes (RR=2 to 3), and liver or cerebrovascular, or breast or colon or pancreas or any cancer causes (RR=1.33 to 1.96). All-cause mortality increased slightly but significantly with median study year (beta=0.0009, 95% CI: 0.001-0.02, p=0.02). Individuals with schizophrenia <40 years of age had increased all-cause and suicide-related mortality compared to those ≥40 years old, and a higher percentage of females increased suicide-related mortality risk in incident schizophrenia samples. All-cause mortality was higher in incident than prevalent schizophrenia (RR=3.52 vs. 2.86, p=0.009). Comorbid substance use disorder increased all-cause mortality (RR=1.62, 95% CI: 1.47-1.80, n=3). Antipsychotics were protective against all-cause mortality versus no antipsychotic use (RR=0.71, 95% CI: 0.59-0.84, n=11), with largest effects for second-generation long-acting injectable anti-psychotics (SGA-LAIs) (RR=0.39, 95% CI: 0.27-0.56, n=3), clozapine (RR=0.43, 95% CI: 0.34-0.55, n=3), any LAI (RR=0.47, 95% CI: 0.39-0.58, n=2), and any SGA (RR=0.53, 95% CI: 0.44-0.63, n=4). Antipsychotics were also protective against natural cause-related mortality, yet first-generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia. Higher study quality and number of variables used to adjust the analyses moderated larger natural-cause mortality risk, and more recent study year moderated larger protective effects of antipsychotics. These results indicate that the excess mortality in schizophrenia is associated with several modifiable factors. Targeting comorbid substance abuse, long-term maintenance antipsychotic treatment and appropriate/earlier use of SGA-LAIs and clozapine could reduce this mortality gap.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Giovanni Croatto
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | | | | | | | | | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Philip Gorwood
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France
- GHU Paris Psychiatrie et Neurosciences (CMME, Sainte-Anne Hospital), Université de Paris, Paris, France
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
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Kompella S, Gallucci F, Jones S, Ikekwere J, Poulsen R, Parker J, Coffey BJ. Catatonia in a 16-Year Old. J Child Adolesc Psychopharmacol 2021; 31:518-520. [PMID: 34543082 DOI: 10.1089/cap.2021.29208.bjc] [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: 11/12/2022]
Affiliation(s)
| | - Felicia Gallucci
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sara Jones
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Raul Poulsen
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jonathan Parker
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Barbara J Coffey
- Miller School of Medicine, University of Miami, Miami, Florida, USA
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15
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Funayama M, Okochi R, Asada S, Shimizu Y, Kurose S, Takata T. Severe diaphoresis and fever during alcohol withdrawal cause hypovolemic shock: case report. BMC Psychiatry 2021; 21:387. [PMID: 34348698 PMCID: PMC8336347 DOI: 10.1186/s12888-021-03393-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Several fatal medical complications have been associated with alcohol withdrawal, such as seizure, cardiac arrhythmia, and takotsubo cardiomyopathy. However, there have been no reports on hypovolemic shock during alcohol withdrawal, although two physical signs of alcohol withdrawal, i.e., diaphoresis and fever, can lead to hypovolemia and its medical consequences. CASE PRESENTATION We describe a patient with alcohol use disorder who exhibited hypovolemic shock and its associated acute renal failure during alcohol withdrawal with severe diaphoresis and fever even though he had consumed almost the full amount of food he was offered. Given his excessive diaphoresis and fever that were related to alcohol withdrawal, his water intake was insufficient. Infusion with extracellular fluid resolved all these medical issues. CONCLUSIONS The increased adrenergic activity associated with alcohol withdrawal might substantially increase a patient's water-intake requirement through diaphoresis and fever and may cause severe hypovolemia and its associated medical complications.
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Affiliation(s)
- Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1, Yobe, Ashikaga-City, Tochigi, 3260843, Japan.
| | - Ryotaro Okochi
- grid.413981.60000 0004 0604 5736Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1, Yobe, Ashikaga-City, Tochigi, 3260843 Japan
| | - Shintaro Asada
- grid.413981.60000 0004 0604 5736Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1, Yobe, Ashikaga-City, Tochigi, 3260843 Japan
| | - Yusuke Shimizu
- grid.413981.60000 0004 0604 5736Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1, Yobe, Ashikaga-City, Tochigi, 3260843 Japan
| | - Shin Kurose
- grid.413981.60000 0004 0604 5736Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1, Yobe, Ashikaga-City, Tochigi, 3260843 Japan
| | - Taketo Takata
- grid.413981.60000 0004 0604 5736Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1, Yobe, Ashikaga-City, Tochigi, 3260843 Japan
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16
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Kumar P, Kumar D. Zolpidem in treatment resistant adolescent catatonia: a case series. Scand J Child Adolesc Psychiatr Psychol 2021; 8:135-138. [PMID: 33564629 PMCID: PMC7863723 DOI: 10.21307/sjcapp-2020-013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Catatonia is a well-established psycho-motor disorder occurring in the background of various psychiatric and medical disorders. Catatonia is commonly associated with psychiatric disorders, especially affective disorders followed by schizophrenia. However, almost 20% occur in the background of different medical and neurological disorders which need to be properly examined and investigated. Catatonia is a serious medical and psychiatric emergency condition; most probably caused by alteration in GABAergic circuits and basal ganglia. If untreated, catatonia can cause life threatening complications like dyselectrolemia, respiratory aspiration, venous thromboembolism, acute renal failure and cardiac arrest because of poor oral intake, immobility and muscular rigidity. The risk of mortality or serious life threatening events further increases in cases of children and adolescents. In children and adolescents, thus, it becomes even more important to diagnose catatonia early and start appropriate treatment. Lorazepam is considered to be the first line treatment and is safe both in adults and children. But evidence is scarce for treatment of lorazepam-resistant adolescent Catatonia. In this report we discuss two adolescent patients diagnosed with catatonia with no medical or neurological disorders in the background. Neither of the patients responded to lorazepam alone or even after augmentation with second generation antipsychotic (olanzapine). Zolpidem, like lorazepam, has a positive allosteric effect on GABA A Receptors (GABAAR) and has been used in some cases successfully to treat resistant catatonia. Here we used zolpidem 30 mg/day in divided doses with marked improvement in few days in all the symptoms. Both cases were discharged on zolpidem extended release (ER) three times a day and maintained well through the next two follow ups in over a two month period. Zolpidem can be a good alternative for children and adolescents in resistant cases.
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Affiliation(s)
- Pravesh Kumar
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | - Deepak Kumar
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, India
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17
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Plahouras JE, Konstantinou G, Kaster TS, Buchman DZ, Foussias G, Daskalakis ZJ, Blumberger DM. Treatment Capacity and Clinical Outcomes for Patients With Schizophrenia Who Were Treated With Electroconvulsive Therapy: A Retrospective Cohort Study. Schizophr Bull 2020; 47:424-432. [PMID: 33145601 PMCID: PMC7965065 DOI: 10.1093/schbul/sbaa144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients with schizophrenia are often found incapable to consent to psychiatric treatment. We evaluated clinical outcomes for incapable and capable patients with schizophrenia treated with electroconvulsive therapy (ECT). METHODS We conducted a chart review of all inpatients treated with an acute course of ECT between 2010 and 2018 at the Centre for Addiction and Mental Health, Toronto, Canada. Short-term outcomes included treatment response and cognitive impairment. We assessed whether incapable patients regained the capacity to consent to treatment. Long-term outcomes included readmissions and subsequent courses of acute or maintenance ECT. RESULTS A total of 159 (67%) incapable and 79 (33%) capable patients were included. Patients experienced treatment response (incapable, n = 108, 67.9%; capable, n = 52, 65.8%; P = .771) and few experienced cognitive impairment (incapable, n = 21, 13.2%; capable, n = 19, 24.1%; P = .043). A minority of patients were treated with a subsequent course of acute ECT (incapable, n = 46, 28.9%; capable, n = 16, 20.3%; P = .162). Incapable patients were more likely to be treated with maintenance ECT for at least 6 months (incapable, n = 46, 28.9%; capable, n = 13, 16.5%; P = .039). Both groups had similar readmission rates (incapable, n = 70, 44.0%; capable, n = 35, 44.3%; P = 1.000). Eight (5.0%) incapable patients regained capacity and 7 consented to further treatment. CONCLUSIONS Irrespective of treatment capacity, the majority of patients demonstrated clinical improvement. Incapable patients experienced less cognitive side effects when compared with capable patients, though they had fewer treatments overall. This study informs clinicians, patients, and substitute decision-makers about the outcomes and challenges of ECT in patients with schizophrenia.
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Affiliation(s)
- Joanne E Plahouras
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gerasimos Konstantinou
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Z Buchman
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada,Bioethics Department, Toronto Western Hospital, University Health Network, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - George Foussias
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Campbell Family Mental Health Institute, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Campbell Family Mental Health Institute, Toronto, ON, Canada,To whom correspondence should be addressed; Centre for Addiction and Mental Health, 1001 Queen St. W. Unit 4, Room 115, Toronto, ON M6J 1H4, Canada; tel: 416-535-8501 x 33662, fax: 416-583-4613, e-mail:
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18
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Dean DJ, Woodward N, Walther S, McHugo M, Armstrong K, Heckers S. Cognitive motor impairments and brain structure in schizophrenia spectrum disorder patients with a history of catatonia. Schizophr Res 2020; 222:335-341. [PMID: 32423702 PMCID: PMC7665847 DOI: 10.1016/j.schres.2020.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/18/2020] [Accepted: 05/05/2020] [Indexed: 12/29/2022]
Abstract
There is growing interest in understanding the behavioral and neural mechanisms of catatonia. Here, we examine cognition and brain structure in schizophrenia spectrum disorder (SSD) patients with a history of catatonia. A total of 172 subjects were selected from a data repository; these included SSD patients with (n = 43) and without (n = 43) a history of catatonia and healthy control subjects (n = 86). Cognitive functioning was assessed using the Screen for Cognitive Impairment in Psychiatry (SCIP) and brain structure was assessed using voxel-based morphometry (VBM) in the CAT12 toolbox. SSD patients with a history of catatonia showed worse performance on tests of verbal fluency and processing speed compared to SSD patients without such a history, even after controlling for current antipsychotic and benzodiazepine use. No differences were found between patients with and without a history of catatonia in terms of brain structure. Both patient groups combined showed significantly smaller grey matter volumes compared to healthy control subjects in brain regions consistent with prior studies, including the anterior cingulate, insular, temporal, and medial frontal cortices. The results highlight a cognitive-motor impairment in SSD patients with a history of catatonia. Challenges and limitations of examining brain structure in patients with a history of catatonia are discussed.
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Affiliation(s)
- Derek J. Dean
- Department of Psychology, Vanderbilt University, Nashville, TN, USA,Corresponding author at: Department of Psychology, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37240, USA. (D.J. Dean)
| | - Neil Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Maureen McHugo
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristan Armstrong
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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19
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Rohde C, Siskind D, de Leon J, Nielsen J. Antipsychotic medication exposure, clozapine, and pneumonia: results from a self-controlled study. Acta Psychiatr Scand 2020; 142:78-86. [PMID: 31875941 DOI: 10.1111/acps.13142] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE By using a self-controlled design, we investigated whether antipsychotic medication exposure was associated with increased pneumonia risk and whether patients receiving clozapine were more likely to develop pneumonia than patients receiving other antipsychotic medications. METHODS Through nationwide health registers, we identified all out-patients with schizophrenia initiating antipsychotic treatment. First, we estimated whether antipsychotic-naïve patients with schizophrenia increased their risk of pneumonia after initiation of either a first- or second-generation antipsychotic medication using a one-year mirror-image model. Afterward, similar analyses were made for individual second-generation antipsychotics. Lastly, the rate of pneumonia for patients initiated on clozapine was compared to patients commenced on other second-generation antipsychotics. RESULTS In total, 8355 antipsychotic-naïve patients with schizophrenia were initiated on a first-generation antipsychotic medication; 0.95% of the patients had developed pneumonia before exposure, compared to 0.68% after exposure (P = 0.057). Similar findings were made for the 8001 antipsychotic-naïve patients with schizophrenia initiated on second-generation antipsychotic medications, with 0.56% developing pneumonia before exposure compared to 0.55% after exposure (P = 1.00). Second-generation antipsychotic medications did not increase the pneumonia risk, except for risperidone (increased by 0.32%; P = 0.007) and clozapine, which gave the largest absolute increase in pneumonia risk although not significant (increased by 0.64%; P = 0.10). The rate of pneumonia was higher after initiation of clozapine than for other second-generation antipsychotic medications. CONCLUSION Most antipsychotic medications were not found to increase the risk of pneumonia. Clozapine exposure might be associated with increased risk of developing pneumonia.
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Affiliation(s)
- C Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | - D Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - J de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
| | - J Nielsen
- Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
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20
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Sichert V, Volz HP. Rapid efficacy of aripiprazole in the treatment of catatonic depression/catatonia with consideration of the drug's unique receptor profile: a case report. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 89:178-181. [PMID: 32575133 DOI: 10.1055/a-1183-3887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Catatonia is a widespread problem in psychiatric hospitals as approximately 10% of patients present with catatonic symptoms upon admission. Catatonia carries the risk of severe, even fatal complications. The first line treatment is usually electroconvulsive therapy (ECT) or benzodiazepines, but ECT may not be readily available and benzodiazepines may not always be effective. We describe the case of a patient presenting with severe symptoms of catatonic depression who completed a 3-day course of 25 mg aripiprazole that rapidly resolved his catatonic symptoms. Several cases have already been reported where administration of aripiprazole successfully resolved catatonic symptoms after other treatment options had failed. Aripiprazole's efficacy and advantages may lie in its unique receptor profile. It acts as a dopamine D2 receptor (D2 R) antagonist and partial D2 R agonist depending on the precise cellular milieu, which may explain its efficacy and favourable side effect profile compared to other antipsychotics used to treat catatonia. Aripiprazole also partially agonises D3 receptors and serotonin 2 C receptors (5-HT2 C), which may contribute to its antidepressant properties. Aripiprazole enhances gamma-aminobutyric acid (GABA) transmission in certain brain areas, and it is widely agreed that low GABA activity may contribute to catatonic symptoms. Pharmacokinetics studies show that peak plasma levels are reached rapidly, within 2-3 hours of intramuscular administration and 4-6 hours of oral administration. Administration of high-dose aripiprazole (>25 mg/day) should be considered as a viable alternative to ECT and benzodiazepines in patients presenting with catatonic symptoms. Aripiprazole also carries a much lower risk of complications compared to other antipsychotics.
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Affiliation(s)
- Verena Sichert
- Krankenhaus für Psychiatrie Psychotherapie und Psychosomatische Medizin Schloss Werneck
| | - Hans-Peter Volz
- Krankenhaus für Psychiatrie Psychotherapie und Psychosomatische Medizin Schloss Werneck
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21
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Catatonia, bedridden status, choking, water intoxication, and suicide are involved in deaths of schizophrenia inpatients. Asian J Psychiatr 2020; 51:102054. [PMID: 32283511 DOI: 10.1016/j.ajp.2020.102054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/23/2022]
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22
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Successful Treatment With Lithium in a Refractory Patient With Periodic Catatonic Features: A Case Report. Clin Neuropharmacol 2020; 43:84-85. [PMID: 32384310 DOI: 10.1097/wnf.0000000000000390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Catatonia is a severe condition in patients. Electroconvulsive treatment or medication with benzodiazepines and/or antipsychotics are regarded as standard treatment. CASE PRESENTATION We report a case of a patient with catatonic features in whom electroconvulsive treatment and benzodiazepine and/or antipsychotic medications failed to achieve efficacy. Additional treatment with lithium ameliorated catatonia. CONCLUSION We concluded that lithium is an optional treatment in patients in whom standard treatment failed.
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Funayama M, Takata T. Psychiatric inpatients subjected to physical restraint have a higher risk of deep vein thrombosis and aspiration pneumonia. Gen Hosp Psychiatry 2020; 62:1-5. [PMID: 31734627 DOI: 10.1016/j.genhosppsych.2019.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 12/21/2022]
Abstract
Physical restraint in clinical settings can lead to potentially lethal complications. Although this is a life-and-death issue, no comprehensive large-scale study relating medical complications to physical restraint has yet been performed. The 1308 psychiatric inpatients in our retrospective cohort study were categorized into two groups: a physical restraint group (those who had been subjected to physical restraint while hospitalized; n = 110) and a non-physical restraint group (those never subjected to physical restraint; n = 1198). We assessed differences between the two groups with respect to the occurrence of medical complications subsequent to restraint. To control for potentially confounding factors, linear discriminant regression analysis was used to identify whether physical restraint itself affected the occurrence of medical complications. The physical restraint group had a higher risk for deep vein thrombosis (P < .01, OR = 6.0, 95%CI: 2.4-13.9) and aspiration pneumonia (P < .01, OR = 4.1, 95%CI: 2.1-7.6) when compared with the non-physical restraint group. Even after controlling for potentially confounding factors, physical restraint substantially raised the risk of deep vein thrombosis and aspiration pneumonia (P < .01, P = .01, respectively). Although this study population was derived from a single psychiatric unit, physical restraint may lead to serious medical conditions. To avoid this unwanted consequence, the use of physical restraint should be minimized and physical therapy is highly recommended.
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Affiliation(s)
- Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Tochigi 3260843, Japan.
| | - Taketo Takata
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Tochigi 3260843, Japan
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Paik H, Kan MJ, Rappoport N, Hadley D, Sirota M, Chen B, Manber U, Cho SB, Butte AJ. Tracing diagnosis trajectories over millions of patients reveal an unexpected risk in schizophrenia. Sci Data 2019; 6:201. [PMID: 31615985 PMCID: PMC6794302 DOI: 10.1038/s41597-019-0220-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023] Open
Abstract
The identification of novel disease associations using big-data for patient care has had limited success. In this study, we created a longitudinal disease network of traced readmissions (disease trajectories), merging data from over 10.4 million inpatients through the Healthcare Cost and Utilization Project, which allowed the representation of disease progression mapping over 300 diseases. From these disease trajectories, we discovered an interesting association between schizophrenia and rhabdomyolysis, a rare muscle disease (incidence < 1E-04) (relative risk, 2.21 [1.80-2.71, confidence interval = 0.95], P-value 9.54E-15). We validated this association by using independent electronic medical records from over 830,000 patients at the University of California, San Francisco (UCSF) medical center. A case review of 29 rhabdomyolysis incidents in schizophrenia patients at UCSF demonstrated that 62% are idiopathic, without the use of any drug known to lead to this adverse event, suggesting a warning to physicians to watch for this unexpected risk of schizophrenia. Large-scale analysis of disease trajectories can help physicians understand potential sequential events in their patients.
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Affiliation(s)
- Hyojung Paik
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 550 16th Street, San Francisco, CA, 9414, USA
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
- Korea Institute of Science and Technology Information, Center for Supercomputing Application, Division of Supercomputing, Daejeon, 34141, South Korea
- National Institute of Health, Division of Bio-Medical Informatics, Center for Genome Science, OHTAC, 187 Osongsaengmyeong2(i)-ro, Gangoe-myeon, Cheongwon-gun, ChoongchungBuk-do, South Korea
| | - Matthew J Kan
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 550 16th Street, San Francisco, CA, 9414, USA
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Nadav Rappoport
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 550 16th Street, San Francisco, CA, 9414, USA
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Dexter Hadley
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 550 16th Street, San Francisco, CA, 9414, USA
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 550 16th Street, San Francisco, CA, 9414, USA
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Bin Chen
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 550 16th Street, San Francisco, CA, 9414, USA
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Udi Manber
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 550 16th Street, San Francisco, CA, 9414, USA
- Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Seong Beom Cho
- National Institute of Health, Division of Bio-Medical Informatics, Center for Genome Science, OHTAC, 187 Osongsaengmyeong2(i)-ro, Gangoe-myeon, Cheongwon-gun, ChoongchungBuk-do, South Korea.
| | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, 550 16th Street, San Francisco, CA, 9414, USA.
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, USA.
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Kurose S, Koreki A, Funayama M, Takahashi E, Kaji M, Ogyu K, Takasu S, Koizumi T, Suzuki H, Onaya M, Mimura M. Resting-state hyperperfusion in the whole brain: A case of malignant catatonia that improved with electric convulsion therapy. Schizophr Res 2019; 210:287-288. [PMID: 31178364 DOI: 10.1016/j.schres.2019.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Shin Kurose
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan; Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Akihiro Koreki
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Eriko Takahashi
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Masataka Kaji
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Kamiyu Ogyu
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Takasu
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Teruki Koizumi
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hisaomi Suzuki
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Mitsumoto Onaya
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Haga T, Ito K, Sakashita K, Iguchi M, Ono M, Tatsumi K. Risk factors for pneumonia in patients with schizophrenia. Neuropsychopharmacol Rep 2018; 38:204-209. [PMID: 30353691 PMCID: PMC7292272 DOI: 10.1002/npr2.12034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 11/10/2022] Open
Abstract
AIM Pneumonia is a major cause of death in patients with schizophrenia. Preventive strategies based on identifying the risk factors are needed to reduce pneumonia-related mortality. This study aimed to clarify the risk factors for pneumonia in patients with schizophrenia. METHODS We retrospectively reviewed the clinical files of consecutive patients with schizophrenia admitted to Tokyo Metropolitan Matsuzawa Hospital during a four-year period from January 2014 to December 2017. We analyzed the clinical differences between patients with and without pneumonia. RESULTS Of the 2209 patients enrolled, 101 (4.6%) received the diagnosis of pneumonia at the time of hospital admission while 2108 (95.4%) did not have pneumonia. Multivariable analysis to determine the risk factors related to pneumonia showed that the use of atypical antipsychotics had the highest odds ratio among the predictive factors (2.7; 95% confidence interval [CI] 1.0-17.7; P = 0.046), followed by a total chlorpromazine equivalent dose ≥600 mg (2.6; 95% CI 1.7-4.0; P < 0.001), body mass index <18.5 kg/m2 (2.3; 95% CI 1.6-3.6; P < 0.001), smoking history (2.0; 95% CI 1.3-3.1; P < 0.001), and age ≥50 years (1.7; 95% CI 1.2-2.6; P = 0.002). CONCLUSIONS We found that advanced age, underweight, smoking habit, use of atypical antipsychotics, and large doses of antipsychotics were risk factors for pneumonia in patients with schizophrenia. Among these factors, it was unclear whether the use of antipsychotics was a direct cause of pneumonia due to is uncertain because our retrospective study design. However, our result might be a good basis of further study focused on reducing pneumonia-related fatalities in schizophrenic patients with pneumonia.
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Affiliation(s)
- Takahiro Haga
- Department of Psychiatry, Kanto Rosai Hospital, Kawasaki, Japan.,Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kae Ito
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Kentaro Sakashita
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Mari Iguchi
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Masahiro Ono
- Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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