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Grover S, Sethi K, Chakrabarti S. Use of ECT in patients with organic catatonia. Asian J Psychiatr 2024; 101:104206. [PMID: 39226755 DOI: 10.1016/j.ajp.2024.104206] [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: 02/11/2024] [Revised: 04/07/2024] [Accepted: 08/29/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is considered to be a treatment of choice in patients with catatonia, who do not respond to lorazepam, irrespective of the underlying aetiology. Although, significant data is available for successful use of ECT in patients with catatonia secondary to affective and psychotic disorders, little information is available for use of ECT in organic catatonia. AIM To assess demographic and clinical profile of patients with organic catatonia receiving ECT. METHODOLOGY Using a retrospective study design, ECT register of the department was reviewed for the period of 2019-2023 to identify the patients with organic catatonia, who received ECT. The treatment records of these patients were reviewed to extract the demographic and clinical profile. RESULTS During the study period, out of the 926 patients who received ECT, 12 (1.3 %) patients diagnosed with organic catatonia received ECT. The mean age of study sample was 41.67 (SD- 20.68) years and mean number of ECTs given in a course of ECT were 8 (SD- 4.3). In majority of the patients, ECT was considered after the failure of lorazepam challenge test. Majority (75 %) of the patients showed good response to ECT and only 16.67 % of the patients experienced complications during the course of ECT. CONCLUSION ECT is an effective and well-tolerated treatment for organic catatonia.
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Affiliation(s)
- Sandeeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Kanika Sethi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Abstract
The mechanism of action of electroconvulsive therapy (ECT) is not fully elucidated, with prevailing theories ranging from neuroendocrinological to neuroplasticity effects of ECT or epileptiform brain plasticity. Youth with autism can present with catatonia. ECT is a treatment that can safely and rapidly resolve catatonia in autism and should be considered promptly. The literature available for ECT use in youth with autism is consistently growing. Under-recognition of the catatonic syndrome and delayed diagnosis and implementation of the anticatatonic treatment paradigms, including ECT, as well as stigma and lack of knowledge of ECT remain clinical stumbling blocks.
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Affiliation(s)
- Sa Eun Park
- Kennedy Krieger Institute, 1741 Ashland Avenue, Baltimore, MD 21205, USA.
| | - Marco Grados
- Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Lee Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, 707 North Broadway Street, Baltimore, MD 21209, USA
| | - Sanjay Kaji
- Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
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Shorter E. The first psychiatric pandemic: Encephalitis lethargica, 1917-27. Med Hypotheses 2020; 146:110420. [PMID: 33268001 DOI: 10.1016/j.mehy.2020.110420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022]
Abstract
Finding a link between COVID-19 and subsequent psychiatric symptoms has resulted in renewed interest in the psychiatric sequelae of pandemics. The first such instance was apparently the encephalitis lethargica pandemic which arose around the time of the First World War, moving in the shadow of a repiratory virus pandemic. The epidemic of encephalitis lethargica (EL), or Von Economo's Disease, in the years 1917-27 was the first pandemic involving the central nervous system. It moved in some places in parallel with the Great Flu Pandemic but does not seem to have been caused by it. Unlike the coronavirus, pandemic EL affected children heavily, leading often to bizarre changes in character and personality. It often left sequelae lasting for decades in the form of postencephalitic Parkinsonism (PEP). Unlike the coronavirus, it had a high mortality of around 20 percent. Although encephalitis lethargica involved a number of systems, psychiatric morbidity was most prominent and entailed severe depression, mania, catatonia and psychosis. It ended without therapeutic or public-health measures; today, sporadic cases of EL continue to be reported. The hypothesis is that we can derive from the EL psychiatric pandemic certain lessons that might be useful in studying tardive COVID symptoms today.
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MESH Headings
- Brain/physiopathology
- Brain/virology
- COVID-19/epidemiology
- COVID-19/psychology
- History, 20th Century
- Humans
- Influenza Pandemic, 1918-1919
- Influenza, Human/epidemiology
- Influenza, Human/history
- Influenza, Human/psychology
- Models, Neurological
- Models, Psychological
- Pandemics/history
- Parkinson Disease, Postencephalitic/epidemiology
- Parkinson Disease, Postencephalitic/history
- Parkinson Disease, Postencephalitic/psychology
- SARS-CoV-2/pathogenicity
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Affiliation(s)
- Edward Shorter
- Jason A Hannah Professor of the History of Medicine, Professor of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 263 McCaul Street, Room 408, Toronto, ON M5T 1W7, Canada.
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Becker MA, Cannon J, Certa K. A Case of Mycoplasma Pneumoniae Encephalopathy Presenting as Mania. J Acad Consult Liaison Psychiatry 2020; 62:150-154. [PMID: 33127068 DOI: 10.1016/j.psym.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Madeleine A Becker
- Department of Psychiatry and Human Behavior, Department of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Jennifer Cannon
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA.
| | - Kenneth Certa
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA
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Abstract
Anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis is a relatively recent autoimmune entity, as it was first described in 2007. Given that it is a condition with neuropsychiatric symptoms, its initial symptom is frequently psychiatric in nature. Hence, psychiatrists are often the first physicians to assess these patients and, as so, must recognize this type of encephalitis as a possible cause. Catatonia may be inaugural or develop throughout the course of the disease. Management of patients with anti-NMDAr encephalitis is based on etiologic treatment with immunotherapy and removal of the associated tumor, if any. However, these catatonic patients may have variable responses to etiologic treatment, sometimes with refractory catatonic symptoms, which attests to the necessary urgency to know how to manage these patients. In the clinical setting, physicians appear to be using guidelines originally created to the management of catatonia due to primary psychiatric conditions. In this literature review, catatonia was historically contextualized and anti-NMDAr encephalitis overall described. Finally, catatonia secondary to this type of encephalitis was discussed.
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Abstract
The mechanism of action of electroconvulsive therapy (ECT) is not fully elucidated, with prevailing theories ranging from neuroendocrinological to neuroplasticity effects of ECT or epileptiform brain plasticity. Youth with autism can present with catatonia. ECT is a treatment that can safely and rapidly resolve catatonia in autism and should be considered promptly. The literature available for ECT use in youth with autism is consistently growing. Under-recognition of the catatonic syndrome and delayed diagnosis and implementation of the anticatatonic treatment paradigms, including ECT, as well as stigma and lack of knowledge of ECT remain clinical stumbling blocks.
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Affiliation(s)
- Sa Eun Park
- Kennedy Krieger Institute, 1741 Ashland Avenue, Baltimore, MD 21205, USA.
| | - Marco Grados
- Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Lee Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, 707 North Broadway Street, Baltimore, MD 21209, USA
| | - Sanjay Kaji
- Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
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[German version of the Northoff catatonia rating scale (NCRS-dv) : A validated instrument for measuring catatonic symptoms]. DER NERVENARZT 2018; 88:787-796. [PMID: 27325247 DOI: 10.1007/s00115-016-0136-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The clinical picture of catatonia includes impressive motor phenomena, such as rigidity, dyskinesia, festination, negativism, posturing, catalepsy, stereotypies and mannerisms, along with affective (e. g. aggression, anxiety, anhedonism or emotional lability) and behavioral symptoms (e.g. mutism, autism, excitement, echolalia or echopraxia). In English speaking countries seven catatonia rating scales have been introduced, which are widely used in clinical and scientific practice. In contrast, only one validated catatonia rating scale is available in Germany so far. In this paper, we introduce the German version of the Northoff catatonia rating scale (NCRS-dv). The original English version of the NCRS consists of 40 items describing motor (13 items), affective (12 items) and behavioral (15 items) catatonic symptoms. The NCRS shows high internal reliability (Crombachs alpha = 0.87), high interrater (r = 0.80-0.96) and high intrarater (r = 0.80-0.95) reliability. Factor analysis of the NCRS revealed four domains: affective, hyperactive or excited, hypoactive or retarded and behavior with individual eigenvalues of 8.98, 3.61, 2.98 and 2.82, respectively, which explained 21.5 %, 9.3 %, 7.6 % and 7.2 % of variance, respectively. In conclusion, the NCRS-dv represents a second validated instrument which can be used by German clinicians and scientists for the assessment of catatonic symptoms.
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Management of Emergency Electroconvulsive Therapy in the Intensive Care Unit for Life-Threatening Psychiatric Conditions: A Case Series. J ECT 2018; 34:55-59. [PMID: 28937547 DOI: 10.1097/yct.0000000000000451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Catatonia can lead to severe complications and may be lethal but is often underdiagnosed. The clinical presentation can be similar to coma. In these situations, electroconvulsive therapy (ECT) can be used as first-line treatment to enable extubation, recovery of autonomy, and rapid discharge from intensive care. We report 4 cases of patients hospitalized in the intensive care unit with comatose clinical presentation and life-threatening condition caused by catatonia. All patients received ECT sessions, after which the catatonic symptoms partially or fully remitted. We discuss the clinical identification, general considerations, ECT feasibility, and parameters in the intensive care unit, as well as the differential diagnosis, drug precautions, and prevention concerns.
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Malas N, Brahmbhatt K, McDermott C, Smith A, Ortiz-Aguayo R, Turkel S. Pediatric Delirium: Evaluation, Management, and Special Considerations. Curr Psychiatry Rep 2017; 19:65. [PMID: 28801871 DOI: 10.1007/s11920-017-0817-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Delirium describes a syndrome of acute brain dysfunction with severe consequences on patient outcomes, medical cost, morbidity, and mortality. It represents a final common pathway of numerous pathophysiologic disturbances disrupting cerebral homeostasis. The diagnosis is predicated on recognition of the clinical features of the syndrome through ongoing clinical assessment. Early identification can be aided by routine screening, particularly in high-risk populations. Evaluation and management are continuous and simultaneous processes involving a multidisciplinary care team including child psychiatry consultation. Prevention, early identification and management are critical in alleviating symptoms, improving outcomes, and reducing distress for patients, families, and care teams. This review highlights our current understanding regarding pediatric delirium, its mechanisms, clinical manifestations, detection and management.
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Affiliation(s)
- Nasuh Malas
- Department of Psychiatry and Pediatrics, University of Michigan Medical School, 1500 East Medical Center Drive, L5023, SPC 5277, Ann Arbor, MI, 48109, USA.
| | - Khyati Brahmbhatt
- Department of Psychiatry, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Cristin McDermott
- Department of Psychiatry and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Allanceson Smith
- Department of Psychiatry, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Roberto Ortiz-Aguayo
- Department of Psychiatry and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Susan Turkel
- Department of Psychiatry and Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, CA, Los Angeles, USA
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Ghaziuddin N, Hendriks M, Patel P, Wachtel LE, Dhossche DM. Neuroleptic Malignant Syndrome/Malignant Catatonia in Child Psychiatry: Literature Review and a Case Series. J Child Adolesc Psychopharmacol 2017; 27:359-365. [PMID: 28398818 DOI: 10.1089/cap.2016.0180] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe the presentation of neuroleptic malignant syndrome (NMS) and malignant catatonia (MC) in children and adolescents. BACKGROUND NMS and MC are life-threatening, neuropsychiatric syndromes, associated with considerable morbidity and mortality. NMS is diagnosed when there is a recent history of treatment with an antipsychotic (AP) medication, while MC is diagnosed when the symptoms resemble NMS but without a history of exposure to an AP agent. Some authorities believe that apart from the history of exposure to an AP medication, the two conditions are identical. The symptoms of NMS/MC include severe agitation, behavior disregulation, motor and speech changes, self-injury and aggression, autonomic instability, and a range of psychiatric symptoms (affective, anxiety, or psychotic symptoms). Patients may be misdiagnosed with another disorder leading to extensive tests and a delay in treatment. Untreated, the condition may be fatal in 10%-20% of patients, with death sometimes occurring within days of disease onset. METHOD We describe the presentation and management of five children and adolescents with NMS/MC. CONCLUSION MC and NMS are life-threatening medical emergencies, which if diagnosed promptly, can be successfully treated with known effective treatments (benzodiazepines and/or electroconvulsive therapy).
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Affiliation(s)
- Neera Ghaziuddin
- 1 Department of Psychiatry, University of Michigan , Ann Arbor, Michigan
| | | | - Paresh Patel
- 1 Department of Psychiatry, University of Michigan , Ann Arbor, Michigan
| | | | - Dirk M Dhossche
- 4 Department of Psychiatry, University of Mississippi Medical Center , Jackson, Mississippi
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Electroconvulsive Therapy in Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report and Review of the Literature. J ECT 2016; 32:225-229. [PMID: 27295461 DOI: 10.1097/yct.0000000000000334] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is a growing scientific literature describing the neuropsychiatric symptoms of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, including the use of electroconvulsive therapy (ECT) to treat those symptoms. We sought to consolidate this literature into a review that highlights its relevance to ECT practitioners. METHODS We performed a PubMed search using the terms electroconvulsive therapy and encephalitis, autoimmune encephalitis, or anti-NMDA receptor encephalitis. We reviewed all relevant studies in detail, cross-referenced all bibliographies, and collected key clinical information related to the practice of ECT. RESULTS We identified 6 studies offering patient-level descriptions of the use of ECT in patients with anti-NMDA receptor encephalitis. In all cases ECT was used to target symptoms of catatonia. Electroconvulsive therapy was delivered safely and effectively irrespective of the timing of diagnosis, tumor removal, or immunotherapy. CONCLUSIONS There are no controlled data on the use of ECT in anti-NMDA receptor encephalitis. Further investigation is needed to determine whether ECT has a disease-modifying effect on this form of autoimmune encephalitis.
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Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review. J Crit Care 2014; 29:881.e1-6. [PMID: 24975569 DOI: 10.1016/j.jcrc.2014.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/02/2014] [Accepted: 05/18/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself. METHODS We treated 5 cases of severe protracted delirium in our ICU with electroconvulsive therapy (ECT) after failure of conventional medical therapy. RESULTS The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma. CONCLUSION Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly increased mortality and severe cognitive decline associated with delirium in the ICU, we find ECT to be a valuable treatment option for this vulnerable patient population. It can be considered when agitation cannot be controlled with medical treatment, when agitation and delirium make weaning impossible, or prolonged deep sedation the only alternative.
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Saddawi-Konefka D, Berg SM, Nejad SH, Bittner EA. Catatonia in the ICU: an important and underdiagnosed cause of altered mental status. a case series and review of the literature*. Crit Care Med 2014; 42:e234-e241. [PMID: 24275514 DOI: 10.1097/ccm.0000000000000053] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Catatonia is a neuropsychiatric syndrome with motor and behavioral symptoms occurring in patients with or without a history of psychiatric illness. Although it is associated with significant morbidity and mortality, the prevalence of catatonia in the ICU setting is unknown. The diagnosis and management of catatonia in the critically ill patient raises unique challenges. Furthermore, the diagnosis and management are not included in most critical care curricula. The objective of this retrospective study is to increase the awareness of this clinically important condition among critical care providers. DESIGN Retrospective case series study. SETTING Multiple critical care units at a university-affiliated tertiary care hospital. PATIENTS Five critically ill patients with catatonia, aged 17 to 78. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All notes, laboratory data, imaging results, other diagnostic studies, therapeutic interventions, and responses to treatment were reviewed for five critically ill patients with catatonia. No unifying cause of catatonia or predisposing conditions were identified for these patients. Currently available diagnostic criteria for catatonia were found to be nonspecific in the ICU setting. New diagnostic criteria for catatonia specific to the critically ill patient are proposed. CONCLUSIONS Catatonia can occur in a wide variety of critical care settings, with or without precedent psychiatric illness, and it may be exacerbated or induced by common intensive care practices. Psychomotor findings are imperative in examination of critically ill patients with altered mental status in order to diagnose catatonia.
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Affiliation(s)
- Daniel Saddawi-Konefka
- 1Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA. 2Psychiatry Consultation Service, Division of Psychiatry and Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Dhossche DM, Goetz M, Gazdag G, Sienaert P. New DSM-5 category ‘unspecified catatonia’ is a boost for pediatric catatonia: review and case reports. NEUROPSYCHIATRY 2013; 3:401-410. [DOI: 10.2217/npy.13.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ghaziuddin N, Dhossche D, Marcotte K. Retrospective chart review of catatonia in child and adolescent psychiatric patients. Acta Psychiatr Scand 2012; 125:33-8. [PMID: 22040029 DOI: 10.1111/j.1600-0447.2011.01778.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Identify the frequency of catatonia among at-risk children and adolescents receiving psychiatric treatment. METHOD Subjects were children and adolescents (<18 years), who had received psychiatric treatment at a University Hospital during 2004-2009, and were diagnosed with disorders with known risk for catatonia or displayed symptoms suggestive of catatonia. Approval was obtained from the Investigational Review Board (IRB). The first 101 (n = 101) subjects were selected among 570 subjects identified by psychiatric diagnoses: any pervasive developmental disorder, psychosis-NOS (Not Otherwise Specified), intermittent explosive disorder, mental retardation, catatonia and neuroleptic malignant syndrome. Subjects met study-defined criteria for catatonia, if they had three or more of the following symptoms: unexplained agitation/excitement, disturbed or unusual movements, reduced movements, repetitive or stereotyped movements, or reduced or loss of speech. RESULTS Eighteen (17.8%) subjects, among a group suspected to be at a higher risk for catatonia, met the study-defined criteria for this syndrome. However, only two subjects had been diagnosed by their treatment providers. Higher rates of intellectual disability and aggression were found among the group that met study-criteria. CONCLUSION We concluded that catatonia is under recognized and undertreated among children and adolescents receiving psychiatric treatment.
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Affiliation(s)
- N Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, 48109, USA.
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Wachtel LE, Dhossche DM, Kellner CH. When is electroconvulsive therapy appropriate for children and adolescents? Med Hypotheses 2011; 76:395-9. [DOI: 10.1016/j.mehy.2010.11.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 11/04/2010] [Indexed: 11/29/2022]
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Abstract
Catatonia has been rediscovered over the last 2 decades as a unique syndrome that consists of specific motor signs with a characteristic and uniform response to benzodiazepines and electroconvulsive therapy. Further inquiry into its developmental, environmental, psychological, and biological underpinnings is warranted. In this review, medical catatonia models of motor circuitry dysfunction, abnormal neurotransmitters, epilepsy, genetic risk factors, endocrine dysfunction, and immune abnormalities are discussed. Developmental, environmental, and psychological risk factors for catatonia are currently unknown. The following hypotheses need to be tested: neuroleptic malignant syndrome is a drug-induced form of malignant catatonia; Prader-Willi syndrome is a clinical GABAergic genetic-endocrine model of catatonia; Kleine-Levin syndrome represents a periodic form of adolescent catatonia; and anti-N-methyl-d-aspartate receptor encephalitis is an autoimmune type of catatonia.
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Catatonia is hidden in plain sight among different pediatric disorders: a review article. Pediatr Neurol 2010; 43:307-15. [PMID: 20933172 DOI: 10.1016/j.pediatrneurol.2010.07.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/07/2010] [Accepted: 07/13/2010] [Indexed: 11/20/2022]
Abstract
Over the past two decades, catatonia has been better demarcated in adult psychiatry as a unique syndrome that consists of specific motor signs with a characteristic response to benzodiazepines and electroconvulsive therapy. Pediatric catatonia is considered rare, but may be underdiagnosed, and hence undertreated. Discussed here are the current diagnostic criteria of catatonia in individual cases of children and adolescents diagnosed with childhood disintegrative disorder, Kleine-Levin syndrome, Prader-Willi syndrome, tic disorder, and autoimmune encephalitis, and the effects of benzodiazepines and electroconvulsive therapy. In these cases, catatonia resolved safely once it was recognized and treated properly. Children and adolescents presenting with these disorders should be systematically assessed for catatonia; when the presence of catatonia is confirmed, the use of benzodiazepines and electroconvulsive therapy should be considered. The occurrence of catatonia in such a wide range of child and adolescent disorders supports the view that pediatric catatonia is not so rare, that there are shared elements in the etiology, psychopathology, and pathophysiology of these disorders, and that catatonia is best classified as a unique neurobiologic syndrome.
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Abstract
BACKGROUND Profoundly depressed states of awareness classified as either catatonia or akinetic mutism have been reported in patients with various general medical conditions including encephalitis, frontal lobe tumors, or paraneoplastic limbic encephalitis. Catatonic features are often difficult to apprise in this context. This can result in electroconvulsive therapy (ECT) discontinuation, although it remains the most effective treatment of catatonia. CASE REPORT We describe the case of a patient with a history of unresectable right retroorbital squamous cell carcinoma, status poststereotactic radiation and cisplatin, and subsequent pneumococcal meningitis of the temporal lobe with abscess formation who became catatonic after receiving 3 bitemporal treatments with ECT for severe depression and whose catatonia improved with continued ECT. Furthermore, she demonstrated progressive improvement in mood, interactivity, and overall neurologic function after ECT treatment was completed. CONCLUSIONS The search for an etiology of a profound catatonic state should include the probability of underlying medical disorder. Although lorazepam may be helpful in some cases, ECT deserves early consideration in catatonia, especially in cases where the underlying cause seems to be uncertain, even if the catatonia begins in the midst of treatment.
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Casamassima F, Lattanzi L, Perlis RH, Litta A, Fui E, Bonuccelli U, Fricchione G, Cassano GB. Neuroleptic Malignant Syndrome: Further Lessons From a Case Report. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70709-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Anderson LL, Vilensky JA, Duvoisin RC. Review: neuropathology of acute phase encephalitis lethargica: a review of cases from the epidemic period. Neuropathol Appl Neurobiol 2009; 35:462-72. [PMID: 19490429 DOI: 10.1111/j.1365-2990.2009.01024.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Encephalitis lethargica (EL), an epidemic disease of the early 20th century, has continued to be diagnosed sporadically since that time, including a report of 20 new cases in 2004. Many of the recent case reports state that the primary neuropathology of acute EL consists of inflammatory changes and lesions within the midbrain, basal ganglia and substantia nigra. However, the neuropathology of acute EL cases from the epidemic period was actually much more widespread. METHODS In order to characterize the neuropathology of acute phase EL, we developed a database of EL pathology based on 112 cases from the years 1915 to 1940, of which most died within 2 weeks of EL onset. RESULTS Our analysis revealed that cortical damage was prevalent in 75% of the 112 cases; damage to the meninges and brainstem occurred in approximately half of the cases; and the substantia nigra was damaged in only 13% of these acute cases. We also found that after 1921, damage to cranial nerve nuclei was not reported. An analysis of the neuropathology and clinical symptoms revealed little correlation. CONCLUSIONS Based on these findings, putative modern cases of acute EL with MRI/CT indicated lesions confined solely to the midbrain, brainstem, and/or basal ganglia should not be considered, consistent with that reported during epidemic period.
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Affiliation(s)
- L L Anderson
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, Indiana, USA
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