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Csihi L, Ungvari GS, Caroff SN, Gazdag G. First 150 years of catatonia: Looking back at its complicated history and forward to the road ahead. World J Psychiatry 2024; 14:600-606. [PMID: 38808080 PMCID: PMC11129151 DOI: 10.5498/wjp.v14.i5.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
Karl Ludwig Kahlbaum (1828-1899) was the first to conceptualize and describe the main clinical features of a novel psychiatric illness, which he termed catatonia in his groundbreaking monograph published 150 years ago. Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course, a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions. In his classification system, Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox (schizophrenia) disease entity. Because of the substantial influence of Kraepelin's classification, catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century. However, with the advent of the psychopharmacotherapy era starting from the early 1950s, interest in catatonia in both clinical practice and research subsided until the early 2000s. The past two decades have witnessed a resurgence of interest in catatonia. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions. The introduction of an independent diagnostic category termed "Catatonia Not Otherwise Specified" significantly stimulated research in this field. The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.
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Affiliation(s)
- Levente Csihi
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Western Australia, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Western Australia, Australia
| | - Stanley N Caroff
- Behavioral Health Service, Corporal Michael J Cresencz, Veterans Affairs Medical Center, Philadelphia, PA 19104, United States
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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Luccarelli J, Smith JR, Fricchione G, Westover MB. Generalized Periodic Discharges Associated With Catatonia and Delirium: A Case Series. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230174. [PMID: 38720623 DOI: 10.1176/appi.neuropsych.20230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
OBJECTIVE Generalized periodic discharges are a repeated and generalized electroencephalography (EEG) pattern that can be seen in the context of altered mental status. This article describes a series of five individuals with generalized periodic discharges who demonstrated signs and symptoms of catatonia, a treatable neuropsychiatric condition. METHODS Inpatients with a clinical diagnosis of catatonia, determined with the Bush-Francis Catatonia Rating Scale (BFCRS), and EEG recordings with generalized periodic discharges were analyzed in a retrospective case series. RESULTS Five patients with catatonia and generalized periodic discharges on EEG were evaluated from among 106 patients with catatonia and contemporaneous EEG measurements. Four of these patients showed an improvement in catatonia severity when treated with benzodiazepines, with an average reduction of 6.75 points on the BFCRS. CONCLUSIONS Among patients with generalized periodic discharges, catatonia should be considered, in the appropriate clinical context. Patients with generalized periodic discharges and catatonia may benefit from treatment with empiric trials of benzodiazepines.
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Affiliation(s)
- James Luccarelli
- Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover)
| | - Joshua R Smith
- Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover)
| | - Gregory Fricchione
- Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover)
| | - M Brandon Westover
- Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover)
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Smith JR, York T, Baldwin I, Fuchs C, Fricchione G, Luccarelli J. Diagnostic features of paediatric catatonia: multisite retrospective cohort study. BJPsych Open 2024; 10:e96. [PMID: 38686558 PMCID: PMC11060083 DOI: 10.1192/bjo.2024.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Catatonia is a neuropsychiatric disorder characterised by psychomotor changes that can affect individuals across the lifespan. Although features of catatonia have been described in adults, the most common clinical symptoms among paediatric patients with catatonia are not well characterised. AIMS The goal of this study was to characterise the symptoms of catatonia demonstrated by paediatric patients, and to explore demographic and diagnostic factors associated with greater catatonia severity. METHOD We conducted a multicentre retrospective cohort study, from 1 January 2018 to 6 January 2023, of patients aged 18 and younger with a clinical diagnosis of catatonia and symptom assessment using the Bush Francis Catatonia Rating Scale (BFCRS). RESULTS A total of 143 patients met inclusion criteria. The median age was 15 (interquartile range: 13-16) years and 66 (46.2%) patients were female. Neurodevelopmental disabilities were present in 55 (38.5%) patients. Patients demonstrated a mean of 6.0 ± 2.1 signs of catatonia on the Bush Francis Catatonia Screening Item, with a mean BFCRS score of 15.0 ± 5.9. Among the 23 items of the BFCRS, six were present in >50% of patients (staring, mutism, immobility/stupor, withdrawal, posturing/catalepsy, rigidity), and four were present in <20% of cases (waxy flexibility, mitgehen, gegenhalten, grasp reflex). In an adjusted model, patients with neurodevelopmental disorders demonstrated greater BFCRS severity than those with other diagnoses. CONCLUSIONS Catatonia was diagnosed in a range of mental health conditions. Further research is needed to define optimal diagnostic criteria for catatonia in paediatric patients, and clarify the clinical course of the disorder.
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Affiliation(s)
- Joshua R. Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA; and Vanderbilt Kennedy Center, Vanderbilt University, Tennessee, USA
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Tennessee, USA
| | - Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA
| | - Gregory Fricchione
- Harvard Medical School, Massachusetts, USA; and Department of Psychiatry, Massachusetts General Hospital, Massachusetts, USA
| | - James Luccarelli
- Harvard Medical School, Massachusetts, USA; and Department of Psychiatry, Massachusetts General Hospital, Massachusetts, USA
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Gómez-Revuelta M, González JR, Liebo PAH, Díez CS, Vázquez-Bourgon J. "Intranasal esketamine monotherapy for ultra-resistant catatonia: A case report". Psychiatry Res 2024; 337:115923. [PMID: 38688119 DOI: 10.1016/j.psychres.2024.115923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/24/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Marcos Gómez-Revuelta
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Cantabria, Spain; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - Jorge Romay González
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Cantabria, Spain; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Paula Alejandra Hernández Liebo
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Cantabria, Spain; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Claudia Sevilla Díez
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Cantabria, Spain; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Cantabria, Spain; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain
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Xia Y, Sun Y, Zhi Q, Cui W, Liu X. A case report of a patient with Turner syndrome who develops catatonia secondary to psychotic symptoms. Medicine (Baltimore) 2024; 103:e37730. [PMID: 38579062 PMCID: PMC10994426 DOI: 10.1097/md.0000000000037730] [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: 12/20/2023] [Accepted: 03/06/2024] [Indexed: 04/07/2024] Open
Abstract
RATIONALE Turner syndrome (TS) is a genetic disorder associated with partial or complete monosomy X abnormalities; some patients may have a higher risk of psychiatric symptoms. Catatonia is associated with a wide range of life-threatening complications with complex pathogenesis; However, It very rare for patients with TS to develop psychotic symptoms and eventually progress to catatonia. This case report describes the diagnostic and therapeutic course of catatonia-associated TS. PATIENT CONCERNS In this study, we report the case of a patient with TS who initially developed sudden hallucinations, delusions, and emotional instability, followed by catatonia. DIAGNOSES The patient was diagnosed with: unspecified catatonia; TS. INTERVENTIONS Treatment included administering a combination of esazolam injections and olanzapine tablets, placing a gastric tube and urinary catheter, and providing nutritional support. OUTCOMES After treatment, the patient's hallucinations, delusions, and catatonia disappeared, with no residual sequelae, and social functioning returned to normal. LESSONS For patients with TS who present with psychotic symptoms and catatonia, a comprehensive evaluation is necessary, and treatment with antipsychotics and benzodiazepines is effective.
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Affiliation(s)
- Yong Xia
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yuyong Sun
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Qianna Zhi
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Wenjing Cui
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaoyan Liu
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
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Badinier J, Lopes R, Mastellari T, Fovet T, Williams SCR, Pruvo JP, Amad A. Clinical and neuroimaging predictors of benzodiazepine response in catatonia: A machine learning approach. J Psychiatr Res 2024; 172:300-306. [PMID: 38430659 DOI: 10.1016/j.jpsychires.2024.02.039] [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: 12/01/2023] [Revised: 01/24/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
Catatonia is a well characterized psychomotor syndrome combining motor, behavioural and neurovegetative signs. Benzodiazepines are the first-choice treatment, effective in 70 % of cases. Currently, the factors associated with benzodiazepine resistance remain unknown. We aimed to develop machine learning models using clinical and neuroimaging data to predict benzodiazepine response in catatonic patients. This study examined a cohort of catatonic patients who underwent standardized clinical evaluation, 3 T brain MRI, and benzodiazepine trial. Based on clinical response, patients were classified as benzodiazepine responders or non-responders. Cortical thickness and regional brain volumes were measured. Two machine learning models (linear model and gradient boosting tree model) were developed to identify predictors of treatment response using clinical, demographic, and neuroimaging data. The cohort included 65 catatonic patients, comprising 30 benzodiazepine responders and 35 non-responders. Using clinical data alone, the linear model achieved 63% precision, 51% recall, a specificity of 61%, and 58% AUC, while the gradient boosting tree (GBT) model attained 46% precision, 60% recall, a specificity of 62% and 64% AUC. Incorporating neuroimaging data improved model performance, with the linear model achieving 66% precision, 57% recall, a specificity of 67%, and 70% AUC, and the GBT model attaining 50% precision, 50% recall, a specificity of 62% and 70% AUC. The integration of imaging data with demographic and clinical information significantly enhanced the predictive performance of the models. The duration of the catatonic syndrome, along with the presence of mitgehen (passive obedience) and immobility/stupor, and the volume of the right medial orbito-frontal cortex emerged as important factors in predicting non-response to benzodiazepines.
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Affiliation(s)
- Jane Badinier
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Renaud Lopes
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Tomas Mastellari
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Steven C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jean-Pierre Pruvo
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience & Cognition, F-59000, Lille, France; Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Attali D, Calligaris C, Grabli D, Slooter AJC. How to manage catatonia, Parkinson and dementia in ICU. Curr Opin Crit Care 2024; 30:151-156. [PMID: 38441073 DOI: 10.1097/mcc.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE OF REVIEW The rising prevalence of neurodegenerative and mental disorders, combined with the challenges posed by their frailty, has presented intensivists with complex issues in the intensive care unit (ICU). This review article explores specific aspects of care for patients with catatonia, Parkinson's disease (PD), and dementia within the context of the ICU, shedding light on recent developments in these fields. RECENT FINDINGS Catatonia, a neuropsychiatric syndrome with potentially life-threatening forms, remains underdiagnosed, and its etiologies are diverse. PD patients in the ICU present unique challenges related to admission criteria, dopaminergic treatment, and respiratory care. Dementia increases the risk of delirium. Delirium is associated with long-term cognitive impairment and dementia. SUMMARY While evidence is lacking, further research is needed to guide treatment for ICU patients with these comorbidities.
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Affiliation(s)
- David Attali
- GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Université Paris Cité, Paris, France
- Institute Physics for Medicine Paris, Inserm U1273, ESPCI Paris, PSL University, CNRS UMR 8063, Paris, France
| | - Charlotte Calligaris
- GHU-Paris Psychiatrie & Neurosciences, Neurointensive Care and Neuroanesthesia Department, Sainte-Anne Hospital, Université de Paris, Paris, France
| | - David Grabli
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, CIC Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France
| | - Arjen J C Slooter
- Departments of Intensive Care Medicine and Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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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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Ramognino V, Fovet T, Horn M, Lebouvier T, Amad A. Catatonia in patients with dementia: A descriptive study of clinical profiles and treatment response. Asian J Psychiatr 2024; 96:104033. [PMID: 38564875 DOI: 10.1016/j.ajp.2024.104033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Catatonia is a highly prevalent syndrome in patients presenting with major neurocognitive disorders (dementia). In this study, we aim to provide a comprehensive description of the clinical and therapeutic aspects of catatonia in patients with dementia. METHOD This descriptive study, conducted between September 2015 and June 2022, collected data from 25 patients diagnosed with dementia, out of 143 patients treated for catatonia in our specialized psychiatry department. We collected sociodemographic, clinical and treatment data for each patient. RESULTS Dementia patients constituted 17% of the catatonic cases. Predominantly female, the cohort had a mean age of 65. Diagnoses included Alzheimer's (4 patients, 17%) and Parkinson's (1 patient, 4%) diseases, Lewy body dementia (5 patients, 21%), vascular dementia (4 patients, 17%) and frontotemporal lobar degeneration (10 patients, 41%). The mean Bush-Francis Catatonia Rating Scale score upon admission was 20/69. Overall, complete remission of catatonia was achieved in 75% of patients (n=18), with only 13% (n=3) responding to lorazepam alone, while others required additional interventions such as electroconvulsive therapy (ECT) and/or amantadine. Vascular dementia was predominantly observed in cases resistant to treatment. CONCLUSION The findings indicate a frequent co-occurrence of catatonia and dementia, highlighting treatability yet suggesting a potential for resistance to lorazepam, which varies by dementia diagnosis. Investigating the mechanisms underlying this resistance and the variability in treatment response is crucial for developing more precise therapeutic strategies.
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Affiliation(s)
- Vanina Ramognino
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France; EPSM des Flandres Bailleul, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Mathilde Horn
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Thibaud Lebouvier
- Univ. Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, CNRMAJ, LiCEND, DistAlz, Lille 59000, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France.
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Smith JR, Baldwin I, Lim S, Luccarelli J. Symptoms of Catatonia Observed in Down Syndrome Regressive Disorder: A Retrospective Analysis. J Autism Dev Disord 2024:10.1007/s10803-024-06249-x. [PMID: 38386254 DOI: 10.1007/s10803-024-06249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Down Syndrome Regressive Disorder (DSRD) is a neuropsychiatric condition associated with severe symptomology and a negative impact on quality of life. DSRD frequently presents with catatonic symptoms. However, few studies have reported the specific catatonic symptoms that occur in DSRD. METHODS We conducted a retrospective analysis of medical records in a large health system in the southern United States to identify patients with diagnoses of DS with catatonic symptoms who presented for clinical care between 1/1/2018 and 12/1/2023. Patients were included in the study if they had a diagnosis of DSRD or met the criteria for DSRD using consensus guidelines on retrospective chart review, and catatonia as confirmed in clinical documentation and had a full Bush Francis Catatonia Rating Scale (BFCRS) documented at the time of initial catatonia diagnosis. RESULTS A total of nine patients who met the criteria for DSRD and catatonia using the BFCRS were identified. The average age of patients at the time of DSRD diagnosis was 21.1 years (SD = 13.87). The mean BFCRS score on initial evaluation was 17.3 (SD = 7.0) and the mean number of positive catatonia signs was 11.1 (SD = 1.5). Staring was present in all cases (n = 9, 100%), followed by mutism, grimacing, and rigidity (n = 7, 77.9%). CONCLUSIONS In a sample of nine patients with DSRD, all patients were diagnosed with catatonia. Catatonia is severe if undiagnosed and untreated. Future research is needed to assess specific symptoms of catatonia in DSRD, and longitudinal outcomes to assess optimal means of treatment.
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Affiliation(s)
- Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21St Avenue South, Suite 2200, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, Vanderbilt University, 110 Magnolia Circle, Nashville, TN, 37203, USA.
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN, 37212, USA
| | - Seri Lim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21St Avenue South, Suite 2200, Nashville, TN, 37212, USA
| | - James Luccarelli
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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11
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Phiri P, Delanerolle G, Hope O, Murugaiyan T, Dimba G, Rathod S, Zingela Z. Catatonia: A deep dive into its unfathomable depths. World J Psychiatry 2024; 14:210-214. [PMID: 38464767 PMCID: PMC10921292 DOI: 10.5498/wjp.v14.i2.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024] Open
Abstract
This editorial addresses catatonia, a complex neuropsychiatric syndrome characterised by a spectrum of psychomotor disturbances. The editorial seeks to clarify the ambiguous aspects of catatonia, integrating recent research findings, including global studies and diagnostic advancements. It discusses catatonia's clinical manifestations, prevalence, and associated psychiatric and medical conditions, with particular emphasis on its frequent co-occurrence with schizophrenia and mood disorders. The prevalence of catatonia, which varies across psychiatric populations, is illustrated by a significant study conducted in Nelson Mandela Bay, South Africa. This study provides valuable insights into the effectiveness of the Bush-Francis Screening Instrument compared to the Diagnostic and Statistical Manual 5 criteria in diagnosing catatonia. The editorial evaluates treatment approaches, primarily focusing on benzodiazepines and electroconvulsive therapy, and discusses emerging therapeutic strategies. It underscores the importance of robust diagnostic frameworks and early intervention in managing catatonia, as recommended by the latest evidence-based consensus guideline. Furthermore, it suggests future research directions, particularly in exploring the neurobiological and genetic factors of catatonia, to enhance our understanding and improve treatment outcomes. This editorial succinctly aims to demystify catatonia and provide valuable insights for clinicians and researchers in mental health care.
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Affiliation(s)
- Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, Hampshire, United Kingdom
| | - Gayathri Delanerolle
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Oliver Hope
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Tharangini Murugaiyan
- Acute Inpatients Services, Southern Health NHS Foundation Trust, Basingstoke RG24 9RH, United Kingdom
| | - Geoffrey Dimba
- Home Treatment Team, South West, Surrey and Borders Partnerships NHS Foundation Trust, Guildford GU2 7XL, Surrey, United Kingdom
| | - Shanaya Rathod
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Zukiswa Zingela
- Faculty of Health Sciences, Nelson Mandela University, Summerstrand 6001, Gqeberha, South Africa
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12
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Ferrafiat V, Wachtel L, Dhossche D, Hauptman A. Catatonia is an outpatient reality. What do we do now? Schizophr Res 2024; 264:233-235. [PMID: 38183961 DOI: 10.1016/j.schres.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Vladimir Ferrafiat
- Section de Psychiatrie du Développement Mental (SPDM-EMDM), Service des Troubles du Spectre de l'Autisme & apparentés, Département de Psychiatrie, centre hospitalier universitaire vaudois (CHUV), Switzerland; Faculté de biologie et de médecine, UNIL, Université de Lausanne, Switzerland
| | - Lee Wachtel
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Dirk Dhossche
- Inland Northwest Behavioral Health, Spokane, WA, USA
| | - Aaron Hauptman
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
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13
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Elmarasi O, Abdelhady S, Mahgoub Y. Thought Blocking as a Manifestation of Catatonia: A Case Report. J Nerv Ment Dis 2024; 212:120-121. [PMID: 38290105 DOI: 10.1097/nmd.0000000000001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
ABSTRACT Catatonia is an underrecognized disorder that has been widely described as a psychomotor syndrome, with little emphasis on its thought and cognitive dimensions. The current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision describes only motor and behavioral presentations, whereas a few catatonia scales describe only one form of thought disorders, which is thought perseveration. Thought blocking, a disorder of the thought process, is characterized by regular interruptions in the thought stream. It was described by several scholars as a sign of schizophrenia, with few reports describing thought blocking in association with catatonia. In this article, we describe the course of a patient with bipolar I disorder who presented with catatonia and demonstrated thought blocking. Her catatonic symptoms and thought blocking improved with the addition of lorazepam, recurred upon lorazepam discontinuation, and improved with resumption of lorazepam, demonstrating a clear on/off phenomenon. This report highlights the importance of recognizing thought and cognitive manifestations of catatonia, as it can enhance recognition and improve treatment.
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Affiliation(s)
- Omar Elmarasi
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Safaa Abdelhady
- Department of Psychiatry, Mansoura General Hospital, Ministry of Health and Population, Mansoura, Egypt
| | - Yassir Mahgoub
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, Pennsylvania
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14
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Dragonetti JD, Posada JG, Key RG, Kugler JL. Catatonia-related adverse outcomes after long-acting injectable antipsychotics: Case series. SAGE Open Med Case Rep 2024; 12:2050313X241229008. [PMID: 38304856 PMCID: PMC10832410 DOI: 10.1177/2050313x241229008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
Due to a lack of controlled, prospective trials examining the pathophysiology and treatment of catatonia, current guidelines vary regarding how and when to best use antipsychotics in the presence of catatonia and what factors to consider in a thorough risk-benefit analysis. The literature is especially limited in describing the risks and benefits of using long-acting injectable antipsychotics in the presence of catatonia. We describe four cases where patients with preexisting catatonia received long-acting injectable first generation antipsychotics and experienced severe adverse effects (three experienced worsening of catatonia and one experienced neuroleptic malignant syndrome). The evidence base for managing comorbid catatonia and psychosis remains underdeveloped and inconsistent, but there are numerous known risk factors for adverse antipsychotic reactions, which we describe in relation to these cases. Finally, we present best practices to consider when managing comorbid psychosis and catatonia, especially when considering the use of long-acting injectable antipsychotics.
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Affiliation(s)
- Joseph D Dragonetti
- Department of Psychiatry & Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Jacqueline G Posada
- Department of Psychiatry & Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Richard Garrett Key
- Department of Psychiatry & Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Joseph L Kugler
- Department of Psychiatry & Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
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15
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Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. Use of ECT for Children With and Without Catatonia: A Single-Site Retrospective Analysis. J ECT 2024:00124509-990000000-00139. [PMID: 38265759 DOI: 10.1097/yct.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. METHODS A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. RESULTS A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation. For all patients, Clinical Global Impressions-Improvement scale scores indicated that it was very likely for a subject to experience at least "much improvement" with the estimated probability of receiving a Clinical Global Impressions-Improvement scale score better than 3 of 0.852 (t.s. = 16.3; P < 0.001; 95% confidence interval, 0.711-0.931). All patients with catatonia demonstrated a positive clinical response and experienced a statistically significant reduction in total Bush-Francis Catatonia Rating Scale scores observed (t = 11.9; df = 20; SD = 6.3; P < 0.001; 95% confidence interval, 12.6-17.9). No significant adverse events were reported for any patient in the cohort. However, 14 (38.9%) patients experienced prolonged seizures, all of which were terminated with propofol (mean, 49.7 mg). CONCLUSIONS This study provides further data supporting the safe and effective use of pediatric ECT in the treatment of various psychiatric conditions. However, more research is needed to determine the risk factors associated with prolonged seizures and the optimal seizure parameters in young people.
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Affiliation(s)
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Katherine Audrey Termini
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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16
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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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17
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Legrand A, Moyal M, Deschamps C, Louveau C, Iftimovici A, Krebs MO, Héron B, Keren B, Afenjar A, Chaumette B. Catatonia and genetic variant in GABA receptor: A case report involving GABRB2. Schizophr Res 2024; 263:191-193. [PMID: 37517920 DOI: 10.1016/j.schres.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/02/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Adrien Legrand
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France
| | - Mylène Moyal
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France
| | - Claire Deschamps
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Cécile Louveau
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France
| | - Anton Iftimovici
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France
| | - Marie-Odile Krebs
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France
| | - Benedicte Héron
- Department of Pediatric Neurology, Armand Trousseau Hospital, AP-HP.Sorbonne University, Paris, France
| | - Boris Keren
- Department of medical genetics, Pitié-Salpêtrière Hospital, AP-HP.Sorbonne University, Paris, France
| | - Alexandra Afenjar
- APHP Sorbonne University, Reference Center for Intellectual Disabilities From Rare Causes, Department of Genetics and Medical Embryology, Armand Trousseau Hospital, F-75012 Paris, France
| | - Boris Chaumette
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France; Department of Psychiatry, McGill University, Montreal, Canada.
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18
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Breit S, Meyer A, Schmitt W, Bracht T, Walther S. The Effect of Electroconvulsive Therapy on Specific Catatonia Symptoms and Predictors of Late Response. PHARMACOPSYCHIATRY 2024; 57:13-20. [PMID: 37995719 DOI: 10.1055/a-2195-1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is known to be effective in the treatment of catatonia, reaching response rates of about 80 to 100%. It is indicated in cases of treatment resistance to benzodiazepines and in life-threatening conditions such as malignant catatonia. Beneficial effects on specific symptoms or predictors of response are less clear. The objective of this retrospective study is to examine the ECT effect on specific catatonia symptoms in the acute phase of the illness and to identify predictors of response. METHODS A retrospective study examined data from 20 patients with catatonia, 18 associated with schizophrenia and 2 with bipolar disorder, who underwent ECT from 2008 to 2021. Ten subjects had more than one ECT-series, resulting in a total of 31 ECT-series. Catatonia symptom severity was assessed with the Bush Francis Catatonia Rating Scale (BFCRS). RESULTS ECT yielded excellent response. Nineteen of 20 patients and 30 of 31 ECT-series achieved response. The mean number of ECT sessions to response was 4.2. Response to ECT was more pronounced for motor inhibition symptoms such as stupor and mutism, while echophenomena, dyskinesia, stereotypy and perseveration responded less well. A predictor of late response was the presence of grasp reflex. DISCUSSION The present study corroborates the high and rapid effectiveness of ECT in the treatment of catatonia. Focus on single catatonia signs may help to identify those who are most likely to achieve remission quickly, as well as those who might need longer ECT-series.
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Affiliation(s)
- Sigrid Breit
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Agnes Meyer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wolfgang Schmitt
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Bracht
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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19
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Ramirez-Bermudez J, Restrepo-Martinez M, Espinola-Nadurille M, Martinez-Angeles V, Lopez-Hernandez JC, Hernandez-Vanegas LE, Martinez-Carrillo F, Ruiz-Garcia R, Rivas-Alonso V, Flores-Rivera J, Pollak TA. Examining the Features of Neuroleptic Malignant Syndrome in Anti-NMDA Receptor Encephalitis: A Case-Control Study. J Acad Consult Liaison Psychiatry 2023:S2667-2960(23)00853-4. [PMID: 38151160 DOI: 10.1016/j.jaclp.2023.12.002] [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: 07/18/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a neuroimmunological disorder that frequently improves with immunotherapy. Symptomatic treatment with antipsychotics is common in the early stages when psychiatric symptoms predominate, and their use has been associated with serious side effects including neuroleptic malignant syndrome (NMS). The observation of an adverse response to antipsychotics, raising the suspicion of NMS, has been included as a criterion for possible autoimmune psychosis. METHODS This case-control study included patients who received antipsychotics before referral to the National Institute of Neurology and Neurosurgery of Mexico, where they were diagnosed as having definite ANMDARE, and patients with ANMDARE who did not receive antipsychotics before referral. The neurologic and systemic features that are used to measure an adverse response to antipsychotics, raising the suspicion of NMS, were measured in both groups, including akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, and hyperthermia. A logistic regression analysis was used to determine the relationship between the previous use of antipsychotics and the occurrence of NMS-like reactions. RESULTS A total sample of 112 patients with definite ANMDARE were included in the study. Fifty patients received antipsychotics before being referred to our institution. In this group, thirty-six patients (72%) were initially classified as having an adverse response, raising the suspicion of NMS, with the following features: akinesia (64%), autonomic instability (58%), generalized rigidity (52%), elevated concentrations of creatine phosphokinase (50%), and hyperthermia (14%). Six patients fulfilled the criteria for NMS (12%). The comparison with patients who did not receive antipsychotics before the clinical assessment did not show a significant difference between groups regarding the frequency of akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, or hyperthermia. Among different antipsychotics, only haloperidol was significantly associated with generalized rigidity as compared to patients who did not receive antipsychotics. CONCLUSIONS Our study supports previous observations about the high frequency of autonomic dysfunction, hyperthermia, tachycardia, rigidity, and elevated creatine phosphokinase levels in patients with anti-NMDAR encephalitis following the administration of antipsychotic medications. Nevertheless, our study does not suggest a causal link between atypical antipsychotics and the onset of these neurological symptoms, as they were equally frequent among the group of patients who did not receive antipsychotic treatment.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico.
| | - Miguel Restrepo-Martinez
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Mariana Espinola-Nadurille
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Victoria Martinez-Angeles
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Juan Carlos Lopez-Hernandez
- Department of Neurological Emergencies, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Laura E Hernandez-Vanegas
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Francisco Martinez-Carrillo
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Ramiro Ruiz-Garcia
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Veronica Rivas-Alonso
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Jose Flores-Rivera
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
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20
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Virolle J, Redon M, Montastruc F, Taïb S, Revet A, Zivkovic V, Da Costa J, Very E. What clinical analysis of antipsychotic-induced catatonia and neuroleptic malignant syndrome tells us about the links between these two syndromes: A systematic review. Schizophr Res 2023; 262:184-200. [PMID: 37599139 DOI: 10.1016/j.schres.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/17/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES Antipsychotic-induced catatonia (AIC) and neuroleptic malignant syndrome (NMS) are life-threatening adverse reactions to antipsychotic medication. We conducted a systematic review of literature following the PRISMA statement guidelines to obtain a description of these syndromes (population, context of occurrence, antipsychotic agents implicated) and draw conclusions about their links. METHODS We searched Medline and Web of science databases from January 1951 to May 2019 (further restricted from 2000 to 2019) using search terms including "catatonia", "neuroleptic malignant syndrome" and "antipsychotic agents" for case reports, case series and analytic studies. After screening 4082 records, 410 full-text articles (describing 555 events) were assessed for eligibility. We included events of AIC and/or NMS according to Diagnostic and Statistical Manual (DSM) criteria and extracted data about patients' characteristics, context of occurrence, antipsychotic agent(s) involved and treatment outcomes. RESULTS We included 165 events (16 AIC, 129 NMS and 20 AIC + NMS) from 144 case reports and case series. The most reported diagnosis was schizophrenia. Comorbid pre-existing conditions such as central nervous system diseases and acute medical events were common. Most of the events (63.3 %) occurred during antipsychotic monotherapy. Second-generation antipsychotics (SGAs, 63.8 %) were overall more implicated than first-generation antipsychotics (FGAs, 36.2 %). DISCUSSION Our findings highlight that any antipsychotic medication, even SGA monotherapy prescribed at recommended dose, is at risk for these side effects. FGAs and polypharmacy seem to represent risk factors for malignant catatonia in AIC. The clinical overlap observed between AIC and NMS events in our review suggests a clinical continuum between catatonia and NMS.
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Affiliation(s)
- Jordan Virolle
- Department of Psychiatry, Psychotherapy, and Art Therapy, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
| | - Maximilien Redon
- Department of Psychiatry, Psychotherapy, and Art Therapy, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
| | - François Montastruc
- CIC 1436, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Toulouse University Hospital, Toulouse, France; Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France.
| | - Simon Taïb
- Department of Psychiatry, Psychotherapy, and Art Therapy, Toulouse University Hospital (CHU Toulouse), Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Inserm UMR 1214, Toulouse III - Paul Sabatier University, Toulouse, France.
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital (CHU Toulouse), Toulouse, France; CERPOP, UMR 1295, Inserm, Toulouse III - Paul Sabatier University, Toulouse, France.
| | - Vuk Zivkovic
- Department of Psychiatry, Psychotherapy, and Art Therapy, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
| | - Julien Da Costa
- Pôle de Psychiatrie et Conduites Addictives en Milieu Pénitentiaire, Gérard Marchant Psychiatric Hospital, Toulouse, France.
| | - Etienne Very
- Department of Psychiatry, Psychotherapy, and Art Therapy, Toulouse University Hospital (CHU Toulouse), Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Inserm UMR 1214, Toulouse III - Paul Sabatier University, Toulouse, France.
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21
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Heckers S, Walther S. Catatonia. N Engl J Med 2023; 389:1797-1802. [PMID: 37937779 DOI: 10.1056/nejmra2116304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Affiliation(s)
- Stephan Heckers
- From the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville (S.H., S.W.); and the Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland (S.W.)
| | - Sebastian Walther
- From the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville (S.H., S.W.); and the Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland (S.W.)
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22
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Patterson EM, Lim J, Fuchs P, Smith JR, Moussa-Tooks A, Ward HB. Use of First-Generation Antipsychotics in an Adolescent Male with Catatonic Schizophrenia. Harv Rev Psychiatry 2023; 31:267-273. [PMID: 37823777 DOI: 10.1097/hrp.0000000000000381] [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: 10/13/2023]
Affiliation(s)
- Emmy Masur Patterson
- From Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN (Drs. Patterson, Moussa-Tooks, and Ward); Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, TN (Dr. Lim); Sheppard Pratt Hospital, Baltimore, MD (Dr. Fuchs); Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN (Dr. Smith); Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN (Dr. Smith)
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23
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Qin M, Chen J, Guo X, Xiang X, Nie L, Wang Y, Mao L. Movement disorders in autoimmune encephalitis: an update. J Neurol 2023; 270:5288-5302. [PMID: 37523063 DOI: 10.1007/s00415-023-11881-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Autoimmune encephalitis (AE) is a form of encephalitis resulting from an immune response targeting central nervous system antigens, which is characterized by cognitive impairment, neuropsychiatric symptoms, seizures, movement disorders (MDs), and other encephalopathy symptoms. MDs frequently manifest throughout the progression of the disease, with recurrent involuntary movements leading to discomfort and, in some cases, necessitating admission to the intensive care unit. Prompt identification and management of MDs can aid in the diagnosis and prognosis of AE. This review synthesizes current knowledge on the characteristics, underlying mechanisms, and treatment options for MDs in the context of AE.
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Affiliation(s)
- Mengting Qin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaojiao Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqing Guo
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuying Xiang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Nie
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ling Mao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Pàmpols-Pérez S, Gisbert-Solà A, Resa-Pérez B, Jiménez-Mayoral A, Forcada-Pach I, Llorca-Bofi V. Neuroleptic Malignant Syndrome Associated With Lurasidone: A Case Report. J Clin Psychopharmacol 2023; 43:548-549. [PMID: 37930214 DOI: 10.1097/jcp.0000000000001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
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25
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Moyal M, Haroche A, Attali D, Dadi G, Raoelison M, Le Berre A, Iftimovici A, Chaumette B, Leroy S, Charron S, Debacker C, Oppenheim C, Cachia A, Plaze M. Orbitofrontal sulcal patterns in catatonia. Eur Psychiatry 2023; 67:e6. [PMID: 37853748 DOI: 10.1192/j.eurpsy.2023.2461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Catatonia is a psychomotor syndrome frequently observed in disorders with neurodevelopmental impairments, including psychiatric disorders such as schizophrenia. The orbitofrontal cortex (OFC) has been repeatedly associated with catatonia. It presents with an important interindividual morphological variability, with three distinct H-shaped sulcal patterns, types I, II, and III, based on the continuity of the medial and lateral orbital sulci. Types II and III have been identified as neurodevelopmental risk factors for schizophrenia. The sulcal pattern of the OFC has never been investigated in catatonia despite the role of the OFC in the pathophysiology and the neurodevelopmental component of catatonia. METHODS In this context, we performed a retrospective analysis of the OFC sulcal pattern in carefully selected homogeneous and matched subgroups of schizophrenia patients with catatonia (N = 58) or without catatonia (N = 65), and healthy controls (N = 82). RESULTS Logistic regression analyses revealed a group effect on OFC sulcal pattern in the left (χ2 = 18.1; p < .001) and right (χ2 = 28.3; p < .001) hemispheres. Catatonia patients were found to have more type III and less type I in both hemispheres compared to healthy controls and more type III on the left hemisphere compared to schizophrenia patients without catatonia. CONCLUSION Because the sulcal patterns are indirect markers of early brain development, our findings support a neurodevelopmental origin of catatonia and may shed light on the pathophysiology of this syndrome.
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Affiliation(s)
- Mylène Moyal
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
| | - Alexandre Haroche
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
| | - David Attali
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Physics for Medicine Paris, Inserm U1273, CNRS UMR 8063, ESPCI Paris, PSL University, Paris, France
| | - Ghita Dadi
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Matthieu Raoelison
- Université Paris Cité, Laboratory for the Psychology of Child Development and Education, CNRS UMR 8240, Sorbonne, Paris, France
| | - Alice Le Berre
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
| | - Anton Iftimovici
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
- NeuroSpin, Atomic Energy Commission, Gif sur Yvette, France
| | - Boris Chaumette
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sylvain Leroy
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Sylvain Charron
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
| | - Clément Debacker
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
| | - Catherine Oppenheim
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
| | - Arnaud Cachia
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
- Université Paris Cité, Laboratory for the Psychology of Child Development and Education, CNRS UMR 8240, Sorbonne, Paris, France
| | - Marion Plaze
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, Paris, France
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Maeda K, Ichiba T, Kashiwa K, Okazaki Y. Severe Recurrence of Neuroleptic Malignant Syndrome: Usefulness of Dexmedetomidine for Antipsychotic Withdrawal. Cureus 2023; 15:e47088. [PMID: 38022067 PMCID: PMC10646332 DOI: 10.7759/cureus.47088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Neuroleptic malignant syndrome (NMS) is a potentially fatal side effect that occurs in patients taking antipsychotics. Patients with NMS are often forced to rechallenge antipsychotic medications to control the underlying psychiatric symptoms. We present a case of severe recurrence of NMS in a patient in whom the administration of antipsychotics was restarted two days after NMS resolution. A 19-year-old man with somatic symptom disorder had been transported for fever, tachycardia, rigidity, and disturbance of consciousness. He was taking atypical antipsychotics with poor medication compliance. A diagnosis of NMS was made, and he was treated with administration of dantrolene sodium and benzodiazepines under tracheal intubation. On day 2, he was extubated. On day 4, his symptoms of NMS improved, but psychiatric symptoms rapidly exacerbated. He and his family strongly insisted on discharge, and we therefore unavoidably restarted the administration of antipsychotics. On day 37, he was retransported, and a diagnosis of recurrence of NMS was made. Blood examination showed marked deterioration of acute kidney injury and disseminated intravascular coagulation compared to those at the first admission. Without the administration of antipsychotics, his psychiatric symptoms were poorly controlled. Administration of dexmedetomidine helped his agitation to be well controlled without antipsychotics for two weeks. Short-term restart of antipsychotic drugs in patients with NMS may result in more severe NMS relapse. Dexmedetomidine may be useful for NMS patients when the administration of antipsychotics cannot be restarted. When antipsychotics are unavoidably rechallenged in patients with NMS, the risk of severe relapse should be taken into consideration, and dexmedetomidine may be used for prolongation of the withdrawal period.
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Affiliation(s)
- Keisuke Maeda
- Department of Emergency Medicine, Hiroshima Citizens Hospital, Hiroshima, JPN
| | - Toshihisa Ichiba
- Department of Emergency Medicine, Hiroshima Citizens Hospital, Hiroshima, JPN
| | - Kenichiro Kashiwa
- Department of Emergency Medicine, Hiroshima Citizens Hospital, Hiroshima, JPN
| | - Yuji Okazaki
- Department of Emergency Medicine, Hiroshima Citizens Hospital, Hiroshima, JPN
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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28
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Fukuyama K, Motomura E, Okada M. A Novel Gliotransmitter, L-β-Aminoisobutyric Acid, Contributes to Pathophysiology of Clinical Efficacies and Adverse Reactions of Clozapine. Biomolecules 2023; 13:1288. [PMID: 37759688 PMCID: PMC10526296 DOI: 10.3390/biom13091288] [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: 07/28/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Clozapine is listed as one of the most effective antipsychotics and has been approved for treating treatment-resistant schizophrenia (TRS); however, several type A and B adverse reactions, including weight gain, metabolic complications, cardiotoxicity, convulsions, and discontinuation syndromes, exist. The critical mechanisms of clinical efficacy for schizophrenia, TRS, and adverse reactions of clozapine have not been elucidated. Recently, the GABA isomer L-β-aminoisobutyric acid (L-BAIBA), a protective myokine in the peripheral organs, was identified as a candidate novel transmission modulator in the central nervous system (CNS). L-BAIBA activates adenosine monophosphate-activated protein kinase (AMPK) signalling in both the peripheral organs and CNS. Activated AMPK signalling in peripheral organs is an established major target for treating insulin-resistant diabetes, whereas activated AMPK signalling in the hypothalamus contributes to the pathophysiology of weight gain and metabolic disturbances. Clozapine increases L-BAIBA synthesis in the hypothalamus. In addition, the various functions of L-BAIBA in the CNS have recently been elucidated, including as an activator of GABA-B and group-III metabotropic glutamate (III-mGlu) receptors. Considering the expressions of GABA-B and III-mGlu receptors (localised in the presynaptic regions), the activation of GABA-B and III-mGlu receptors can explain the distinct therapeutic advantages of clozapine in schizophrenia or TRS associated with N-methyl-D-aspartate (NMDA) receptor disturbance compared with other atypical antipsychotics via the inhibition of the persistent tonic hyperactivation of thalamocortical glutamatergic transmission in the prefrontal cortex. L-BAIBA has also been identified as a gliotransmitter, and a detailed exploration of the function of L-BAIBA in tripartite synaptic transmission can further elucidate the pathophysiology of effectiveness for treating TRS and/or specific adverse reactions of clozapine.
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Affiliation(s)
| | | | - Motohiro Okada
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (K.F.); (E.M.)
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29
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Smith JR, Baldwin I, York T, Anderson C, McGonigle T, Vandekar S, Wachtel L, Luccarelli J. Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis. FRONTIERS IN CHILD AND ADOLESCENT PSYCHIATRY 2023; 2:1208926. [PMID: 37397642 PMCID: PMC10312099 DOI: 10.3389/frcha.2023.1208926] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Introduction Pediatric catatonia is a highly co-morbid condition with treatment options often limited to electroconvulsive therapy (ECT) or lorazepam. However, lorazepam may not be readily available, and access to ECT is limited by restrictive legislation and stigma. This study aims to provide alternative treatment options for pediatric catatonia. Methods The study involved a single-site retrospective analysis of a private university hospital in the southern United States. The study included patients under eighteen with catatonia who received psychopharmacologic treatment with an agent other than lorazepam. The patients were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), and Kanner Catatonia Examination (KCE) at the time of initial evaluation and upon stabilization. A retrospective clinical global impressions-improvement (CGI-I) score was assigned by four authors. Results 102 pediatric patients diagnosed with catatonia were identified, and 31 met criteria for the study. 20 (65%) were white, 6 (19%) were Black, 4 (13%) were Hispanic, and 1 (3%) were Indian. Most patients (N = 18; 58%) were insured by Medicaid. The mean age at the time of catatonia diagnosis was 13.5 years. All patients were stabilized on either clonazepam or diazepam, with 21 (68%) requiring treatment with an additional medication of either an anti-epileptic, N-methyl-D-aspartate (NMDA) receptor antagonist, and aripiprazole or clozapine. Statistically significant reductions in the BFCRS [t = 11.2, df = 30, std = 6.3, p < 0.001, 95% CI = (7.8, 15.1)], KCS [t = 4.6, df = 38, p < 0.001, 95% CI = (12.0, 31.0)], and KCE [t = 7.8, df = 30, std = 1.8, p < 0.001, 95% CI = (1.9, 3.2)] were observed. For CGI-I the results showed that the estimated probability of observing a score better than no change (>4) is 0.976 [t.s. = 43.2, p < 0.001, 95% CI = (0.931,0.992)], indicating the average subject is expected to experience some improvement. Discussion In conclusion, all patients responded to these treatments with improvement in their catatonic symptoms. Alternative pharmacologic interventions for catatonia, including benzodiazepines other than lorazepam, valproic acid, NMDA receptor antagonists, and atypical antipsychotics were safe and effective in treating catatonia in this population.
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Affiliation(s)
- Joshua R. Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United States
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, United States
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United States
| | - Carina Anderson
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United States
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Lee Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - James Luccarelli
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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30
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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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