ObjectiveCatatonia is a debilitating psychomotor disorder. Previous neuroimaging studies have used small samples with inconsistent results. We aimed to describe the structural neuroradiological abnormalities in clinical MRI brain scans of patients with catatonia and compare them to psychiatric inpatients without catatonia. We report the largest study of catatonia neuroimaging to date. MethodsIn this retrospective case-control study, neuroradiological reports of psychiatric inpatients who had undergone MRI brain scans for clinical reasons were examined. Abnormalities were classified by lateralisation, localisation and pathology. The primary analysis was prediction of catatonia by the presence of an abnormal MRI scan, adjusted for age, sex, Black ethnicity and psychiatric diagnosis. ResultsScan reports from 79 patients with catatonia and 711 other psychiatric inpatients were obtained. Mean age (SD) in the cases was 36.4 years (17.3) and 44.5 (19.9) in the comparison group. Radiological abnormalities were reported in 27 out of 79 cases (34.2%) and in 338 out of 711 in the comparison group (47.5%), OR 0.57 (0.35 to 0.93), aOR 1.11 (0.58 to 2.14). Among the cases, most abnormal scans had bilateral abnormalities (n=23, 29.1%), involved the forebrain (25, 31.6%) and involved atrophy (17, 21.5%). ConclusionsPatients with catatonia are commonly reported to have brain MRI abnormalities, which largely consist of diffuse cerebral atrophy rather than focal lesions, but there is no evidence that these abnormalities are more common than in other psychiatric inpatients undergoing neuroimaging, after adjustment for demographic variables. Study limitations include a heterogeneous control group and selection bias in requesting scans.

Background Although we do not know how often doctors enquire about their patients’ work, evidence suggests that occupation is often not recorded in clinical notes. There is a lack of research into doctors’ views on the importance of patient occupation or their educational needs in this area. Aims To assess doctors’ attitudes to using patient occupation information for care-planning and to determine doctors’ need for specific training in occupational health. Methods We undertook a cross-sectional survey of doctors in cardiology, obstetrics and gynaecology, oncology and orthopaedics. Our questionnaire explored attitudes of the doctors to asking patients about their occupational status, their training and competency to do so, and their training needs in occupational health. Results The response rate was 42/46 (91%). Obstetrics and gynaecology 6/9 (67%) and oncology doctors 3/6 (50%) reported enquiring about the nature of patients’ occupations’ ‘most of the time’/‘always’ and that it rarely influenced clinical decisions. This contrasted with orthopaedic doctors 12/12 (100%) and cardiology doctors 14/15 (93%). Although 19/42 (45%) participants felt it was important to ask patients their occupation, only 10/42 (24%) ‘always’ asked patients about their work. The majority of participants 29/41 (71%) reported receiving no training in occupational health, but 37/42 (88%) considered that some training would be useful. Conclusions Training on the importance of occupation and its’ role as a clinical outcome in care-planning, might help doctors feel more competent in discussing the impact of health on work with patients.

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