Catatonia in Neurologic and Psychiatric Patients at a Tertiary Neurological Center

Abstract

This study describes the prevalence, phenomenology, treatment, and outcome of neurological patients and psychiatric patients with catatonia at a tertiary neurological center. Clinical variables included nosological diagnoses and complications. Admission length and days with catatonia were used as outcome measures. Of 2,044 patients who were evaluated prospectively, 68 (3.32%) had catatonia, 42 (61.7%) were neurological patients, 19 (27.9%) were psychiatric patients, and 7 (10.2%) had drug-related diagnoses. Of all patients, the ratio of neurological to psychiatric patients was 3:1. Encephalitis was the most common diagnosis (N=26 [38.2%]), followed by schizophrenia (N=12 [17.6%]). Psychiatric patients exhibited a stuporous type of catatonia (15 [83.3%] versus 14 [33.3%], p>0.001), whereas neurological patients exhibited a mixed form of catatonia (25 [59.5%] versus 1 [5.6], p<0.001). Neurological patients had more complications, longer hospitalizations, and more days with catatonia. A total of 56 patients (82.3%) received lorazepam, and 14 patients (20.5%) underwent ECT. Second- and third-line treatments included amantadine, bromocriptine, and levodopa. Catatonia is a prevalent syndrome that can remit with proper and opportune treatment.

Catatonia in patients with anti‐NMDA receptor encephalitis

“…Regarding ECT, it has proven useful in the symptomatic treatment of psychosis and catatonia in ANMDARE. After careful consideration of its side‐effect profile in ANMDARE patients with status epilepticus, autonomic instability, and arrhythmias, it can be an important addition to the treatment armamentarium in ANMDARE catatonias …”

“…After careful consideration of its side-effect profile in ANMDARE patients with status epilepticus, autonomic instability, and arrhythmias, it can be an important addition to the treatment armamentarium in ANMDARE catatonias. [25][26][27] Catatonia should be regarded as one of the hallmarks of ANMDARE. Efforts are needed to increase its recognition and to identify its signs and symptoms in order to start prompt specific immunomodulatory therapy.…”

NMDAR antibody encephalitis and fluctuating catatonia

“…10 A study has reported some differentiating features that show psychiatric patients can exhibit a stuporous type of catatonia more frequently, whilst neurological patients demonstrate a mixed form of catatonia with more complications, longer hospitalisations, and more days with catatonia. 1 The index case had a similar presentation as the latter. Anti-NMDAR encephalitis may be suspected for acute presentations of catatonia where there are atypical presentations with viral-like prodrome, oddities in movements, or when the symptoms are not responding adequately to the usual treatment.…”

“…1,2 One of the common neurological conditions linked to catatonia is encephalitis, 1 and in recent years NMDAR antibody encephalitis is also being reported more frequently. 3,4 Various symptomatic presentations like psychosis, catatonia, movement disorders, short-term memory deficit and seizures have been reported in patients with synaptic autoimmunity, 4,5,6,7 which often results in patients being seen in different departments before final diagnosis.…”

Comparison of International Therapy Guidelines with Regard to the Treatment of Malignant Catatonia

“…Estimated prevalence of catatonia among psychiatric inpatients is 7.7 % [8], whereas the prevalence in neurological settings is lower (3.3 %) [9]. However, epidemiological data on the occurrence of MC in the literature is rare.…”