Catatonia in the elderly

Abstract

Catatonia in geriatric patients has been insufficiently investigated. We reviewed 71 case descriptions from 45 studies to clarify the phenomenology, diagnosis, etiology, and treatment of catatonia in the elderly. In elderly patients, catatonia is frequently observed in association with general medical conditions. In patients with a history of depression or schizophrenia, physicians occasionally overlook the medical conditions because they believe the previous psychosis to be the cause of the catatonic features. Despite historical discussions of a relation between the disorders, the number of patients with catatonia and a prior diagnosis of schizophrenia or another psychotic disorder is not large. A diagnosis of catatonia should be considered in cases of atypical "collapse" in elderly patients with a previous psychiatric history of mood disorder. Catatonia due to anxiety/adjustment disorder is quite rare, whereas catatonia in association with neuroleptic malignant syndrome is fairly common. For early commencement of treatment, early detection of catatonia in the elderly is important. In studies of psychotropic drug treatment, many authors observed a beneficial response to lorazepam in catatonic patients. For medication-refractory patients, electroconvulsive therapy should be considered. It is important to prevent the development of venous thrombosis as a serious complication in stuporous catatonic patients.

Recognizing Catatonia in Medically Hospitalized Older Adults: Why It Matters

“…Table 1 provides a non-exhaustive list of etiologies. From studies exploring catatonia in older adults, the most frequent diagnoses associated with catatonia were, in no special order, stroke, encephalitis, hyponatremia, urinary tract infection, depression, chronic psychosis, and dementia [5,10,11,13,14]. In three series, all cases presented with at least one vascular risk factor, and in over 50% of cases, there was recent or current exposure to antipsychotic drugs [5,10,14].…”

“…The frequency of catatonia attributed to general medical conditions is 21–46% of all catatonia cases [13,17,18]. Catatonia has also been reported to cause diagnostic dilemmas in unresponsive patients attending emergency departments [19], where its frequency due to a general medical condition is up to 41% of all cases [20].…”

Catatonia in an Alzheimer's dementia patient

“…Although catatonia is known to occur at any age, 3 the present case was unique in terms of the late age of presentation with Alzheimer's dementia and diabetes leading, which led to a diagnostic dilemma and problems with management. Catatonia occurring during the course of dementia has been reported with Lewy body dementia or in association with the use of donepezil in patients with Parkinson's disease 4 .…”

Catatonia in Patients with Dementia Admitted to a Geriatric Psychiatry Ward

“…The early detection and treatment of catatonia in dementia can lead to significant symptomatic improvement, and this may help prevent potentially serious complications. [ 2 3 ] Clinicians should be aware of catatonia as a diagnostic possibility in this patient group and look for it proactively.…”

“…Catatonia is a treatable neuropsychiatric disorder characterized by motor, behavioral, and autonomic abnormalities,[ 1 ] which remains underdiagnosed in older adults and those with dementia. [ 2 3 ] In this group, its frequency is unclear, etiology tends to be multifactorial,[ 2 3 ] and there is a greater risk of complications if undiagnosed or untreated. [ 2 ] To ascertain the frequency and clinical characteristics of catatonia in patients with dementia admitted to an acute old age psychiatry ward, we undertook a prospective survey that identified six patients with dementia and catatonia over a 6-month period, using the BFCSI.…”