Catatonia in the medically ill: Differences and parallels in etiology, phenomenology and management

Abstract

Objective Catatonia is a disorder characterized by psychomotor symptoms. The etiology, symptomatology, response and outcome of catatonia in the medically ill has not been vigorously studied. Those who have catatonia associated with another mental disorder versus. catatonic disorder due to another medical condition may differ. The aim of this study is to study the causes, phenomenology and outcomes of medically ill patients with catatonia and explore differences among those who have catatonia associated with psychiatric illness vs. systemic medical illness. Method We studied the incidence of catatonic symptoms in medically hospitalized patients to identify any apparent differences in clinical manifestations due to distinctive etiologies. Specifically, we assessed if there are differences between those who had catatonia associated with another mental disorder versus those with catatonic disorder due to another medical condition in their phenomenology, management and likelihood of response to treatment. Results Of our 40 patients, 18 patients (45%) had catatonia associated with another mental disorder, 17 (42.5%) had catatonic disorder due to another medical condition, and in 5 patients (12.5%) the cause of catatonia was not identified. The most common catatonic symptoms regardless of etiology in our medically ill were mutism, followed by rigidity, and immobility. Bipolar disorder, schizophrenia, major depressive disorder, metabolic abnormalities, anti NMDAR encephalitis were the most frequent causes of catatonia in our medically ill patients. Compared to subjects with catatonic disorder due to another medical condition, those with catatonia associated with another mental disorder had more frequent mannerisms (Chi-square = 4.27; p = 0.039), waxy flexibility (Chi-square = 11.0; p < 0.01), and impulsivity (Chi-square = 4.12, p = 0.042). Nonsignificant trends were noted for posturing (Chi-square = 3.74, p = 0.053), perseveration (Chi-square = 3.37, p = 0.067), and stereotypy (Chi-square = 2.91, p = 0.088) also being more frequent in catatonia associated with a psychiatric cause. Discussion Our data supports phenomenological differences between medical and psychiatric causes of catatonia in the medically ill.

Catatonia in adult anti-NMDAR encephalitis: an observational cohort study

“…In the 11th revision of the International Classification of Diseases (ICD-11), new diagnostic grouping has been added and catatonia can be divided into three conditions: (1) associated with another mental disorder; (2) induced by psychoactive substances, including medications; and (3) secondary catatonia due to a medical condition [2]. These changes made catatonia no longer limited to schizophrenia, but become an independent nosological entity, facilitating the identification of catatonia in the context of other psychotic disorders, the use of substances and general medical conditions, such as encephalitis [3,4]. Several studies revealed that serious medical complications might occur if catatonia cannot be recognized and interventions are not initiated in a timely manner [5,6].…”

Successful ECT in an adolescent with catatonia and psychosis due to COVID-19

“…This change was further expanded in the DSM-V, where catatonia is postulated to independently arise in the context of multiple different psychiatric and other medical etiologies. Regardless of etiology, studies and case reports have shown that catatonia responds similarly to ECT ( Espi Forcen et al, 2022 ).…”

Catatonia Psychopathology and Phenomenology in a Large Dataset

“…The first is the extent to which particular catatonic signs associate with the diagnoses underlying the catatonia. One retrospective study of 40 patients with catatonia in a general hospital found that stereotypy, mannerism, waxy flexibility and impulsivity were each more common where catatonia was due to a psychiatric disorder (such as depression or schizophrenia), compared to cases where catatonia was due to an underlying medical condition (such as autoimmune encephalitis or a space-occupying lesion) ( 13 ). Another study of 140 patients with catatonia in a specialist hospital found that patients with psychotic disorders had more posturing than those with a medical disorder, but there were no differences between those with psychotic and those with affective disorders ( 14 ).…”