Catatonic Schizophrenia: A Cohort Prospective Study

Abstract

Background: In the 20th century, catatonia was usually deemed a subtype of schizophrenia. Recently, the nature and classification of catatonia are being reconsidered. This study is the first to describe catatonia using prospectively collected data and to examine how catatonic schizophrenia differs from, or resembles, other types of schizophrenia. Methods: Data were analyzed in a cohort of 90 079 offspring followed from birth till ages 29-41 years. Proportional hazards models were used, calculating time to first psychiatric hospital admission, to compare risk factors for catatonic schizophrenia vs ''other schizophrenia.'' Results: Of 568 cases of schizophrenia, 43 (7.6%) had catatonic schizophrenia. The sexes were equally at risk for catatonic schizophrenia in contrast to other schizophrenia, for which the incidence was higher in males (1.70, 1.42-2.03, P < .0001). Advancing paternal age had no influence on the risk of catatonic schizophrenia in contrast to other schizophrenia, in which the risk to offspring of fathers age 351 was 1.27 (1.03-1.57, P 5 .03) compared with those of younger fathers. Those with catatonic schizophrenia were somewhat more likely to have older mothers (aged 351) (relative risk 5 2.14, 0.85-5.54) while maternal age was not related to other schizophrenia. Both were equally affected by parental history of schizophrenia. Patients with catatonia were significantly more likely to attempt suicide (P 5 .006). Conclusion: Patients with catatonic schizophrenia show a somewhat different profile of risk factors from those with other types of schizophrenia in this cohort and are more likely to attempt suicide. This lends some support to the hypothesis that catatonic schizophrenia may have a distinct etiology.

Motor Symptoms and Schizophrenia

“…Due to these definition problems, the reported prevalence rates of catatonia in schizophrenia vary extensively (table 1). In a birth cohort study from Israel, 7.6% of the subjects who developed schizophrenia by the age of 35 years displayed the catatonic subtype [68]. The prevalence of catatonia appeared to decrease over the past century [69,70].…”

Catatonia in DSM-5

“…The continued importance of identifying the presence of catatonia in these different contexts is supported by its familial aggregation and co-aggregation with schizophrenia and major mood disorders (Peralta and Cuesta, 2007), clear etiological attribution to a range of specific general medical conditions (Weder et al, 2008), and most importantly its relatively specific response to treatment with benzodiazepines and electroconvulsive therapy (Rohland et al, 1993;Hawkins et al, 1995;Bush et al, 1996;Caroff et al, 2007). Relative proportions of mood, primary psychotic, and neurological/medical disorders in samples of patients with catatonia vary across studies (Rosebush and Mazurek, 2010;Kleinhaus et al, 2012).…”

The Syndrome of Catatonia

“…This would also seem to counter the argument that delayed treatment caused catatonia. In another cohort study of 568 cases of catatonic patients, Kleinhaus and Harlap found an association with the schizophrenic diagnosis [30]. This may have been due to a selection bias in a sample with many psychotic patients.…”

“…Common theories to explain decreased prevalence of catatonia have included: use of increasingly-restrictive definitions of the syndrome; more reliable exclusion criteria; and improved treatment resulting in fewer cases reaching the catatonic stage associated with advanced illness [29,30,31,32,33]. Employment of alternative classification systems such as the Leonhard approach have yielded significantly more cases of catatonia than the use of RDC [21].…”

“…It is also possible that some “false negatives” occurred in which true cases of catatonia were mistaken for neuroleptic malignant syndrome. Clinicians noted a tendency for catatonic episodes to last at least six months in almost all cases studied, as well as multiple hospital admissions [30,33]. All of these variables may contribute to the underestimation of catatonia in clinical systems.…”