Diagnostic Variations and Treatment Responses of Catatonic Patients in the Psychiatric In-Patient Department of a Rural Tertiary Care Centre - A Clinical Study from Eastern India

Abstract

A B S T R A C T BACKGROUNDThere are very few studies regarding diagnostic variations and treatment response in catatonia in India. We wanted to assess the treatment response according to the background psychiatric diagnoses of in-patient catatonic patients. METHODSThis is a cross-sectional descriptive study done in the Psychiatric indoor of North Bengal Medical College between December 2018 to December 2019. Catatonia was diagnosed using DSM-5 criteria in the patients admitted. A total 30 patients were included in the study. The patients were assessed by Bush-Francis Catatonia Rating Scale, were given oral or parenteral lorazepam as needed and observed for 2-3 weeks. Non-responders were given modified ECT as per convention. Background diagnoses were checked by thorough history taking and investigations. RESULTSMajority of the patients were Hindu males in their twenties from rural lower-middle socio-economic families, around 20% of them having family history of affective and psychotic illnesses. They were diagnosed mostly with schizophrenia and other psychotic illnesses (53%) and mood disorders (30%). The mean BFCRS score at the time admission was 20.93 ± 6.16. The commonly found symptoms were mutism, staring, negativism, rigidity, posturing/catalepsy, mannerism, and withdrawal. It was seen that 83.33% of cases responded well to lorazepam only, whereas the rest 13.33% required ECT after non-response or partial response to lorazepam. Only one case after diagnosis with catatonia following organic condition was referred to the Medicine Department. The duration of hospital stay was found to be significantly different [F= 3.58 (>3.35)] among different diagnoses groups (mood disorders, psychotic disorders and others) when the catatonic severity, lorazepam dosage and the duration of treatment response were assessed among those groups using multiple one-way ANOVA. CONCLUSIONSThis study has yielded important findings regarding the age and socio-demographic profiles of the patients, family history of psychiatric disorders, clinical features, and significance of diagnostic variations in relation to the treatment with lorazepam and ECT in catatonic patients in the psychiatric indoor in a tertiary care rural hospital of Eastern India.

Influence of sociodemographic factors, diagnostic variations, and phenomenology toward the treatment response in adolescent catatonia in a tertiary care centre in Eastern India

“…13,14,16,17,24 Although it is often argued that over long-term observation, sometimes, the diagnosis of brief psychosis and unspecified psychosis can be changed into affective disorders. 36 Apart from the psychotic spectrum, affective, conversion, and substance use, and organic etiologies were also found albeit at the lower proportions. Studies based on similar age range found almost similar distribution.…”

“…Prior studies conducted among children and adolescents as well as among persons of mixed age range found a varying proportion of lorazepam response from 50% to 85%. [13][14][15][16][17]24,25,36 The varying rate of response in different studies can be attributed to delay in presentation to treatment facilities as well as the duration of untreated illness. 32 In this case, prolonged lorazepam treatment due to difficulty to pursue ECT protocol during pandemic could be one contributory reason as well.…”