Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

Abstract

The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.

Neuroleptic Malignant Syndrome Associated With Lurasidone

“…In this report, we described a patient with NMS caused by lurasidone treatment. Early recognition of the syndrome, immediate discontinuation of the offending agent, and prompt treatment with dantrolene and benzodiazepine in accordance with current clinical guidelines 16,17 resulted in a successful recovery of the patient. This case underscores the potential occurrence of NMS with atypical antipsychotics, emphasizing the importance of remaining vigilant regarding their adverse effects.…”

“…In such situations, a detailed pharmacological history, thorough physical examination, and clinical laboratory profiles are crucial in aiding the differentiation process: the clinical features associated with serotonin syndrome are clonus, hyperreflexia, tremor, mydriasis, and gastrointestinal syndromes, whereas severe muscle rigidity and bradykinesia are well-recognized clinical features of NMS and are associated with elevations in creatine kinase level, liver function tests, and white blood cell count. The differential diagnosis should also include an episode of malignant catatonia 16 with resultant dehydration (because of inadequate oral intake) and muscle injury secondary to prolonged immobility. Again, both entities can appear indistinguishable, but the recent exposure to dopamine-blocking agents supports the diagnosis of NMS.…”

Thought Blocking as a Manifestation of Catatonia

“…Several reports discussed the long-term use of lorazepam to prevent the reemergence of catatonia (Grover and Aggarwal, 2011; Mader et al, 2020; Manjunatha et al, 2007); however, recent guidelines by the British Association of Psychopharmacology recommend tapering lorazepam after resolution of catatonia, and if catatonia reemerges after lorazepam discontinuation, they recommended a slower taper while adequately treating underlying conditions if catatonia. In addition, they recommended the use of lithium as a reasonable option for the prevention of periodic catatonia (Rogers et al, 2023).…”

First 150 years of catatonia: Looking back at its complicated history and forward to the road ahead

“…The gold standard for the treatment of catatonic symptoms is still lorazepam or other benzodiazepines. If benzodiazepines proved to be ineffective, then electroconvulsive therapy (ECT) is the second option[ 56 ]. If psychosis is the underlying cause of catatonia, second generation antipsychotics could be used with caution due to the risk of inducing neuroleptic malignant syndrome[ 57 ].…”