Prevalence of catatonic signs and symptoms in an acute psychiatric unit from a tertiary psychiatric center in India

Subramaniyam, Bhaskaran Aandi; Muliyala, Krishna Prasad; Hara, Suchandra Hari; Reddi, Venkata Senthil Kumar

doi:10.1016/j.ajp.2019.07.003

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…With respect to clinical diagnosis, non-affective disorders (63%) were overrepresented compared to affective disorders (37%) in both groups in our study, similar to that noted in a recent study from a different center in India (Grover et al, 2019). While consistent with the recent literature published from our center and other Indian studies as well (Grover et al, 2011;Ramdurg et al, 2013;Subramaniyam et al, 2019), the preponderance of psychosis in our sample is at variance with the view that catatonia is more frequently associated with affective disorder and that catatonia in schizophrenia is rare nowadays (Abrams and Taylor, 1976;Bush et al, 1996a;Rosebush et al, 1990). Importantly, the range of diagnostic distribution in our sample also attests to the acknowledgment in DSM-5 that several psychiatric conditions are associated with catatonia (American Psychiatric Association, 2013; Heckers et al, 2010).…”

Section: Discussionsupporting

confidence: 92%

“…Combativeness was not noted in our sample, while perseveration, grasp reflex, impulsivity, verbigeration, stereotypy, mannerism and grimacing had low severity scores. These findings are similar to the available literature indicating that the group in our study did not differ significantly with respect to commonly noted catatonic signs in other studies (Chalasani et al, 2005;Grover et al, 2011;Lee et al, 2000;Subramaniyam et al, 2019;Wilson et al, 2015). In a recent publication, we provided a three-factor solution for catatonia, namely, 'retarded', 'excited' and 'aberrant volitional' (Aandi Subramaniyam et al, 2020) wherein catatonia was an objectively derived representative group from a large sample of acute inpatients that allowed for accurate determination of the catatonia dimensions.…”

Section: Discussionsupporting

confidence: 89%

“…Greater insights from research into catatonia over the 21st century have resulted in a paradigm shift nosologically, being accorded an independent status in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (American Psychiatric Association, 2013). Specifically, in psychiatric disorders associated with catatonic presentations, various studies across the world have estimated its prevalence to be ranging from 1.64% to 10% (Grover et al, 2015;Ishida et al, 2016;Narayanaswamy et al, 2012;Solmi et al, 2018;Subramaniyam et al, 2019;van der Heijden et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

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Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting

Suchandra

Reddi

Subramaniyam

et al. 2020

Aust N Z J Psychiatry

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Objective: Catatonia can be life-threatening unless timely identified and treated. Lorazepam’s ubiquitous response has led to its universal acceptance as being the first-line management of catatonia and alludes to catatonia’s neurobiological underpinnings. Lorazepam challenge test (LCT) is widely used to either confirm a catatonia diagnosis or determine lorazepam sensitivity. It has a proposed schedule for administering lorazepam. However, efficacy of recommended LCT doses lack systematic evidence, resulting in variable LCT doses used in clinical and research settings contributing to findings that are challenging to generalize or assist with developing standardized lorazepam treatment protocols for catatonia. Given the same, this study aimed to objectively compare the response between two groups receiving different LCT doses and factors influencing the same. Methods: The 6-month study in a psychiatric emergency setting at a tertiary neuropsychiatric center in India evaluated 57 catatonia patients, before and after administration of single 2 mg ( n = 37; LCT-2) or 4 mg ( n = 20; LCT-4) lorazepam dose, applying Bush Francis Catatonia Rating Scale (BFCRS), Mini International Neuropsychiatric Interview (MINI 5.0) and obtaining sociodemographic, clinical data. Results: No between-group differences (LCT-2 vs LCT-4) for sociodemographic, clinical profiles or BFCRS severity score changes to lorazepam on Mann–Whitney U test were noted. Applying Wilcoxon signed rank test comparing individual sign severity demonstrated response variability, with significant response noted to both doses (stupor, mutism, staring, posturing, withdrawal, ambitendency, automatic obedience) and others selectively to 2 mg (echolalia, rigidity, negativism, mitgehen). Notably, sign resolution (present/absent) only to 2 mg was significant for stupor, mutism, staring, posturing, echolalia, rigidity, negativism and mitgehen. Conclusion: This study suggests 2 mg lorazepam may be an optimal LCT dose, given significant response to most catatonic signs thereby ensuring accurate detection and preventing misinterpretation of response. It offers future studies direction for standardizing lorazepam dosing schedules for catatonia management and exploring neurobiological underpinnings for individual catatonic signs that may be potentially different, given these findings.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting

Suchandra

Reddi

Subramaniyam

et al. 2020

Aust N Z J Psychiatry

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“…Catatonia was revealed to be more severe in the early stages of illness, in those with prior episodes of catatonia and in the pediatric population. 12 This case report demonstrated the importance of a high index of clinical suspicion, proper physical and mental status assessment in diagnosing catatonia that is co-occurring with another mental illness. Our patient's diagnosis was delayed and missed by both the medical and psychiatric team because of the low index of suspicion, hence was easily overlooked.…”

Section: Discussionmentioning

confidence: 82%

Catatonia in major depressive disorder: diagnostic dilemma. A case report

Ojimba¹,

Isidahome²,

Odenigbo³

et al. 2019

JPCPY

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Catatonia is a complex neuropsychiatric syndrome that is often associated with psychiatric, neurological and/or medical conditions. In order to make a diagnosis of catatonia, the clinical picture must be dominated by three or more of the following symptoms; cataplexy, waxy flexibility, stupor, agitation, mutism, negativism, posturing, mannerisms, stereotypies, grimacing, echolalia, and echopraxia. We present a case of a 58-year-old female with no prior psychiatric history who presented to the psychiatric emergency room with a threeweek history of feeling depressed, anhedonic, hopeless, helpless, and worthless, associated with poor sleep, poor concentration, low energy, significant weight loss due to lack of appetite, and suicidal ideations after she saw her ex-boyfriend holding hands with another woman. Patient exhibited symptoms such as mutism, hyperextension of spine, clinching of jaw, psychomotor retardation which suggested probable diagnosis of catatonia at the background of major depressive disorder nonresponding to treatment. This case report demonstrates the need for a high index of suspicion and early screening for catatonia in psychiatric patients given the high morbidity and mortality that is associated with this condition if delayed or undiagnosed.

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“…These conditions can lead to hypernatremia, pneumonia, rhabdomyolysis, sepsis, pulmonary embolism, renal and liver dysfunction, deep venous thrombosis, arrhythmia and neuroleptic malignant syndrome (2). It is found to be more severe in the younger age group (3). In adolescents it increases the risk of premature death up to 60 fold in comparison to the general population of the same sex and age (4).…”

Section: Introductionmentioning

confidence: 99%

Zolpidem in treatment resistant adolescent catatonia: a case series

Kumar

2020

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Catatonia is a well-established psycho-motor disorder occurring in the background of various psychiatric and medical disorders. Catatonia is commonly associated with psychiatric disorders, especially affective disorders followed by schizophrenia. However, almost 20% occur in the background of different medical and neurological disorders which need to be properly examined and investigated. Catatonia is a serious medical and psychiatric emergency condition; most probably caused by alteration in GABAergic circuits and basal ganglia. If untreated, catatonia can cause life threatening complications like dyselectrolemia, respiratory aspiration, venous thromboembolism, acute renal failure and cardiac arrest because of poor oral intake, immobility and muscular rigidity. The risk of mortality or serious life threatening events further increases in cases of children and adolescents. In children and adolescents, thus, it becomes even more important to diagnose catatonia early and start appropriate treatment. Lorazepam is considered to be the first line treatment and is safe both in adults and children. But evidence is scarce for treatment of lorazepam-resistant adolescent Catatonia. In this report we discuss two adolescent patients diagnosed with catatonia with no medical or neurological disorders in the background. Neither of the patients responded to lorazepam alone or even after augmentation with second generation antipsychotic (olanzapine). Zolpidem, like lorazepam, has a positive allosteric effect on GABA A Receptors (GABAAR) and has been used in some cases successfully to treat resistant catatonia. Here we used zolpidem 30 mg/day in divided doses with marked improvement in few days in all the symptoms. Both cases were discharged on zolpidem extended release (ER) three times a day and maintained well through the next two follow ups in over a two month period. Zolpidem can be a good alternative for children and adolescents in resistant cases.

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Prevalence of catatonic signs and symptoms in an acute psychiatric unit from a tertiary psychiatric center in India

Cited by 14 publications

References 23 publications

Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting

Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting

Catatonia in major depressive disorder: diagnostic dilemma. A case report

Zolpidem in treatment resistant adolescent catatonia: a case series

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