The Phenomenology and Treatment Response in Catatonia: A Hospital Based Descriptive Study

Abstract

Background:Literatures regarding clinical symptomatology and treatment response of catatonia are very few.Objective:To assess onset, clinical profile, diagnostic break up, treatment response and outcome in patients diagnosed as Catatonia, reported to a tertiary care hospital.Methods:The present study was a cross-sectional descriptive study conducted in indoor of Mental Health Institute (Centre of Excellence), S.C.B. Medical College, between March 2015 to March 2016. A total of 34 patients were included in the study who reported at outdoor department of Mental Health Institute with catatonic symptoms. All patients admitted in inpatient department were routinely assessed through a detailed semi-structured interview. The diagnosis of catatonia was made if the patients present with three or more symptoms out of twelve symptoms fulfilling the criteria of DSM-5. All the patients were assessed through Bush-Francis Catatonia Rating Scale. They were initially given parental lorazepam at the doses ranging from 4-12 mg per day as per requirement. Patients who did not respond to lorazepam trial were given ECT.Results:The patients were predominantly presented with retarded symptoms of catatonia such as staring, mutism, withdrawal, posturing and negativism. Schizophrenia and other psychotic spectrum disorders were more commonly presented as catatonia as compared to mood disorders. Younger age group patients were mainly responded to lorazepam only, whereas older age group patients responded to both ECT and lorazepam.Conclusion:This study has came out with very important insights in the age of incidence, phenomenology, clinical profile, source of referral, diagnostic break up and treatment response with lorazepam and ECT in catatonic patients following mental disorder.

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

“…The study showed catatonia to be occurring commonly in young, having its onset in twenties (24.63 years) which is in accordance with previous studies. 7,[10][11][12] It was found to be common in males, patients with high school education, Hindu religion, housewives and semiskilled workers, patients from mostly rural background, which again matches with other studies from India and represented profile of the majority of the patients. [10][11][12] Few patients had a family history of psychiatric illness (20%) suggestive of possible genetic etiology that is comparable with other studies.…”

“…7,[10][11][12] It was found to be common in males, patients with high school education, Hindu religion, housewives and semiskilled workers, patients from mostly rural background, which again matches with other studies from India and represented profile of the majority of the patients. [10][11][12] Few patients had a family history of psychiatric illness (20%) suggestive of possible genetic etiology that is comparable with other studies. [11][12] Substance use disorder was found to be less common in our patients, compared to the sample from other studies 7 which might be due to small sample size.…”

“…7-10 regarding the background diagnoses, most Indian studies, unlike that of western ones, show a higher contribution of psychotic illnesses rather than mood disorders producing catatonic symptoms. 7,11,12 Prior Indian studies mostly yielded mutism, immobility/stupor, staring, negativism, rigidity, posturing/catalepsy and withdrawal as the catatonic phenomenology. 7,11,12 Characteristically the treatment response and background diagnoses of catatonia were very sparsely dealt with in prior Indian studies.…”

“…7,11,12 Prior Indian studies mostly yielded mutism, immobility/stupor, staring, negativism, rigidity, posturing/catalepsy and withdrawal as the catatonic phenomenology. 7,11,12 Characteristically the treatment response and background diagnoses of catatonia were very sparsely dealt with in prior Indian studies. 11 The wide variety of catatonic signs and symptoms resulted in the inception of a few scales for identification and severity assessment like Bush-Francis Catatonia Rating Scale (BFCRS) 13 and the modified Roger's Rating Scale.…”

“…After detailed evaluation, all patients presenting with catatonia are initially given a trial of parenteral or oral lorazepam for 1-2 weeks at doses ranging from 4-16 mg/day as per the existing treatment protocol of catatonia and as reciprocated by multiple prior studies. 4,7,11,12,17 Longer duration was considered in case of slower response in few cases. Patients who do not respond to lorazepam trial are applied modified electroconvulsive therapy (MECT) as per the standard treatment protocol.…”