The Presentation and Treatment Response of Catatonia in Patients Admitted to the Psychiatric Inpatient Unit at Jimma University Medical Center, Ethiopia

Abstract

Background. Catatonia is among the most mysterious and poorly understood neuropsychiatric syndrome. It is underresearched and virtually forgotten but still a frequent neuropsychiatric phenotype in both developed and low-income countries. Catatonia is associated with a number of medical complications like pulmonary embolism, dehydration, or pneumonia if it is not treated and managed adequately. In Ethiopia, however, almost no studies are available to describe the symptoms and the response to treatment in patients with catatonia. The aim of this retrospective study was therefore to describe the symptom profile of catatonia and to evaluate the treatment and outcome of catatonia in patients admitted to the psychiatric inpatient unit at Jimma University, Ethiopia. Method. Detailed treatment records of all inpatients were reviewed for the period from May 2018 to April 2019. All patients with catatonia at the inpatient unit of Jimma University Medical Center were assessed with the Bush-Francis Catatonia Rating Scale (BFCRS), and all comorbid psychiatric diagnoses were made according to the criteria of the Diagnostic Statistical Manual V. The presence and severity of catatonia were assessed by using the BFCRS at baseline and at discharge from the hospital. Result. In the course of one year, a total of 18 patients with the diagnosis of catatonia were admitted. The mean age of the participants was 22.8 years (SD 5.0; range: 15 to 34 years). The most common diagnosis associated with catatonia was schizophrenia (n=12; 66.7%), followed by severe depressive disorders (n=4; 22.2%). Mutism, posture, and withdrawal were registered in all patients (n=18, 100%). All patients received an injection of diazepam and had improved at discharge. Conclusion. Our study provides further evidence that catatonia is most commonly associated with schizophrenia, followed by major depressive disorder, and that mutism, posturing, and withdrawal are the most common signs and symptoms of catatonia.

A prospective descriptive study on prevalence of catatonia and correlates in an acute mental health unit in Nelson Mandela Bay, South Africa

“…The study was conducted in a 35-bed acute mental health unit in Dora Nginza Hospital, which is in Nelson Mandela Bay Metro, Eastern Cape, Africa. This is a city with a population of 1.2 million people and has high rates of unemployment and morbidity of mental illness [ 13 – 15 ]. Mental health services at the MHU include 24-hour care for acute mental illness and electroconvulsive therapy.…”

Assessment of catatonia and inter-rater reliability of three instruments: a descriptive study

“…As much as prevalence studies on catatonia have revealed that catatonia is not a rare clinical syndrome, the defocus of the current diagnostic and classification systems on catatonia as an entity of clinical significance and importance has landed catatonia amid the forgotten syndromes in psychiatry [ 26 , 27 ]. This has left clinicians in a difficult position where modern training in psychiatry no longer focuses on equipping clinicians with skills to identify and categorize these presentations and may therefore be a contributor to the apparent assumption that a condition like catatonia is rare in modern times, despite the evidence to the contrary regarding the prevalence rates of catatonia [ 1 – 3 , 6 , 7 , 9 , 11 , 13 ].…”

“…To assess the severity of catatonia, its use is complemented by completion of the full 23-item BFCRS if two or more signs of catatonia are present [ 5 , 7 ]. The BFCRS has also been recommended by Sienaert et al for routine use because of its good reliability, validity, and relative ease of application [ 9 ].…”

“…The Bush Francis Catatonia Screening Instrument (BFCSI)/Bush Francis Catatonia Rating Scale (BRCRS) meets these criteria as an acceptable screening tool because it has shown good IRR and has been successfully used at study sites to screen new admissions for catatonia [ 4 , 7 , 8 ]. Several studies have also indicated that the BFCSI is a reliable and valid screening tool for catatonia [ 1 – 4 , 7 – 9 ].…”

“…Although the lack of recognition of catatonia in the clinical setting remains a challenge, concerted efforts have been made to increase catatonia recognition, diagnosis, and treatment [ 2 , 9 ]. The remaining challenges in recognition of catatonia could be due to several factors, including the assumption that catatonia is rare, the fluctuation and periodic nature of the presentation in some patients with waxing and waning of symptoms during an episode, and the misinterpretation of catatonic symptoms as being “put on” by patients to gain attention [ 2 , 8 , 9 ].…”