Abstract
Catatonia is a syndrome that has been associated with several mental illness disorders but that has also presented as a result of other medical conditions. Schizophrenia and other psychiatric disorders such as mania and depression are known to be associated with catatonia; however, several case reports have been published of certain medical conditions inducing catatonia, including hyponatremia, cerebral venous sinus thrombosis, and liver transplantation. Neuroleptic Malignant Syndrome and anti-NMDA receptor encephalitis are also prominent causes of catatonia. Patients taking benzodiazepines or clozapine are also at risk of developing catatonia following the withdrawal of these medications—it is speculated that the prolonged use of these medications increases gamma-aminobutyric acid (GABA) activity and that discontinuation may increase excitatory neurotransmission, leading to catatonia. The treatment of catatonia often involves the use of benzodiazepines, such as lorazepam, that can be used in combination therapy with antipsychotics. Definitive treatment may be found with electroconvulsive therapy (ECT). Aberrant neuronal activity in different motor pathways, defective neurotransmitter regulation, and impaired oligodendrocyte function have all been proposed as the pathophysiology behind catatonia. There are many clinical challenges that come with catatonia and, as early treatment is associated with better outcomes, it becomes imperative to understand these challenges. The purpose of this manuscript is to provide an overview of these challenges and to look at clinical studies regarding the pathophysiology, diagnosis, and treatment of as well as the complications and risk factors associated with catatonia.
Highlights
Catatonia is a syndrome that has been associated with several mental illness disorders but that has presented with other medical conditions
Patients who responded to short-term lorazepam treatment showed significantly increased serum homovanillic acid (HVA) (p = 0.004), Abnormal Involuntary Movement Scale (AIMS) scores (p = 0.022), and Hamilton Anxiety Scale (HAM-A) scores (p = 0.025) and significantly decreased Subjective Experiences of Psychosis Scale (SEPS) scores (p = 0.049) relative to patients who were nonresponsive [82]. These findings suggest that serum HVA, SEPS, AIMS, and HAM-A may be useful in determining whether a patient with acute catatonia is more likely to respond to short-term lorazepam treatment [82]
Catatonia is a complex condition with varying presentations and that is associated with multiple disorders, which can make recognition, diagnosis, and treatment a challenging process for healthcare professionals
Summary
Catatonia is a syndrome that has been associated with several mental illness disorders but that has presented with other medical conditions. It is defined as a group of symptoms that involve a lack of movement as well as a lack of communication. Bleuler took it a bit further and thought that a patient with catatonia was suppressing unpleasant memories by “silence, tenseness and rigidity, refusal to obey commands, and displacing rising emotion and tensions into motor acts that shut out reality” [3] It was often previously categorized with schizophrenia or associated with other mental health disorders and neurological disorders, new changes in the DSM-5 have opened up an opportunity for it to be recognized independently of these conditions. There have been cases reported where treatment with an atypical antipsychotic relieved symptoms [15]
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