Abstract
BackgroundCatatonia is a potentially life-threatening but treatable neuropsychiatric condition. Although considered more common in low income countries, data is particularly sparse in these settings. In this study we explore the symptomatology, treatment, and short-term outcome of catatonia in Ethiopia, a low income country.MethodsThe study was a prospective evaluation of patients admitted with a DSM-IV diagnosis of catatonia. Diagnosis of Catatonia and its severity were further assessed with the Bush-Francis Catatonia Rating Scale (BFCRS).ResultsTwenty participants, 5 male and 15 female, were included in the study: 15 patients (75 %) had underlying mood disorders, 4 patients (20 %) had schizophrenia and 1 patient (5 %) had general medical condition. The most common catatonic symptoms, occurring in over two-thirds of participants, were mutism, negativism, staring and immobility (stupor). Eighteen (90 %) of the twenty patients were on multiple medications. Antipsychotics were the most commonly prescribed medications. ECT was required in seven patients (35.0 %). Dehydration, requiring IV rehydration, and infections were the most important complications ascribed to the catatonia. These occurred in seven patients (25 %). Almost all patients (n = 19/20) were discharged with significant improvement.ConclusionThis study supports the growing consensus that catatonia is most often associated with mood disorders. Overall prognosis appears very good although the occurrence of life-threatening complications underlines the serious nature of catatonia. This has implication for “task-shifted” service scale up plans, which aim to improve treatment coverage by training non-specialist health workers to provide mental health care in low income countries. Further larger scale studies are required to clarify the nature and management, as well as, service requirements for catatonia.
Highlights
Catatonia is a potentially life-threatening but treatable neuropsychiatric condition
Fifteen participants (75 %) had a diagnosis of mood disorder with catatonic features; all of these had depressive disorder except one who was admitted with a depressive phase of bipolar I disorder
Despite a good overall outcome, the incidence of lifethreatening complications in catatonia is not negligible. This risk has to be taken into account in the context of the current efforts to improve service coverage in Low and Middle Income Countries (LAMICs)
Summary
Catatonia is a potentially life-threatening but treatable neuropsychiatric condition. Since Karl Kahlbaum’s original description in his historical monograph entitled catatonia or tension insanity [14, 15] over a century ago, catatonia has been a subject of constant fascination and controversy. While some consider it to be a potentially distinct syndrome deserving its own nosological status [3, 16, 17], others are unsure [18, 19]. The primary purpose of this study was to describe the profile of symptoms occurring in catatonia, and to evaluate the treatment and outcome of catatonia in a low income country. It was hoped that the study would help to clarify effective management choices in low income countries
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