Catatonia Research Articles

Lithium, ECT, and Pregnancy in the Catatonic Patient: A Literature Review and Case Example.

The Journal of ECT: September 2020 - Volume 36 - Issue 3 - p e36-e42 doi: 10.1097/YCT.0000000000000700

M97. PREDICTORS OF TRANSITION TO SCHIZOPHRENIA IN BRIEF PSYCHOTIC DISORDER: FINDINGS FROM A 3-YEAR LONGITUDINAL STUDY IN THE PAFIP COHORT

BackgroundThe category ‘brief psychotic disorder’ (BPD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a short-lived psychotic condition in which delusions, hallucinations, disorganised speech or grossly disorganised or catatonic behaviour are present for at least 1 day but less than 1 month. BPD is a relatively uncommon disease accounting for 2–7% of first-episode psychoses (FEP) and it has been poorly investigated in comparison with other psychotic disorders, probably due to its low prevalence and associated good prognosis. However, FEP patients with BPD have low diagnostic stability at follow-up and a high transition rate (around 55%) to long-lasting psychotic disorders, mainly to schizophrenia. This study explored the proportion of diagnostic transition to schizophrenia after 3 years in a cohort of FEP patients with BPD, to determine whether there were early predictive factors for such transition in this BPD population.MethodsA 36-month prospective observational study of patients with first-episode BPD was conducted. The sample included subjects aged 18–60 from the intervention programme of first-episode psychosis non-affective psychosis (PAFIP) of the University Hospital Marques de Valdecilla (Spain). BPD diagnoses were confirmed using the Structured Clinical Interview for DSM-IV (SCID-I) at 6 months following admission into the PAFIP programme. Sociodemographic, premorbid and baseline clinical variables were collected and patients were followed over 3 years while they received treatment in the PAFIP programme. A DSM-IV diagnostic reassessment was performed on those patients who completed the follow-up and subjects were classified according to whether or not they had developed schizophrenia after 3 years. Univariate screening was performed to determine variables eligible for the predictive model, and factors that reached statistical or marginal significance (p ≤ 0.1) were selected for multivariate logistic regression analysis. Significant statistical level was set at 0.05. All statistical evaluation was performed using MedCalc Statistical Software (version 19.0.7).ResultsOf the 569 patients enrolled in the PAFIP programme between 2001 and 2018, 59 met the criteria for BPD. Of those, 40 (67.8%) completed the 36-month follow-up and 16 (40%) maintained their initial BPD diagnosis. Among the patients who developed other mental disorders by the end of the study period (60%; n = 24), the proportion of transition to schizophrenia was 62.5% (n = 15). Being younger at psychosis onset, living alone, a poor premorbid adjustment, acute onset of psychotic symptomatology, and higher severity of hallucinatory behaviour were variables that showed univariate associations with subsequent development of schizophrenia. A multivariate logistic regression model revealed that transition to schizophrenia was independently significantly associated with younger age at psychosis onset (OR = 0.83, 95% CI 0.69–0.99; p = 0.048), living alone (OR = 14.3, 95% CI 1.09–186.77; p = 0.042) and greater hallucinatory activity (OR = 1.81, 95% CI 1.07–3.07; p = 0.028).DiscussionOur main findings were that 37.5% of patients who presented an initial BPD diagnosis developed schizophrenia in the following 36 months. Being younger at psychosis onset, living alone and experiencing greater hallucinatory activity at baseline were independent predictors of diagnostic transition to schizophrenia in this BPD population. Individuals with BPD presenting these risk factors should therefore be targeted for intensive interventions similar to those performed on patients with first-episode schizophrenia.

Clinical and psychopathological aspects of catatonia pathomorphosis

Over the last century frequency of diagnosed catatonic states continuously decreased. This phenomenon can be explained through hypothesis of pathomorphosis of psychiatric diseases. Pathomorphosis is an important aspect of mental diseases, including catatonic states, especially therapeutic pathomorphosis. Changes in clinical presentation of psychosis led to under-recognition of catatonic signs, that cause incorrect diagnostic and treatment tactics. The aim of this study is to investigate clinical and psychopathological features of psychosis with catatonic features and actual differences in clinical presentation compared to traditional descriptions and earlier clinical cases. Two groups of patients was explored. First is patients, which admitted to psychiatric hospital due to psychosis with catatonic features. Second group contains archival clinical cases of patients, which were treated since 1969 to 1972, before introduction of atypical antipsychotics to clinical practice.

Henry VI: catatonic stupor, and the case series of 15th-century psychiatric miracles attributed to his posthumous intercession – psychiatry in history

Henry VI: catatonic stupor, and the case series of 15th-century psychiatric miracles attributed to his posthumous intercession – psychiatry in history

Unmet medical needs and other challenges in the treatment of patients with schizophrenia.

Schizophrenia is a chronic mental health disorder hallmarked by a variety of symptoms impacting mental state, emotions, and behaviors, including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, and cognitive impairment. Schizophrenia leaves patients with the inability to function appropriately in their daily lives, including at work, in relationships, and even with self-care. The exact cause of this disorder has yet to be elucidated; however, multiple factors, including genetic susceptibility and environmental influences, have been implicated in its development. Patients with schizophrenia frequently demonstrate medication nonadherence and have multiple concurrent comorbidities that lead to increased morbidity and mortality. Schizophrenia is estimated to affect more than 21 million individuals globally, and while many therapies have become available for management, the disorder still presents unique challenges to providers, caregivers, and the healthcare system. Unmet medical needs remain for this complex disease state, and research is ongoing to address these needs and improve the overall health and outcomes of patients living withschizophrenia.

Vataja Unmada: Schizophrenia or Dementia or Mood Disorder with Psychosis?

Unmada (a broad term which includes different psychiatric conditions under one umbrella) is characterized by the derangement of manas (mind), buddhi (cognitive functions), samgna gnana (orientation), smriti (memory), bhakti (interests), sheela (character/personality), cheshtha (psychomotor activity/behavior), and achara (conduct). Unmada is classified into five (vataja, pittaja, kaphaja, sannipataja and agantuja) types, and “Vataja Unmada” (VU) is one among them. The description of VU is available in all major Ayurvedic classical texts, and it comes under “Doshaja” (psychiatric disorder which occurs due to the aggravation of doshas) category. Studies or scientific literature on VU has been lacking, and the present work is focused on to explore this condition. The etiopathology of VU denotes deficiency of various nutritional factors such as vitamins, minerals, omega-3-fatty acids, amino acids, and antioxidants. Lacking or deficiency of these nutritional factors leads to structural and/or functional damage and degeneration of the brain (neurodegenerative or demyelinating pathology) which ultimately leads to the manifestation of different degenerative psychiatric disorders. The clinical picture of VU resembles various psychiatric or neuropsychiatric conditions such as “disorganized schizophrenia” or “hebephrenia” or “catatonia” or “dementia” or “bipolar disorder with psychotic features” or “mania with psychotic features,” or “organic or secondary psychoses.” VU is a treatable condition, and it can be managed successfully by “Panchakarma” procedures along with internal medicines.

Schizofrenia katatoniczna, ciągłe wyzwanie terapeutyczne – opis przypadku

Schizofrenia katatoniczna, ciągłe wyzwanie terapeutyczne – opis przypadku

Neuroleptic Malignant Syndrome Presenting with Self Injurious Behaviour

Neuroleptic Malignant Syndrome (NMS) is an emergency condition produced as an ill effect of certain drugs. Tetrad of symptoms includes fever, muscle rigidity, autonomic features and altered mental status. Pathophysiology underlying this condition is dopamine receptor blockade or depletion of dopamine. Author presented a case of 45-year-old female, alcoholic with symptoms of self-mutilating behaviour such as finger biting and tongue bites, elevated Creatine Phosphokinase (CPK) levels and no signs of autonomic dysfunction. Differential diagnosis included was malignant hyperthermia, neuroleptic malignant syndrome, serotonin syndrome, lethal catatonia, meningitis/encephalitis, heat stroke and anticholinergic toxicity. Final diagnosis of neuroleptic malignant syndrome was made according to Caroff SN and Mann SC criteria. She was treated with bromocriptine with an improvement in her condition. Clear workup including identification of other systemic and neuropsychiatric conditions with overlapping symptoms is important for accurate diagnosis of this condition.

Substance Use Patterns and Schizophrenia Spectrum Disorders: A Retrospective Study of Inpatients at a Community Teaching Hospital.

BackgroundSchizophrenia is one of the chronic mental illnesses, characterized by delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and cognitive decline. It frequently leads to a lifetime of impairment and disability that span the entire lifespan of the patients. Several epidemiologic studies have shown that schizophrenia spectrum disorders (SSDs) contribute significantly to years lived with disability. Additionally, substance use disorders have been reported to co-occur commonly among patients with SSD (a comorbidity also known as dual diagnosis), attracting notable attention over the past few decades. This dual diagnosis often requires treatment modifications to ensure for best patient outcomes.MethodsThis study was a retrospective review of the electronic medical charts. The patients included in the study were discharged from the psychiatric unit of our hospital between July 1, 2017 and October 31, 2017. Patients were included in the study using three inclusion criteria: 1) age ≥18 years; 2) had a diagnosis of SSD at discharge; and 3) had urine drug screen performed. Sociodemographic and clinical variables were abstracted. Univariate analysis and summary statistics were performed. Bivariate and multivariate analyses were done via logistic regression models to determine the odds ratios (ORs) and corresponding P values (P).ResultsA total of 365 (52.2%) patients had a diagnosis of SSD at discharge. Of these, 349 met the inclusion criteria. The age ranged from 19 to 79 years, with a mean age of 42.2 years, and 76.8% of the patients used substances. Out of the 269 patients who used substances, 199 (74%) used two or more substances. Tobacco use was most prevalent (62.3%), followed by cannabis use (41.5%), alcohol use (40.2%), and cocaine use (27.4%). Patients who reported using tobacco, were more likely to have comorbid alcohol use (OR = 7.24; P = 0.000), cannabis use (OR = 2.80; P = 0.000), cocaine use (OR = 5.00; P = 0.000), and synthetic cannabis (K2) use (OR = 4.62; P = 0.048). Results of the multivariate analyses supported the other findings.ConclusionsOur study found a high association between schizophrenia spectrum disorders and substance use, with three out of four patients with SSD using a substance. This prevalence is higher than previously reported by other studies. Among those who use substances, about three in four use multiple substances. These point to some interaction between the substances and appear to be heavily influenced by significant social determinants of mental health that continue to plague the community. It is important to establish if a patient with schizophrenia has a comorbid substance use disorder, because addressing both generally leads to better patient outcomes.

Anti-Inflammatory Diets and Schizophrenia.

Schizophrenia is a mental illness characterized by symptoms such as hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, and negative symptoms (emotional flatness, apathy, and lack of speech). It causes social and economic burdens to patients and their family. Although etiology of schizophrenia is still uncertain, dopamine dysregulation is traditionally considered as a main etiological factor of schizophrenia, which has been utilized to develop drugs for treating schizophrenia. Recently, inflammation has presented being a risk factor for schizophrenia in that neuroinflammation contributes to the pathophysiology of schizophrenia and the exacerbation of symptom severity. Various factors including diet can regulate inflammatory state. Specific foods or dietary patterns have anti- or pro-inflammatory potentials. Increased levels of pro-inflammatory cytokines and microglia activation have been reported in schizophrenia populations and were related to the pathogenesis of schizophrenia. Omega-3 fatty acids were often recommended to schizophrenia patients because of their anti-inflammatory activities. In this review, we investigate the inflammation-related pathogenesis of schizophrenia and summarize potential nutritional approaches to inhibit the manifestation of symptoms and to alleviate symptom severity using anti-inflammatory nutrients or functional components.

Prevalence of Catatonic Schizophrenia Symptoms in a Psychiatric Hospital: A Retrospective Study

Prevalence of Catatonic Schizophrenia Symptoms in a Psychiatric Hospital: A Retrospective Study

Psychotic Symptoms and Idiopathic Adult Hydrocephalism: Case Report

The assessment of a psychotic patient requires consideration of the possibility that psychotic symptoms (i.e., delusions, hallucinations, disorganized speech, markedly disorganized or catatonic behavior)..

Catatonic State as a Rare Presentation of Neurobrucellosis: A Case Report

Introduction: Brucellosis is a zoonotic endemic disease, which is transmitted to the human through occupational exposure or ingestion of contaminated dairy products. Neurobrucellosis has been detected in 5% - 10% of patients with diverse manifestations. Case Presentation: In this study, an atypical case of neurobrucellosis is reported. The patient was a 28-year-old man suffering from psychiatric symptoms and catatonic states. The CSF analysis was unremarkable but the diagnosis was made according to Enzyme-linked Immune Sorbent Assay, other serology tests, and brain MRI findings. Conclusions: It should be mentioned, one of the differential diagnoses in patients with unexplained neurological and psychiatric symptoms in endemic areas is neurobrucellosis and a multidisciplinary approach to these patients is essential.

GABA and Negative Affect-Catatonia as Model of RDoC-Based Investigation in Psychiatry.

GABA and Negative Affect-Catatonia as Model of RDoC-Based Investigation in Psychiatry.

Mediating effect of trait coping style on nurses' occupational stress and fatigue

Objective To investigate the fatigue status and influencing factors of nurses, and to evaluate whether trait coping styles mediate the relationship between occupational stress and fatigue. Methods A total of 167 nurses in Shaoxing Municipal Hospital were selected by cluster random sampling in April, 2018.Their fatigue status was assessed by Chinese version of multidimensional fatigue scale, occupational stress was assessed by occupational stress inventory revised edition, and trait coping style was assessed by trait coping style questionnaire.The data were analyzed by SPSS22.0. Results A total of 164 valid questionnaires were obtained, the physical fatigue score was (22.9±9.3)points, the decreased activity score was (6.7±2.7)points, the decreased motivation score was (6.6±2.6)points, the mental fatigue score was (9.0±4.0)points, the total fatigue score was (47.3±13.5)points.The total fatigue scores of nurses with different ages(F=2.520, P=0.043), nursing years(F=3.388, P=0.020), educational background(t=-2.571, P=0.011), professional title(F=3.743, P=0.026), departments(F=4.412, P=0.001) and night shift frequency(F=3.412, P=0.019) were significantly different.The total fatigue scores were positively correlated with negative coping(r=0.274, P=0.009), occupational tasks(r=0.351, P=0.007) and stress response(r=0.348, P=0.004) respectively.Negative coping styles partially mediated the relationship between occupational stress and fatigue.The total effect of occupational stress on fatigue was 0.066, the ratio of negative coping to total effect was 49.62%. Conclusion There are many factors influencing nurses' fatigue, and negative coping styles play a mediating role between occupational stress and fatigue. Key words: Nurse; Fatigue; Occupations; Catatonia; Positive coping; Negative coping; Night shift; Mediating effect

Les symptômes catatoniques des patients autistes hospitalisés en psychiatrie : intérêt d’une différenciation nosologique fine

ObjectivesIn our department that receives autistic adults with severe deficit, we are struck by presence of symptoms of catatonic lineage that are very similar to those observed in catatonic forms of schizophrenia in adults, even if there are, of course, changes due to the appearance of manifestations in early childhood. This corroborates conclusions of many authors who state that catatonic symptoms are common in autism. Symptoms common to both disorders include poor verbal responses, echolalia, repetition of expression or sentence, repetitive behaviors, stereotypy, posture, grimaces, rigidity, mannerisms, and aimless agitation. This comorbidity can be seen in terms of a progression from autistic symptoms to catatonia, as suggested by the different perspectives that we approach. Materials and methodsThe complex relationships between autism spectrum disorder, catatonia and schizophrenia are first approached from a DSM-5 perspective. It is possible to use diagnosis of attenuated psychosis with predominant negative and catatonic symptoms, to consider diagnosis of catatonia, which requires only three out of twelve symptoms, or to seize the possibility of adding the specifier “with catatonia” to autistic spectrum disorder. Then, the return to the phenomena is chosen as the first clinical orientation: absence of natural movements of expression, impression in the contact, withdrawal, subjective capacities. Through several clinical vignettes, we illustrate the richness and scope of the fine nosological differentiations from Karl Leonhard's work. ResultsAutism spectrum disorders can be forms of early expression of catatonic disorders as defined by Karl Leonhard. Thus, some autistic patients evolve favorably during their development and do not become catatonic. This could proceed from stopping the progression of pathological process before it becomes complicated with functional repercussions. It is thus possible that the development of autism takes place in two phases: first the expression movements and the direct emotional contact are affected, then the rest of the motility is affected in case of progression of the disorder towards the emergence of psychomotor disorders. This hypothesis predicts that the same susceptibility genes will be found in autism and catatonia. These genes may be those of GABAa receptor subunits located on the long arm of chromosome 15.

Maintainance ECT for Recurrent Catatonia-A Case Report

Abstract Catatonia was first described by Kahlbaum as a disorder of movement and speech .Kraeplin grouped catatonia along with other sub types of schizophrenia. In ICD-10 catatonia is mentioned as sub type of schizophrenia. DSM-5 gives independent status to catatonia. Catatonia may be caused by many medical conditions ,but in psychiatry it is associated more with mood disorders and schizophrenia. There are certain conditions with recurrent catatonia like the Periodic catatonia .We present a case of 35year old woman who has recurrent catatonia for the past 15 years .She was diagnosed with catatonic schizophrenia initially, treated with adequate trials of different antipsychotics , mood stabilisers and benzodiazepines with poor response. For the past several years she is being given maintainance ECT to which she is showing good response. ECT is effective in the treatment of recurrent catatonia and can be maintained. Key words – recurrent catatonia, maintainance ECT, good response

Maintainance ECT for Recurrent Catatonia-A Case Report

Abstract Catatonia was first described by Kahlbaum as a disorder of movement and speech .Kraeplin grouped catatonia along with other sub types of schizophrenia. In ICD-10 catatonia is mentioned as sub type of schizophrenia. DSM-5 gives independent status to catatonia. Catatonia may be caused by many medical conditions ,but in psychiatry it is associated more with mood disorders and schizophrenia. There are certain conditions with recurrent catatonia like the Periodic catatonia .We present a case of 35year old woman who has recurrent catatonia for the past 15 years .She was diagnosed with catatonic schizophrenia initially, treated with adequate trials of different antipsychotics , mood stabilisers and benzodiazepines with poor response. For the past several years she is being given maintainance ECT to which she is showing good response. ECT is effective in the treatment of recurrent catatonia and can be maintained. Key words – recurrent catatonia, maintainance ECT, good response

Catatonia Associated with Hypernatremia.

Catatonia Associated with Hypernatremia.

Cat-a-tonic.

Cat-a-tonic.