Catatonic Patients Research Articles

Clinical features and predictors of non-response in severe catatonic patients treated with electroconvulsive therapy

Objective To explore the demographic and clinical features of severe catatonic patients, comparing responders and non-responders to ECT in order to detect possible predictors of non-response. Methods This naturalistic study included 59 catatonic inpatients with a diagnosis of mood disorder according to DSM-IV-TR criteria. All patients were treated with bilateral ECT and evaluated before and after ECT course. The response to ECT was defined as a Clinical Global Impression (Improvement subscale) rating 1 ‘very much improved’ or 2 ‘much improved’. Clinical variables were compared between responders and non-responders; logistic regression was used to predict the probability of non-response, with regard to the symptoms presented by the patients. Results The response rate was 83.1%. Non-responders (n = 10) to ECT showed neurological comorbidities, treatments with dopamine agonists and anticholinergic drugs, waxy flexibility, and echophenomena more frequently than respondents (n = 49). Echophenomena resulted a significant predictor of non-response in the multivariate analysis. Conclusion In line with previous reports, ECT resulted effective in the vast majority of severe catatonic patients. The association between ECT resistant catatonia and neurological comorbidity, use of dopamine-agonist and anticholinergic medications is consistent with the hypothesis that ECT is more effective in ‘top-down’ than in ‘bottom-up’ variant of catatonia. Key points Catatonic symptoms are frequently associated with severe and psychotic mood disorders. Electroconvulsive therapy is effective in treating most forms of severe catatonia. Neurological comorbidity and the presence of ‘echopraxia/echolalia’ could represent predictors of non-response to ECT.

The blues, and an almost shocking surprise – Unexpected PE in a catatonic patient, that almost had ECT

AimsTo present a case of a near-miss, where an unexpected Pulmonary Embolism (PE) was identified in a patient with psychotic depression and catatonia, who almost had Electroconvulsive Therapy (ECT). Our aim is to highlight the importance of Venous-Thrombo Embolism (VTE) risk assessment in all psychiatric inpatients, particularly those with catatonia, and those about to undergo ECT.MethodA 53-year-old female admitted with her first presentation of psychotic depression, catatonia, poor oral intake, and significant weight loss in the community for months prior to admission. She was recommended for emergency ECT as the severity of her self-neglect was becoming life threatening. Her first ECT session was cancelled due to low potassium levels prior to ECT, which proved to be a fortunate event. She developed sudden onset chest pain the next day, and following further medical investigations; was diagnosed to have a bilateral PE, and subsequently treated with Apixaban. Due to the potential risk of ECT dislodging the clots, treatment was done by optimising medication alone; Venlafaxine 300 mg, Mirtazapine 45 mg, Haloperidol 6 mg. She made a slow but successful recovery, and was discharged home, with ongoing support from Early Intervention in Psychosis services.ResultWe conducted a literature search, and it is well known that there is an increased risk of VTE in catatonic patients, as well as other psychiatric inpatients; due to anti-psychotic medication. Furthermore, cases have been reported where ECT was associated with increased risk of death in patients with known VTE/PE.On retrospective review of the patient's risks of developing VTE in the community, it was clear, that she was at very high risk of developing VTE. It was also noted that she should have had a VTE risk assessment on admission, in accordance with NICE guidelines; where all acute psychiatric inpatients should have this assessed as soon as possible.ConclusionThrough a process of assessment and treatment, VTE is often preventable. Identification of high-risk patients on admission to hospital is therefore crucial. It is thus, imperative that a comprehensive VTE risk assessment is completed on admission and regularly reviewed.This case highlights the risk of missing VTE assessments in WAA Inpatients, particularly those with catatonia, about to undergo ECT, which could have been fatal. As such, VTE/PE risk assessment in such patients, about to undergo ECT, is particularly crucial.Clinicians need to have a high index of suspicion of VTE/PE, particularly in patients with catatonia.

Preliminary investigation into the identification and management of catatonia in patients admitted to adult inpatient units

AimsThe prevalence of catatonia is considered to be approximately 10% in psychiatric inpatients. Clinical experience suggests a lower documented prevalence. This could cause longer admissions and complications, such as Neuroleptic Malignant Syndrome (NMS). We carried out a service evaluation to investigate the recognition and management of catatonia on inpatient units in Southern Health Foundation Trust (SHFT). We reviewed the local documented prevalence of catatonia, treatment offered and prevalence of complications.MethodWe retrospectively reviewed the electronic records of 95 consecutive admissions to four adult inpatient units in SHFT, starting on 1st August 2020. We reviewed notes for the admission to establish whether catatonia was suspected and identified. We applied the screening questions from the Bush-Francis Catatonia Rating Scale (BFCRS) to the documented mental state examinations (MSE) prior to, and shortly after, admission. We also recorded the prescriptions issued during the first 72 hours of admission, and whether patients developed neuroleptic malignant syndrome (NMS), serotonin syndrome or required admission to a general hospital during admission.ResultCatatonia was documented as a possibility for 2 patients (2.1%). One showed possible posturing and stupor, while there were no documented symptoms for the other. In both cases the possibility was discounted by the clinical team. Twelve patients (12.6%) showed one or more possible or confirmed signs of catatonia. Eleven of these were prescribed regular antipsychotic medication on admission, but only 3 were prescribed regular benzodiazepines. NMS was more likely to be suspected in patients with a BFCRS of 1 or more compared with those with a score of 0, with an odds ratio of 8.1 (95% CI [1.03-64.0], Fisher's exact test = 7.79, p = .076).ConclusionCatatonia is likely under-recognised and under-treated locally among psychiatric inpatients. Although only approaching statistical significance, the higher rate of suspected NMS in patients showing possible catatonia is noteworthy and needs further investigation. Regular benzodiazepines were not frequently prescribed in this group, while antipsychotics, prescribed in all of these patients, can precipitate NMS. Alternatively, this finding could reflect the overlap in clinical presentation between NMS and catatonia. Data collection was limited by the frequent use of “remote clerking”, in the context of the COVID-19 pandemic. Additionally, the quality of mental state examinations was often not sufficient to draw any conclusions on the possible presence or absence of catatonic symptoms. This project has highlighted practice in need of improvement, which will be further prospectively investigated and improved via a Quality Improvement Project.

Giving Neurons Relaxation after Hyperactivity: A Case Report and Literature Review of Post Ictal Catatonia

Background: Catatonia is a common psychiatric manifestation of multiple diagnosis such as Schizophrenia and Mood Disorders. It presents as a symptom cluster of psychomotor and behavioral symptoms such as automatism, negativism, waxy flexibility, echolalia amongst others. Papers have alluded to the existence of Schizophrenia like Psychosis (SLP) in patients who have Epilepsy, especially, Frontal and Temporal Lobe Epilepsy. However, very few papers talk of the occurrence of catatonic features in a patient in the post ictal period. Materials and Methods: In our poster, we will present a case of catatonia following the onset of a seizure and will also review existing literature which alludes to the topic. Case Report: Our patient is a 58-year-old male with current psychiatric diagnoses of Dissociative Amnesia, Diabetes Type II and Hypertension who was sent to the medical unit after he was found unresponsive by nurse staff. He was noted to be having a seizure with rapid twitching of eyelids and uncontrolled movement and appeared post-ictal afterwards, including having no memory of the episode. Discussion: Studies have alluded to Frontal Lobe Epilepsy (FLE) and Temporal Lobe epilepsy (TLE) to correlate mostly with SLP. Adachi et al, found that FLE correlated more with the hebephrenic presentation of blunted affect, disorganized thought and asociality while TLE corresponded more with paranoia, hallucinations and delusions. However, their study found limited occurrence of catatonic features. Catatonia has been found to be associated with unique findings on imaging. PET Scans have shown frontal and temporal hypometabolism. MRI has found wh8ite matter abnormalities. SPECT Scans also showed frontal and temporal hypometabolism. Given the changes seen by Adachi et al as well as the findings on imaging in catatonic patients, it could be assumed that epilepsy , especially in the frontal and temporal region may lead to catatonic features. However, our literature search found limited data about post and inter ictal catatonia. Conclusion: Further research into functional imaging in catatonia and the impact of seizures in FLE and TLE may further validate this finding. This may have treatment implications as Benzodiazepines are the preferred treatment modality for catatonia and seizures.

Getting to know neurologist Oliver Sacks

On PBS, famously shy Oliver Sacks opens up Whenever a documentary about a scientist comes on TV, the Newscripts gang reaches for the popcorn, as we recently did to learn about the neuroscientist and writer Oliver Sacks. Newscripts got a sneak preview of “Oliver Sacks: His Own Life,” an episode of the PBS series American Masters that will air on local PBS stations. Notably, Sacks joins Albert Einstein and James Watson as the only scientists who have been profiled in the series to date. Many fans of Sacks first learned about him when he was played by Robin Williams in the 1990 movie Awakenings . Based on a book by Sacks of the same name, the movie depicts his 1969 work using l -dopa to treat catatonic patients in a New York City hospital. Long living with sleeping sickness, they woke from their locked-in states, but the transformation was only

Catatonia in patients with dementia

IntroductionCatatonia has been reported with almost all types of dementia but it remains under-diagnosed.ObjectivesDescribe the characteristics of catatonia in patients with dementia and the efficiency of early management.MethodsWe review a case of a young patient admitted in our psychiatric department for catatonia and after efficient treatment, assessment revealed a dementia.ResultsA 49-year-old male treated with classic antipsychotic drug for an acute psychotic episode at age of 35 years. Three years later, the patient was admitted for behavioral disorders with delirium and confusion. The patient was treated with high-doses of antipsychotic drugs with vasodilator treatment. Currently, ten years later, he was hospitalized in a stuporous state with food refusal, sustained posture and worsening of his overall situation. At the mental assessment, the patient was motionless, mute and rigid with frozen facial expression and gaze stare. Negativity and opposition were obvious against any solicitation. Moreover, the physical examination has shown a worsening of the overall state of health, weight loss and walking difficulties. After symptomatic treatment of catatonia with benzodiazepine, the assessment revealed an aphaso-apraxo-agnotic syndrome with memory dysfunctions such as amnesia with false recognition and executive dysfunction as well as limitations in intellectual abilities. A brain scan revealed cortical and subcortical atrophy predominant in the bilateral fronto-temporo-parietal region associated with ventricular system expansion. The diagnosis of Alzheimer’s disease was made. Following atypical antipsychotic treatment combined with benzodiazepine, there was release of inhibition.ConclusionsCatatonia is a severe neuropsychiatric syndrome with an excellent prognosis if recognized and treated without delay.

ECT Utilization in the Treatment of Catatonic Patients in the United States: A Nationwide In-Patient Sample Analysis.

Primary objective was to evaluate baseline characteristics for catatonic patients treated with and without electroconvulsive therapy (ECT). We also studied the trends of ECT utilization in catatonia patients. The Nationwide Inpatient Sample data were used to compare patients and hospital-level characteristics between catatonic patients treated with and without ECT in the United States. Multivariate and trend analysis were performed. Electroconvulsive therapy was performed in 8.3% in patients with the diagnosis of catatonia (n = 24,311; mean age, 43.1; 38% White; 52.1% male). Racially, more patients in the ECT group were White (47% vs 38%) and had a comorbid diagnosis of major depressive disorder. In the multivariate analysis, the odds of receiving ECT was more with increase in age (P = 0.007). Urban area hospitals had 3 times higher odds of receiving ECT (P = 0.001) compared with rural hospitals. The odds of receiving ECT for catatonia were the highest for large bed hospitals compared with small/medium size (P < 0.001). In the trend analysis, catatonia patients undergoing ECT decreased initially from 7.0% in 2002 to 2005 to 5.2% in 2006 to 2009. After that, there was an upward trend with 10.6% patients undergoing ECT in the quarter 2014 to 2017. There was an upward trend in ECT utilization for catatonic patients with comorbid bipolar disorders and psychotic disorders. Electroconvulsive therapy is underutilized for catatonia treatment in the United States. White catatonic patients are most likely to get ECT at an urban large bed hospital. In recent years, there is an upward trend in the use of ECT. Additional controlled clinical trials are warranted.

Oral Valproate Sodium as an Alternative to Benzodiazepine in the Treatment of Catatonia- A Case Report

Alternative therapies are necessary to treat catatonia in patients with comorbidities that are not amenable to therapy with benzodiazepines or ECT. This is a patient with schizophrenia with catatonic features and a history of polysubstance abuse. Consequently, he was not a candidate for treatment with benzodiazepines, so an alternative needed to be found. GABAergic medications have been used previously as alternatives to benzodiazepines and ECT. In this case we chose sodium valproate, due to its cross-reaction with GABAergic systems. There are five reported cases using sodium valproate. Three of which were treated with intravenous valproate, while the remaining two do not specify the route of administration. We present a case where oral sodium valproate was used successfully for both acute and long-term catatonic treatment. To our knowledge, no other report has looked at both acute and long-term treatment with sodium valproate. Oral sodium valproate can be considered for patients with substance use disorders like COPD, sleep apnea or myasthenia gravis in which benzodiazepines are contraindicated and where ECT is not an option for treatment.

Reduced functional connectivity in the prefrontal cortex of elderly catatonia patients: A longitudinal study using functional near-infrared spectroscopy

Catatonia is a syndrome that manifests in patients with mental disorders and general medical conditions. However, functional changes to the brain that cause catatonia remain unknown. In the present study, we used functional near-infrared spectroscopy (fNIRS) to assess spontaneous hemodynamic activities in the brain at the times of onset and resolution of catatonic symptoms in patients with catatonia. We used 22-channel and 49-channel fNIRS to examine hemodynamic activities in the prefrontal cortex (PFC), and both frontal and parietal cortices, respectively. A total of ten patients who were diagnosed with catatonia were included in the study. Resting state measurements were taken for five minutes at the time of the onset and resolution of catatonic symptoms. Analyses were performed for the prefrontal region and the motor cortex within the parietal-frontal region of the brain. Functional connectivity between the cerebral hemispheres was evaluated systematically based on spontaneous oscillation of Δ[HbO2]. In the PFC, the resting state functional connectivity (RSFC) was significantly lower in the catatonic state than in the eyes-closed non-catatonic state (p = 0.047). The study demonstrated that the RSFC in the PFC, measured using fNIRS, may be an objective indicator of the change in catatonic symptoms.

Catatonia

Disorders of mental activity during catatonia, based on my observations, are very different from what many authors have seen with this disease. At the beginning of my study of catatonia, for a long time I could not understand why what I saw was so different from the descriptions of this disease in textbooks, I did not trust my observations for a long time, explaining this disagreement with the imperfection of research, tried to find what they saw in other observers. But the more I studied these patients, the more I became convinced that the mental disorders of the catatonic patients were still described neurologically. I insist that the catatonic people do not have any delusions or hallucinations; even illusions are extremely rare.

Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting.

Catatonia can be life-threatening unless timely identified and treated. Lorazepam's ubiquitous response has led to its universal acceptance as being the first-line management of catatonia and alludes to catatonia's neurobiological underpinnings. Lorazepam challenge test (LCT) is widely used to either confirm a catatonia diagnosis or determine lorazepam sensitivity. It has a proposed schedule for administering lorazepam. However, efficacy of recommended LCT doses lack systematic evidence, resulting in variable LCT doses used in clinical and research settings contributing to findings that are challenging to generalize or assist with developing standardized lorazepam treatment protocols for catatonia. Given the same, this study aimed to objectively compare the response between two groups receiving different LCT doses and factors influencing the same. The 6-month study in a psychiatric emergency setting at a tertiary neuropsychiatric center in India evaluated 57 catatonia patients, before and after administration of single 2 mg (n = 37; LCT-2) or 4 mg (n = 20; LCT-4) lorazepam dose, applying Bush Francis Catatonia Rating Scale (BFCRS), Mini International Neuropsychiatric Interview (MINI 5.0) and obtaining sociodemographic, clinical data. No between-group differences (LCT-2 vs LCT-4) for sociodemographic, clinical profiles or BFCRS severity score changes to lorazepam on Mann-Whitney U test were noted. Applying Wilcoxon signed rank test comparing individual sign severity demonstrated response variability, with significant response noted to both doses (stupor, mutism, staring, posturing, withdrawal, ambitendency, automatic obedience) and others selectively to 2 mg (echolalia, rigidity, negativism, mitgehen). Notably, sign resolution (present/absent) only to 2 mg was significant for stupor, mutism, staring, posturing, echolalia, rigidity, negativism and mitgehen. This study suggests 2 mg lorazepam may be an optimal LCT dose, given significant response to most catatonic signs thereby ensuring accurate detection and preventing misinterpretation of response. It offers future studies direction for standardizing lorazepam dosing schedules for catatonia management and exploring neurobiological underpinnings for individual catatonic signs that may be potentially different, given these findings.

Brainstem alterations contribute to catatonia in schizophrenia spectrum disorders

Catatonia is a severe psychomotor syndrome that frequently occurs in patients with schizophrenia spectrum disorders (SSD). Accumulating neuroimaging evidence suggests orbitofrontal, frontoparietal and cerebellar network dysfunction in catatonia. Very little is known about contributions of brainstem regions (as part of the dopaminergic-based subcortical-cortical motor circuit) to catatonia in SSD patients. Here, we used structural magnetic resonance imaging (MRI) at 3 T to examine volumes of brainstem regions in catatonic SSD patients compared to non-catatonic SSD patients. Catatonia severity was measured with the Northoff Catatonia Rating Scale (NCRS). The segmentation of the brainstem in order to investigate the volumes of medulla oblongata, pons, superior cerebellar pedunculus, and midbrain was carried out using FreeSurfer vers. 6.0. Catatonic patients (NCRS total score ≥ 3; at least 1 point in the three different symptom categories; i.e., motor, behavioral, and affective; n = 30) had significantly smaller midbrain volumes (p = 0.004, Bonferroni corr.) when compared to non-catatonic patients (NCRS total score = 0; n = 29). In catatonic patients, significant correlations were detected between NCRS motor scores and whole brainstem (p = 0.015, Bonferroni corr.) volumes. These results support a neuromechanistically important role of brainstem structures in catatonia in SSD, particularly in motor symptom expression.

Catatonia in elderly psychiatric inpatients is not always associated with intense anxiety: Factor analysis and correlation with psychopathology.

Catatonic stupor has been linked to extreme fear. Whether the underlying phenomenology of every catatonic dimension is intense anxiety or fear remains unknown. One hundred and six patients aged ≥64 years were assessed for catatonia and clinical variables during the first 24 hours of admission. Two-sample t test were used to test for group differences. A principal component analysis was developed. Analysis of variance was performed to assess for differences in the diagnostic groups. Correlation coefficients were used to examine the association between catatonic dimensions and psychopathological variables. There were statistically significant differences between catatonic and non-catatonic patients in the Hamilton and NPI scores. The three factor-model accounted for 52.23% of the variance. Factor 1 loaded on items concerned with "excitement," factor 2 on "inhibition" items, and factor 3 on "parakinetic" items. There was a significant effect for factor 1 (F [5.36] = 2.83, P = .02), and not significant for factor 2 and factor 3. Compared with patients with depression, patients with mania scored significantly higher on factor "excitement" (P < .05). Factor 2 showed a moderate correlation with Hamilton total score (r = .346, P = .031) and Hamilton psychic score (r = .380, P = .017). Catatonic patients experienced more anxiety and hyperactivity. A three-factor solution provided best fit for catatonic symptoms. Patients with mania scored highest on Excitement, patients with depression on Inhibition, and patients with schizophrenia on Parakinetic. The main finding in this study was a positive moderate correlation between the Hamilton psychic score and the Inhibition factor score, meaning that not every catatonic dimension is associated to intense anxiety.

COVID-19 Catatonia—Would We Even Know?

COVID-19 Catatonia—Would We Even Know?

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

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.

Catatonia in Patients with Autism Spectrum Disorder.

Catatonia was first described by Karl Ludwig Kahlbaum in 1874, occurring in association with other psychiatric and medical disorders. However, in the nineteenth century the disorder was incorrectly classified as a subtype of schizophrenia. This misclassification persisted until the publication of DSM-5 in 2013 when important changes were incorporated. Although the etiology is unknown, disrupted gamma-aminobutyric acid has been proposed as the underlying pathophysiological mechanism. Key symptoms can be identified under 3 clinical domains: motor, speech, and behavioral. Benzodiazepines and electroconvulsive therapy are the only known effective treatments. Timely recognition and treatment have important outcome, and sometimes lifesaving, implications.

Multiparametric mapping of white matter microstructure in catatonia

Catatonia is characterized by motor, affective and behavioral abnormalities. To date, the specific role of white matter (WM) abnormalities in schizophrenia spectrum disorders (SSD) patients with catatonia is largely unknown. In this study, diffusion magnetic resonance imaging (dMRI) data were collected from 111 right-handed SSD patients and 28 healthy controls. Catatonic symptoms were examined on the Northoff Catatonia Rating Scale (NCRS). We used whole-brain tract-based spatial statistics (TBSS), tractometry (along tract statistics using TractSeg) and graph analytics (clustering coefficient-CCO, local betweenness centrality-BC) to provide a framework of specific WM microstructural abnormalities underlying catatonia in SSD. Following a categorical approach, post hoc analyses showed differences in fractional anisotrophy (FA) measured via tractometry in the corpus callosum, corticospinal tract and thalamo-premotor tract as well as increased CCO as derived by graph analytics of the right superior parietal cortex (SPC) and left caudate nucleus in catatonic patients (NCRS total score ≥ 3; n = 30) when compared to non-catatonic patients (NCRS total score = 0; n = 29). In catatonic patients according to DSM-IV-TR (n = 43), catatonic symptoms were associated with FA variations(tractometry) of the left corticospinal tract and CCO of the left orbitofrontal cortex, primary motor cortex, supplementary motor area and putamen. This study supports the notion that structural reorganization of WM bundles connecting orbitofrontal/parietal, thalamic and striatal regions contribute to catatonia in SSD patients.

Neutrophil-lymphocyte ratio in catatonia

Abstract Background There is growing evidence of subclinical inflammation in mental disorders. Objective The aim of this study was to investigate frequency of symptoms of catatonia and the newly diagnosed subclinical inflammatory markers which are neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), monocyte/lymphocyte (MLR) ratios in catatonia patients due to mental disorders. Methods: Patients who were admitted to psychiatry clinic with the diagnosis of catatonia according to DSM 5 in the last two years and equal number of control group were included in this retrospective study. Univariate analysis of covariance controlled for possible confounders was used to compare NLR, PLR, MLR ratios between patients and the control group. Results A total of 34 catatonia patients and 34 healthy controls were included in the study. Patients’ mean age was 30.88 + 13.4. NLR value was significantly higher in the patient group than control group. There was no significant difference between the patients and control group according to PLR, MLR values. Discussion The presence of subclinical inflammation in catatonic syndrome due to mental disorders should be considered. Subclinical inflammation that was observed in numerous mental disorders continues in catatonia due to mental disorders. Large-scale studies are needed to determine the role of inflammation in catatonia.

Higher Serum C-Reactive Protein Levels in Catatonic Patients: A Comparison to Non-catatonic Patients and Healthy Controls.

Catatonia is a psychomotor syndrome defined by a constellation of predominantly motor symptoms. The aim of the present study was to determine whether recently admitted psychiatric patients with catatonia exhibited higher serum C-reactive protein (hs-CRP) levels compared to non-catatonic psychiatric patients and healthy controls (HCs). Recently admitted psychiatric patients were screened and evaluated for the catatonia syndrome using the Bush-Francis Catatonia Rating Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The study sample was formed by 150 individuals (39 male and 111 female), including 51 catatonic patients, 55 non-catatonic patients, and 44 HCs. Serum hs-CRP levels were processed with the enzyme-linked immunosorbent assay. Serum levels of creatine kinase (CK), adrenocorticotropic hormone (ACTH), immunoglobulin G (IgG), complement component 3 (C3), and complement component 4 (C4) were also determined. There was a significantly higher percentage of patients with high inflammatory levels (hs-CRP > 3000ng/ml) in the catatonic (43.1%) than in the non-catatonic (14.5%) or HCs group (9.1%) (χ 2 =18.9, P < .001). Logistic regression showed that catatonic patients had significantly higher hs-CRP levels compared to non-catatonic patients even after controlling for other clinical and laboratory variables (OR = 3.52, P = .015, 95% CI 1.28-9.79). Multiple linear regression analysis revealed that log-transformed hs-CRP was independently predicted by body mass index and log-transformed C4, ACTH, and Cortisol in catatonic patients. Findings of the present study suggest that catatonia is specifically linked to a higher level of systemic inflammation, not merely attributable to the overall psychopathology, or alterations in the stress level and complement system.

ULTRABRIEF RIGHT UNILATERAL ECT AND CATATONIA: A CASE SERIES AND LITERATURE REVIEW

Introduction Catatonia is a neuropsychiatric syndrome that affects both behavior and motor function, resulting potentially in unresponsiveness in an individual who otherwise appears to be awake. Catatonia can occur in the context of several underlying psychiatric or medical condition. Electroconvulsive Therapy (ECT) is an evidence-based, first-line treatment for catatonia and its efficacy has been demonstrated since the early 1930s. ECT is not only proven to relieve catatonia but some of the underlying psychopathology including mood disorders. The conventional modality of ECT that has been used for the treatment of catatonia is bilateral (BL) lead placement with brief pulse width (>0.5 milisec). Although (BL) ECT placement is more commonly used, cognitive side effects are an important limitation for the use of this technique. The literature is limited regarding the use of ultrabrief pulse width (UB) ( Methods A case series of two catatonic patients successfully treated with RUL ECT at an academic center is presented. Ms. B, a 66-year-old female with bipolar disorder with psychotic features and a recent history of intentional overdose, presenting for depression and catatonia. During the past four years she had 6 hospital admissions due to similar episodes.Ms. K, a 55-year-old female with MDD with psychotic features and catatonia presenting for worsening mood, neurovegetative symptoms, psychosis and catatonic symptoms. Her catatonic symptoms had partially improved with initiation and titration of Lorazepam.Existing literature is reviewed to compared with other published cases and discussion of treatment effectiveness. A table presenting the cases found in the literature will be added. Results The patients were cleared by anesthesia. Ms. B completed an acute course of 11 UB-RUL ECT treatments with 2 more UB-RU ECT treatments were completed as taper. Her baseline QIDS improved from baseline 10 to post-ECT 1. CGI post treatment was very much improved. No major side effects were noted or reported.Ms. K completed an acute course of 13 UB-RUL ECT treatments. 3 more UB-RUL ECT treatments were completed as taper over a period of twenty-three days. Her baseline QIDS improved from 18 to 6 post treatment. Her CGI was rated as very much improved. No major side effects were noted or reported.Both patients experienced significant improvement of their symptoms. Conclusions UB RUL ECT is a safe and effective treatment modality for patients with Catatonia independent of the underlying cause. Patient with catatonia are vulnerable to relapse and may require prolonged courses of ECT and maintenance. To mitigate the risk of cognitive side effects these patients may benefit from UB RUL ECT. This research was funded by: No funding