Onset Of Catatonia Research Articles

Exploring seasonality in catatonia diagnosis: Evidence from a large-scale population study

Catatonia is a severe psychomotor syndrome mainly associated with psychiatric disorders, such as mood disorders and schizophrenia. Seasonal patterns have been described for these psychiatric disorders, and a previous study conducted in South London showed for the first time a seasonal pattern in the onset of catatonia. In this study, we aim to extend those findings to a larger national sample of patients admitted to French metropolitan hospitals, between 2015 and 2022, and to perform subgroup analyses by the main associated psychiatric disorder. A total of 6225 patients diagnosed with catatonia were included. A seasonal pattern for catatonia diagnosis was described, using cosinor models. Two peaks of diagnoses for catatonic cases were described in March and around September–October. Depending on the associated psychiatric disorder, the seasonality of catatonia diagnosis differed. In patients suffering with mood disorders, peaks of catatonia diagnosis were found in March and July. For patients suffering with schizophrenia, no seasonal pattern was found.

Catatonia induced by abrupt discontinuation of clozapine - case report

IntroductionCatatonia is characterized by a bizarre and severe psychomotor change. According to DSM-5, the presence of three or more symptoms is necessary to affirm the diagnosis: stupor, catalepsy, brain flexibility, mutism, negativism, posturing, mannerisms, stereotypes, agitation not influenced by external stimuli, grimaces, echolalia or echopraxia. The association between first- and second-generation antipsychotics (AP) and the onset of catatonia is well established in the literature. In contrast, clozapine is one of the second-generation APs that is recognized for its effectiveness in treating catatonia, rather than inducing it. However, it has been documented that abrupt discontinuation of clozapine can induce rapid clinical deterioration with multiple presentations including: psychoses, cholinergic rebound states, serotonergic syndromes and catatonia.ObjectivesReview the literature on catatonia associated with abrupt interruption of clozapine. Describe a clinical case.MethodsObservation of the patient and consultation the clinical file. Non-systematic literature review on catatonia, clozapine, side effects associated with rapid discontinuation and respective treatment.Results34-year-old man, with the diagnosis of Schizoaffective Disorder. Admitted due to an acute decompensation with psychotic symptoms resistant to treatment requiring the introduction of clozapine. In the absence of a clinical response, clozapine was suspended, with the consequent appearance of catatonia resistant to benzodiazepines in high doses.ConclusionsIts already well established that the abrupt discontinuation of clozapine can trigger catatonia. This clinical case and literature review suits to emphasize the importance of educating psychiatrists on the adverse effects of psychiatric drugs and, in this case, the cautious discontinuation of clozapine in order to avoid its rebound effects.

Catatonie maligne compliquant une démence à corps de Lewy traitée par électro-convulsivo-thérapie : à propos d’un cas

Malignant catatonia is a life-threatening syndrome, associated mostly with psychiatric diseases but also with neurological and neurodegenerative syndromes. We report the case of a 72-year-old patient, hospitalized for a major depressive episode with delusional symptoms, who presented a malignant catatonia. The patient had been transferred to an intensive care unit and treated with electroconvulsive therapy (ECT) leading to a rapid disappearance of the catatonic syndrome associated with a remission of the depressive symptoms. Complementary investigations helped us to secondarily diagnose a Lewy Body Dementia, which probably caused, associated with a treatment by haloperidol, the onset of catatonia. This case illustrates the need of an early diagnosis of neurodegenerative diseases in psychiatric outpatients and the importance of a quick management of catatonia, including ECT.

Catatonia in a Tertiary Care Center in Eastern Part of Nepal: A Descriptive Study

Introduction: Catatonia is still an ill-understood phenomenology and we could not find any case based publications from Nepal. This study was undertaken to observe the proportion of catatonic patients in a year, to describe their frequencies, and to relate catatonia to mode of onset of catatonia, stressors and to diagnostic categories.Method: One-year prospective study was carried out in Psychiatry Ward of B. P. Koirala Institute of Health Sciences, Dharan. Socio-demographic variables were collected in structured Performa and Semi-Structured Performa was used for number of catatonic signs, life events, and mode of onset. Catatonia was screened and rated by Bush-Francis Catatonia Rating Scale. Psychiatric diagnoses were based on International Classification of Mental and Behavioral Disorder, Diagnostic and Research Guidelines, tenth version. Medical diagnoses were made by the consultant in Internal Medicine. Those who could not be admitted at least 24 hours for observation were not taken into study and 2 cases were excluded due to extreme of ages.Result: The proportions of patients with catatonia were 9.3% in psychiatric in-patients. Mutism was the most common sign and larger proportion had retarded catatonia. Mode of onset of catatonia, stressors, and disorders were not related. Medical and psychiatric catatonia could not be differentiated from the pattern of catatonic signs, even though echolalia occurred only in seizure disorder in our sample.Conclusion: The phenomenon of catatonia is common in our set-up. Mutism was the most common symptom. It is important to rule out organic etiology first. Depression is a common diagnosis with catatonia.

Hyperammonemic Encephalopahty Can Result from a Duodenal Switch

A 41-year-old female had inadequate weight loss 2 years after a vertical sleeve gastrectomy. 1 year prior to presentation, she underwent revision to a duodenal switch with formation of a duodeno-ileal anastomosis. At presentation she had evidence for protein-calorie malnutrition. She denied alcohol use; total parenteral nutrition (TPN) was initiated. Upper endoscopy revealed a normal esophagus and post-operative changes of sleeve gastrectomy with duodenal switch; a nasoileal tube was placed to begin enteral nutrition. On day 9, the patient was moved to the intensive care unit after onset of catatonia and unresponsiveness. On exam, she had no signs of chronic liver disease. Her INR was 1.4, platelet count 237 and had minimal elevations of serum ALT and AST. She had no evidence for metabolic acidosis (AGAP-8 and lactic acid-1.1). CT scan of the head was unremarkable. There was no deficiency of vitamin B12, folate, copper, or zinc, but she had hyperammonemia with a blood level of 223 mcg/dl. The differential diagnosis for non-hepatic hyperammonemia includes medications, hyperalimentation, infections with urease producing bacteria, surgical-induced nutritional deficiency, and errors of metabolism. Other potential explanations were excluded for this patient. She was started on a protein restriction of 40 grams/day, lactulose enemas and high dose intravenous thiamine. She had a decrease in her serum ammonia levels with improvement in her mental status. A 24-hour urine collection revealed an elevated orotic acid level (2.9 mmol/mol Cr) supporting Ornithine Transcarbamylase Deficiency. She underwent revision of her ileo-ileostomy, and the common channel was increased in length. On day 30, TPN was discontinued. She was discharged on a protein limited diet and oral lactulose. This exceedingly rare phenomenon with similar presentations has been described previously involving predominantly female patients developing an often fatal hyperammonemic encephalopathy after gastric bypass surgery, which in some patients was up to 28 years post-operatively. The exact mechanism remains unclear, but this disorder is believed to involve unmasking of inborn errors of urea metabolism after bariatic surgery, the most common of which is Ornithine Transcarbamylase Deficiency. This case report demonstrates that this disorder can also occur after duodenal switch. Gastroenterologists need to be aware of this disorder due to the number of patients undergoing bariatric surgery.

Dexamethasone-induced catatonia in a patient with multiple myeloma

Catatonia is a complex neuropsychiatric syndrome, caused by different underlying metabolic, neurologic, psychiatric and toxic conditions. Although catatonia is often associated with psychiatric disorders such as schizophrenia or depression, in about 20 to 39% of the patients a somatic illness is found. Unfortunately, this diagnosis is often missed although catatonia is characterized by a specific symptom complex. We report a case of acute catatonia with psychotic features in a patient with multiple myeloma (MM), caused by systemic use of dexamethasone. Physicians should be aware of possible psychiatric side effects when prescribing high doses of dexamethasone. Further, MM patients on corticosteroids should be closely monitored for mild psychological and/or psychiatric symptoms since they may be predictive for the onset of catatonia.

Combined Use of Electroconvulsive Therapy and Amantadine in Adolescent Catatonia Precipitated by Cyber-Bullying

Catatonia is a unique motor dysregulation syndrome characterized by identifiable signs such as immobility, sometimes alternating with excessive motor activity, that is apparently purposeless and not influenced by external stimuli, extreme negativism or muteness, peculiarities of voluntary movement, echolalia, or echopraxia (Fink and Taylor 2009). Catatonia accompanies a number of general medical and neurologic conditions (Dhossche and Wachtel 2010), with acute or insidious onset. In its most severe forms, catatonia may become life threatening, especially when aggravated by autonomic dysfunction and fever. Although previously considered to be rare in children and adolescents (Cohen et al. 1999), recent reports suggest that the prevalence of catatonic symptoms in these age groups is in fact similar to that reported in adults (Ghaziuddin et al. 2012). Overwhelming stress and trauma may trigger catatonia in children and adolescents (Dhossche et al. 2012). Benzodiazepines and electroconvulsive therapy (ECT) are considered first-line treatments (Weiss et al. 2012); however, the literature offers little guidance in cases that do not respond or that respond slowly to a course of these primary treatments. We present an adolescent case with close temporal relationship between onset of catatonia and cyber-bullying, a severe but common stressor nowadays for many adolescents, which resolved with daily ECT and adjunctive amantadine. We did not find any prior published accounts of these features in adolescents.

Onset of Catatonia at Puberty

Catatonia is a syndrome of motor and behavioral disturbance. It is a poorly understood condition, which is underrecognized and may go untreated despite intensive medical workup and numerous unsuccessful medication trials. However, with treatments known to be effective, such as benzodiazepines and/or electroconvulsive therapy, patients may return to their baseline functioning. Autism and catatonia have been previously reported together. We report 2 patients with autism and mental retardation who developed catatonic symptoms at the onset of puberty. Both patients experienced persistent symptoms over several years and presented with a history of motor disturbance, functional decline, and episodic aggression. Both patients were treated with electroconvulsive therapy resulting in a positive response and functional improvement. Catatonia may persist as a chronic condition, lasting over several months or years, if not recognized and treated.

Memantine in Major Depression with Catatonic Features

Memantine in Major Depression with Catatonic Features