Prevalence Of Catatonia Research Articles

Catatonia in autism spectrum disorders: Prevalence, functional impact, and diagnostic insights

The current study aimed to evaluate subtle catatonia behaviors and functionality in adolescents with autism spectrum disorders (ASD). The sample consisted of 48 patients (11 female, 37 male) aged 12–18 (13.77 ± 2.01). DSM-5 catatonia criteria and Bush-Francis Catatonia Rating Scale (BCRS) was utilized to assess catatonia, while the impairment in functionality was appraised using the Global Assessment Scale. Parents fulfilled the Revised Child Anxiety and Depression Scale-Parent version (RCADS-PV) and Repetitive Behavior Scale-Revised (RBS-R). The presence of catatonia was detected in 18 out of 48 (37.5 %) participants according to BCRS, and in 16 cases (35.4 %) according to DSM-5 criteria. A significant association between two diagnostic tools was observed (p < 0.001). In the group with mild impairment in functionality, 2 cases had catatonia (12.5 %), while in the group with more impaired functionality, 16 cases (50 %) had catatonia (p = 0.011) according to BCRS. Major depressive disorder subscale scores of RCADS-PV and stereotypic movements (RBS-R) were correlated with the presence of catatonia (p < 0.05). The findings suggest a higher prevalence of catatonia in ASD, and a potential correlation between the presence of catatonia and functionality. More research is warranted to highlight the presence and course of catatonia beginning from the early years of ASD.

Exploring genetic risk for catatonia in a genome wide association study and polygenic risk score analysis

BackgroundCatatonia is an under-recognized disorder characterized by psychomotor (increased, decreased, or abnormal) changes, affective symptoms, and disturbance of volition, which may arise in the setting of decompensated psychiatric or non-psychiatric medical disorders. Genetic studies of catatonia are limited, and to the best of our knowledge no prior genome wide association studies of catatonia have been performed to date. MethodsFirst we performed a genome wide association study of catatonia regardless of etiology (psychiatric or non-psychiatric). Secondarily we evaluated whether there was an elevated genetic risk profile for predisposing psychiatric disorders (schizophrenia spectrum disorder, bipolar affective disorder, etc.) in patients with catatonia. We used a matched case control design and applied polygenic risk scores to evaluate for a shared polygenetic contribution to catatonia from common psychiatric phenotypes that show a high prevalence of catatonia in their decompensated states. ResultsAnxiety, bipolar affective disorder, schizophrenia spectrum disorder and cross disorder polygenic risk scores were significantly associated with catatonia case status in both unadjusted and adjusted logistic regression models for the European Ancestry set even after correcting for multiple comparisons. Depression, Alzheimer's, Autism Spectrum Disorder and Obsessive Disorder polygenic risk scores were not significantly associated with catatonia status in participants of European Ancestry. In the African Ancestry set, no psychiatric polygenic risk scores were significantly associated with catatonia status in either the unadjusted or adjusted regression models. ConclusionsEven after controlling for relevant covariates, anxiety, bipolar affective disorder, schizophrenia spectrum disorder and cross disorders were significantly associated with catatonia status suggesting that there might be a shared genetic risk for those disorders amongst patients with catatonia.

Catatonia and Neuroleptic Malignant Syndrome in Patients With Cerebral Palsy: Two Case Reports and a Systematic Review of the Literature.

Patients with cerebral palsy, a group of movement disorders with motor, and possibly communication and behavioral features that mimic catatonic signs, may benefit from efforts to improve the detection and treatment of comorbid catatonia. Given that cerebral palsy frequently co-occurs with conditions associated with catatonia, such as autism spectrum disorder, epilepsy, intellectual disability, and mood and psychotic disorders, lifetime prevalence of catatonia in this population may be high. This study aimed to systematically review the literature on catatonia and the related condition of neuroleptic malignant syndrome (NMS) in patients with cerebral palsy while presenting 2 additional cases of catatonia. We used the terms "cerebral palsy" in combination with "catatoni∗," related terms for catatonia, and "neuroleptic malignant syndrome" to query Ovid MEDLINE (1948 to November 28, 2022), PsycINFO, Cumulative Index to Nursing, and Allied Health Literature, and Embase for applicable case reports. The Neuroleptic Malignant Syndrome Information Service database was also manually searched. In addition to our 2 catatonia reports, we identified 10 reports of catatonia in patients with cerebral palsy, as well as 8 reports of NMS. Patients with both conditions responded well, and sometimes rapidly, to treatment. Notably, of the 5 patients with catatonia and cerebral palsy who received electroconvulsive therapy, 2 developed recurrent self-limited hyperthermia posttreatment. We also identified several cases of baclofen withdrawal, which can be life threatening because of seizure risk, presenting with NMS-like features in patients with cerebral palsy who had malfunctioning intrathecal baclofen pumps for spasticity management. Given frequent comorbidity of conditions associated with catatonia in patients with cerebral palsy, as well as routine treatment with medications that can induce NMS, such as metoclopramide and anticholinergics, catatonia and NMS may be underreported in the cerebral palsy patient population, despite being highly treatable. Possible underdiagnosis of catatonia in patients with cerebral palsy may be because of misattribution of overlapping features between the 2 conditions to cerebral palsy. Clinicians should be aware of possible recurrent self-limited fever when using electroconvulsive therapy to treat patients with catatonia and cerebral palsy while also being vigilant for intrathecal baclofen withdrawal when encountering NMS-like features in patients with cerebral palsy.

A Cautionary Tale of Antidepressant in the COVID-19 Era: A Case Report of Vortioxetine-Induced Catatonia

During the coronavirus (COVID-19) pandemic, antidepressant prescriptions increased by 18.6%, clearly leading to proportionally increased chances of side effects due to medication exposure. Catatonia is a complex and heterogeneous neuropsychiatric syndrome manifesting up to 40 different signs and symptoms that were categorized into 4 groups, including pure motor, volition disturbance, disinhibited complex motor activities, and autonomic instability. The prevalence of catatonia ranges from 7.6% to 38% in patients presenting with acute psychiatric symptomatology. Though most often associated with psychiatric disorders, it is critical to rule out other medical etiologies. The literature reveals catatonia may manifest in several medical conditions and medications have been implicated in the pathophysiology of catatonia. We present a case of possible vortioxetine-induced catatonia in a patient with a history of schizoaffective disorder bipolar type. [ Psychiatr Ann . 2023;53(5):224–227.]

On catatonia again... - literature review

Introduction: In addition to the symptoms, the symptoms of catatonia have been classified as a subtype of schizophrenia (catatonic schizophrenia). Currently, however, catatonia is treated as a single psychopathological syndrome that can occur in the course of various disorders. Catatonia has been the subject of many disputes in the scientific community over the years, and many of its elements remain unexplored. Material and method: The aim of the study is to review current research on catatonia in the field of: main, leading to catatonia, neuroimaging, immunology, methods of treatment and psychoactive compounds, COVID-19, therapy of pediatric and geriatric patients. The article reviews research and scientific papers from 2014-2022 on catatonia, interest in the PubMed and Google Scholar databases. Results: Studies showing a prevalence of catatonia of approximately 10.6 cases per 100,000 tax recipients. The assessment of the prevalence of individual catatonias varies depending on the criteria. Deep vein embolism has been confirmed in approximately 25.3% of patients with cardiac catatonia. Conclusions: Catatonia is a common neuropsychiatric syndrome that significantly prolongs hospitalization time. Additional studies using the technique of functional neuroimaging of the brain are needed. Effects of treatment with the effect of: zolpidem, memantine, amantadine and augmentation with amisulpiride.

3.86 Catatonia in the Child and Adolescent Population at the Johns Hopkins Hospital During the COVID-19 Pandemic: A Retrospective Study

3.86 Catatonia in the Child and Adolescent Population at the Johns Hopkins Hospital During the COVID-19 Pandemic: A Retrospective Study

Catatonia as the Initial Presentation of Depression in an Older Adult

<h3>Introduction</h3> Background: Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral, emotional, and autonomic abnormalities. It can be caused by general medical, neurological, or psychiatric disorders, as well as by medications and drugs of abuse . Although there is a high prevalence of catatonia in the geriatric population, there is less data available when compared to other age group. . Among psychiatric disorders, depression is commonly associated with catatonia. And in most instances, there is a known history of depression reported in these catatonic patients. We are presenting a unique case in which an older adult presented with catatonia as the initial presentation of depression. We will then present a review of the literature of catatonia in older adults. Case: Mr. B is a 75 year old man with a history of alcohol use disorder in sustained remission for five years, no other psychiatric history, who was admitted to neurology for encephalopathy developed after a hernia repair surgery. His neurological work up including MRI brain, CSF analysis, Vit B12, TSH, video EEG, all of which were normal. The neurology team considered treating the patient with steroids for possible autoimmune encephalitis. They consulted psychiatry as he demonstrated posturing and echolalia. Upon psychiatric evaluation, his presentation was notable for stupor, mutism and negativism. He showed modest response to an initial lorazepam challenge with improved speech. Upon receiving a second dose of lorazepam, the response was significant, marked by improvement in his speech, thought process, and the ability to verbalize his subjective experience . As his catatonia improved, his depression was unmasked. He demonstrated depressed mood, feelings of guilt, helplessness, hopelessness, ruminations about past alcohol use, paranoia against the hospital staff, auditory hallucinations and referential thinking. His condition did not improve with aripiprazole or olanzapine, so team decided to administer electroconvulsive treatment in addition to escitalopram. Over the course of 7 index sessions, the patient showed minimal improvement. With a switch to bilateral ECT (index sessions #8-15), the patient ultimately showed significant improvement, including complete resolution of catatonia, and remission of depressive and psychotic symptoms. This was evidenced by improved mood, sleep, and consistent denial of AH and paranoia. He was discharged on maintenance ECT, escitalopram, and quetiapine. <h3>Methods</h3> Electronic searches of the standard bibliographic databases PubMed, MEDLINE, EMBASE, and PsycINFO will be performed for papers focusing on catatonia, first episode of depression and older adults. <h3>Results</h3> The literature on catatonia in older adults will be reviewed. The prevalence, complexities in diagnosis, and prognosis will be described, as available in the literature. <h3>Conclusions</h3> In the geriatric population, its crucial to identify and treat the catatonia in early stages to limit overall morbidity and preserve functioning. In some instances, the underlying etiology becomes evident after the treatment of catatonia. <h3>This research was funded by</h3> None

Recurrent Catatonia Onset in an Octogenarian Woman Managed with Electroconvulsive Therapy

<h3>Introduction</h3> Catatonia is a neuropsychiatric syndrome of motor, affective and behavioral dysregulation, accompanied by potential systemic complications with significant morbidity and mortality¹^,². Multiple disorders have been associated with catatonia; these include structural and intrinsic brain diseases, systemic disorders, and psychiatric disorders³,⁴. In the elderly, the prevalence of catatonia fluctuates between 5.5%-11.22% depending on the clinical setting⁵^,⁶. Despite the significant prevalence, there is limited literature regarding the clinical characteristics of recurrent catatonia in the elderly. <h3>Methods</h3> We hereby describe a case of a 91-year-old woman with recurrent major depressive disorder, who presented with recurrent catatonia and comorbidities of atrial fibrillation on therapeutic anticoagulation, hypertension, mild cognitive impairment, and constipation. <h3>Results</h3> The patient's initial presentation occurred at the age of 87 years when she presented with symptoms of catatonia consisting of immobility, mutism, rigidity, negativism, and severe decline in oral intake as the initial manifestation of her first non-psychotic depressive episode. During her initial presentation, catatonia was treated with lorazepam with an adequate response but was transitioned to an acute course of bilateral electroconvulsive therapy (ECT) due to side effects with lorazepam. Her symptoms rapidly resolved after three ECT treatments, and she was on maintenance antidepressant therapy with venlafaxine extended-release 75 mg daily. Catatonia symptoms recurred after two years concomitantly with a depressive episode with psychotic features. The patient responded well once again to the acute course of bilateral ECT during her second episode of depression and required a prolonged course of maintenance ECT every one to three weeks with adequate tolerance. She had a recurrence of catatonia at the age of 91 years in the context of her husband's death. She was managed with an acute course of six ECT treatments and transitioned to weekly maintenance ECT. During all presentations, extensive medical workup was unremarkable for organic causes, and there was no evidence of cognitive decline. Her symptoms of catatonia remitted completely in between depressive episodes. <h3>Conclusions</h3> Catatonia can be a life-threatening emergency. Recurrent catatonia could be a precursor of severe major depressive episodes. This case highlights the importance of identifying catatonia in the elderly, brings awareness to the multiple etiologies to be considered when catatonia arises, including affective disorders, and the potential role of ECT in the management of recurrent catatonia. Further studies are needed regarding the prognosis of recurrent catatonia in the geriatric population. <h3>This research was funded by</h3> None

A prospective descriptive study on prevalence of catatonia and correlates in an acute mental health unit in Nelson Mandela Bay, South Africa.

Catatonia is a psychomotor abnormality caused by neurological, medical or severe psychiatric disorders and substances. Its prevalence ranges from less than 10% to just above 60%. Diagnosis may be influenced by the screening tools used. Screening of new admissions to a mental health unit for catatonia was undertaken using three instruments to determine prevalence of catatonia. Participants ranged from age 16 years and over. Recruitment took place from September 2020 to August 2021. The setting was a mental health unit within a general hospital in Nelson Mandela Metro, South Africa. Five assessors were trained by the principal investigator to apply the Bush Francis Screening Instrument (BFCSI), the Bush Francis Catatonia Rating Scale (BFCRS), and the Diagnostic and Statistical Manual 5 (DSM-5), to assess participants. Clinical and demographic data were collected using a specially designed datasheet. Data analysis was performed to identify significant associations between presence or absence of catatonia and clinical and demographic data. Up to 241 participants were screened and 44 (18.3%) had catatonia. All 44 cases were identified through the BFCSI while the DSM-5 identified only 16 (6.6%%) of the 44 cases even though the remaining 28 (63.6%) participants still required treatment for catatonic symptoms. The DSM-5 diagnostic criteria excluded staring, which was the commonest sign of catatonia identified through the BFCSI [n = 33 (75%)]. Close to half (21; 47.7%) of those with catatonia on the BFCSI had schizophrenia. The rest had bipolar disorder (12; 27.3%), substance-induced psychotic disorder (7; 15.9%) and no specified diagnosis in one (1; 2.6%). The BFCSI was very effective at identifying catatonia while the DSM-5 was inadequate, missing close to 64% (28 of 44) of cases. Predictors of catatonia in this sample were a younger age and being male. A prevalence of 18.3%, indicates that assessment for catatonia should be routinely conducted in this and similar settings.

Advanced Age Is Associated With Catatonia in Critical Illness: Results From the Delirium and Catatonia Prospective Cohort Investigation.

Introduction: Catatonia, characterized by motor, behavioral and affective abnormalities, frequently co-occurs with delirium during critical illness. Advanced age is a known risk factor for development of delirium. However, the association between age and catatonia has not been described. We aim to describe the occurrence of catatonia, delirium, and coma by age group in a critically ill, adult population.Design: Convenience cohort, nested within two clinical trials and two observational cohort studies.Setting: Intensive care units in an academic medical center in Nashville, TN.Patients: 378 critically ill adult patients on mechanical ventilation and/or vasopressors.Measurements and Main Results: Patients were assessed for catatonia, delirium, and coma by independent and blinded personnel, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method for the Intensive Care Unit (ICU) and the Richmond Agitation and Sedation Scale. Of 378 patients, 23% met diagnostic criteria for catatonia, 66% experienced delirium, and 52% experienced coma during the period of observation. There was no relationship found between age and catatonia severity or age and presence of specific catatonia items. The prevalence of catatonia was strongly associated with age in the setting of critical illness (p < 0.05). Delirium and comas' association with age was limited to the setting of catatonia.Conclusion: Given the significant relationship between age and catatonia independent of coma and delirium status, these data demonstrate catatonia's association with advanced age in the setting of critical illness. Future studies can explore the causative factors for this association and further elucidate the risk factors for acute brain dysfunction across the age spectrum.

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.

Brain Injury in Critical Illness and a Note on the Virus

Brain Injury in Critical Illness and a Note on the Virus

Protocol for a prospective descriptive prevalence study of catatonia in an acute mental health unit in urban South Africa

IntroductionCatatonia arises from serious mental, medical, neurological or toxic conditions. The prevalence range depends on the setting and the range is anything from 7% to 63% in other countries. South...

Psychiatric autoimmune conditions in children and adolescents: Is catatonia a severity marker?

ObjectivesPatients with autoimmune encephalitis (AE) are likely to exhibit an acute onset of severe psychiatric features, including psychosis and/or catatonia. Based on the high prevalence of catatonia in AE and our clinical experience, we hypothesized that catatonia might be a marker of severity requiring more aggressive treatment approaches. MethodsTo reach a sufficient number of cases with brain-autoimmune conditions, we pooled two samples (N = 58): the first from the French National Network of Rare Psychiatric diseases and the second from the largest Italian neuro-pediatrics center for encephalopathies. Autoimmune conditions were diagnosed using a multidisciplinary approach and numerous paraclinical investigations. We retrospectively compared patients with and without catatonia for psychiatric and non-psychiatric clinical features, biological and imaging assessments, type of immunotherapy used and outcomes. ResultsThe sample included 25 patients (43%) with catatonia and 33 (57%) without catatonia. Forty-two patients (72.4%) had a definite AE (including 27 anti-NMDA receptor encephalitis) and 16 (27.6%) suspected autoimmune encephalitis. Patients with catatonia showed significantly more psychotic features [18 (72%) vs 9 (27.3%), p < 0.001)] and more movement disorders [25 (100%) vs 20 (60.6%), p < 0.001] than patients without catatonia. First line (corticoids, immunoglobulin and plasma exchanges) and second line (e.g., rituximab) therapies were more effective in patients with catatonia, with 24 (96%) vs 22 (66.7%) (p = 0.006) and 17 (68%) vs 9 (27.3%) (p = 0.002), respectively. However, those with catatonia received more combinations of first and second line treatments and had more relapses during outcomes. ConclusionDespite its exploratory design, the study supports the idea that autoimmune catatonia may be a marker of severity and morbidity in terms of initial presentation and relapses, requiring the need for early and aggressive treatment.

Diagnosing catatonia and its dimensions: Cluster analysis and factor solution using the Bush Francis Catatonia Rating Scale (BFCRS).

Advances in research into catatonia in the preceding two decades has offered increasing clarity and an improved understanding of various aspects of this complex syndrome. Despite the above, there are several aspects that hinder a broader interpretation of these findings, the most common being a lack of consensus on the criteria required for diagnosing catatonia. Whilst being the most frequently used tool for diagnosis, the number of signs from Bush-Francis Catatonia Rating Scale (BFCRS) needed to diagnose catatonia remain unclear. This study aimed to determine the number of signs required to accurately diagnose catatonia using BFCRS and delineate its dimensions in an acute inpatient unit in the Indian setting. A random sample of 300 patients were evaluated for catatonia within 24 h of admission. Cluster Analysis followed by discriminant analysis and receiver operating curve analysis (ROC) provided cut-off values for diagnosing catatonia syndrome. Principle Component Analysis (PCA) with varimax rotation was used to identify factors in those with catatonia. Findings revealed that a cut off of two signs from both Bush-Francis Catatonia Screening Instrument or BFCSI (sensitivity of 100 %, specificity of 96.2 % as well as a positive predictive value [PPV] of 79.6 % and negative predictive value [NPV] 100 % with ROC AUC value of 0.98) and complete BFCRS (sensitivity of 100 % and specificity of 90.7 %, PPV of 80.7 and NPV of 100 % with ROC AUC for at least two items cut-off being 0.95) accurately detected catatonia. However, the prevalence of catatonia in the same population increased by 4% from 16.3% to 20.3% using the BFCRS rather than the BFCSI. The BFCRS generated a 3-factor model accounting for 65.48 % variance offering the best fit, indicating three discrete dimensions to catatonia, namely retarded, excited and what we named as "aberrant volitional". Interestingly, the aberrant volitional dimension comprises of signs that need to be elicited rather than passively observed and excluding one, none of them are part of the BFCSI. Findings of this study suggest that the BFCRS more accurately detects catatonia rather than the BFCSI. Additionally, three dimensions of catatonia more coherently explain the catatonic syndrome given that 55.7 % of the sample had signs from more than one factor concurrently. We propose that the BFCRS rather than BFCSI be routinely administered for evaluating all suspected cases of catatonia to ensure more accurate detection as well as identifying the aberrant volitional dimensional signs more consistently. The three-dimensional model also offers great opportunities to further unravel the pathophysiological basis of catatonic signs more systematically.

Prevalence of catatonic signs and symptoms in an acute psychiatric unit from a tertiary psychiatric center in India.

The prevalence of catatonia varies with the setting and type of rating scale used to measure catatonia. Catatonia, initially subsumed under schizophrenia, now is increasingly recognized in association with affective disorders. We aimed to examine the prevalence of catatonia in an acute psychiatric inpatient unit in a tertiary center in India. Study subjects (n = 300) were randomly selected from amongst the inpatients over one year and evaluated within 24 h of admission using BFCRS and NCS, besides a sociodemographic and clinical proforma. During the inpatient stay MINI PLUS 5.0 was applied. Among 300 inpatients recruited, 88 (29.3%) demonstrated at least one catatonic sign in either of the rating scales. As per the diagnostic cut-offs defined by BFCRS and NCS, the prevalence of catatonia syndrome was 49 (16.3%) and 32 (10.6%) respectively. The prevalence rates as per ICD-10 criteria and DSM-5 criteria were 19% and 5.3% respectively. The two most frequently noted signs - staring and withdrawal, were not listed as signs in either the ICD-10 or DSM V. The prevalence of catatonic symptoms was different in psychotic disorders in contrast to affective disorders. Severity of catatonia was associated with younger age, lesser duration of primary illness and prior episodes of catatonia. The prevalence of catatonia varies from 5.3% to 19% based on the criteria used. Identification warrants use of structured instruments. Catatonia is more severe in the initial years of illness, those with prior episodes of catatonia and in the younger age group.

Prevalence of Catatonia and Its Moderators in Clinical Samples: Results from a Meta-analysis and Meta-regression Analysis.

Catatonia is an independent syndrome that co-occurs with several mental and medical conditions. We performed a systematic literature review in PubMed/Scopus until February 2017 and meta-analyzed studies reporting catatonia prevalence. Across 74 studies (cross-sectional = 32, longitudinal = 26, retrospective = 16) providing data collected from 1935 to 2017 across all continents, mean catatonia prevalence was 9.0% (k = 80, n = 110764; 95% CI = 6.9-11.7, I2 = 98%, publication bias P < .01), decreasing to 7.8% (k = 19, n = 7612, 95% CI = 7-8.7, I2 = 38.9%) in a subgroup with low heterogeneity. Catatonia prevalence was 23.9% (k = 8, n = 1168, 95% CI = 10-46.9, I2 = 96%) in patients undergoing ECT/having elevated creatinine phosphokinase. Excluding ECT samples, the catatonia prevalence was 8.1% (k = 72, n = 109606, 95% CI = 6.1-10.5, I2 = 98%, publication bias P < .01), with sensitivity analyses demonstrating that country of study origin (P < .001), treatment setting (P = .003), main underlying condition (P < .001), and sample size (P < .001)moderated catatonia prevalence, being highest in Uganda (48.5%, k = 1) and lowest in Mexico (1.9%, 95% CI = 0.4-8.8, I2 = 67%, k = 2), highest in nonpsychiatric out- or inpatient services (15.8%, 95% CI = 8.1-28.4, I2 = 97%, k = 15)and lowest in psychiatric outpatients services (3.2%, 95% CI = 1.7-6.1, I2 = 50%, k = 3), highest in presence of medical or neurological illness with no comorbid psychiatric condition (20.6%, 95% CI = 11.5-34.2, I2 = 95%, k = 10)and lowest in mixed psychiatric samples (5.7%, 95% CI = 4.2-7.7, I2 =98%, k = 43), highest in studies with sample sizes <100 (20.7%, 95% CI = 12.8-31.6, I2 = 90%, k = 17) and lowest in studies with sample sizes >1000 (2.3%, 95% CI = 1.3-3.9, I2 = 99%, k = 16). Meta-regression showed that smaller sample size (P < .01) and less major depressive disorder (P = .02) moderated higher catatonia prevalence. Year of data collection did not significantly moderate the results. Results from this first meta-analysis of catatonia frequencies across time and disorders suggest that catatonia is an epidemiologically and clinically relevant condition that occurs throughout several mental and medical conditions, whose prevalence has not decreased over time and does not seem to depend on different rating scales/criteria. However, results were highly heterogeneous, calling for a cautious interpretation.

Catatonia in an inpatient gerontopsychiatric population

There are limited data on the prevalence of catatonia in the elderly. The aim of this study was to determine the prevalence of catatonia in elderly patients (=/> 65 years) acutely admitted to the psychiatric unit of a general hospital. All patients aged 65 years and above admitted to a general hospital psychiatric unit over a 4-month period were screened for catatonia with the 14-item Bush-Francis Catatonia Screening Instrument (BFCSI). Patients with a minimum of 2 symptoms on the BFCSI were rated with the 23-item Bush-Francis Catatonia Rating Scale (BFCRS). Catatonia was simultaneously evaluated according to DSM-5 criteria. Clinical diagnoses were established using the validated Hungarian versions of the Structured Clinical Interview for DSM-IV Disorders, the Mini Mental State Examination and the Clock Drawing Test. Ninety-eight (28.1%) of the 342 patients admitted to the psychiatric unit during the study period were above 65 years of age; 11 (11.22%) and 6 (6.12%) patients were classified as having catatonia according to the BFCRS and DSM-5 criteria, respectively. The majority of the patients had catatonia due to a medical condition. A significant minority of gerontopsychiatric inpatients present with catatonia. Dementia was not a risk factor for catatonia.

Prevalence and characteristics of catatonia on admission to an acute geriatric psychiatry ward

BackgroundThis study aims to describe the prevalence of catatonia in a population of older acute psychiatric inpatients according to different diagnostic criteria. Secondary objectives are: to compare the catatonic symptom profile, prevalence, and severity, in respect to the underlying aetiology, and to evaluate the association between catatonic and somatic comorbidity. MethodsThe study included 106 patients admitted to an acute geriatric psychiatry ward. Catatonia was assessed using the Bush Francis Catatonia Rating Scale (BFCRS). ResultsCatatonia was highly prevalent (n=42; 39.6%), even when using restrictive diagnostic criteria: Fink and Taylor (n=19; 17.9%) and DSM 5 (n=22; 20.8%). Depression was the most frequent psychiatric syndrome among catatonic patients (n=18; 42.8%). Catatonia was more frequent in depression (48.6%) and delirium (66.7%). Affective disorders showed a higher risk than psychotic disorders to develop catatonia (OR=2.68; 95% CI 1.09–6.61). This association was not statistically significant when controlling for dementia and geriatric syndromes. The most prevalent catatonic signs were excitement (64.3%), verbigeration (61.9%), negativism (59.5%), immobility/stupor (57.1%), and staring (52.4%). ConclusionsCatatonia in older psychiatric inpatients was highly prevalent. Depression was the most common psychiatric syndrome among catatonic patients, and catatonia was more frequent in depression and mania, as well as in delirium. Affective disorders were associated with a higher risk of developing catatonia compared to psychotic disorders. Somatic and cognitive comorbidity played a crucial aetiological role in catatonia in this series.

P282 Repetitive Transcranial Magnetic Stimulation (rTMS) improves catatonia features associated with Major Depressive Disorder (MDD): Case study

Objective To investigate the possible effect of rTMS in improving catatonic features associated with MDD. Case study A 17 year old male patient with the diagnosis of MDD (DSM-IV 296.20) with catatonic features (motoric immobility, evidenced by stupor, negativism, mutism and posturing), was referred to our lab for assessment. The family stated that the patient stopping eating (losing 8 kg), drinking, talking plus sleep disturbances and assumption of certain postures for hours for a duration of 8 days. 2 protocols were done every session: (a) 30 pps,100 pulse/train, 20 trains, 2 s inter train interval, intensity 10%, With total number of pulses 2000 each using stroke method over the scalp. followed by (b) 5 pps, 100 pulse/train, 20 trains, 20 s inter train interval, intensity 45% with total number of pulses 2,000 over the LDPFC (F3) for 5 consecutive sessions for 2 weeks. TMS machine used was MagVenture Pro 30, with coil Type: 125. Results drastic and rapid improvement after the first rTMS session as the patient was able to eat, drink few glasses of water, and sleep better but with no initial improvement on verbal and nonverbal communication. These improvements were sustained with enhancement of nonverbal and verbal communications by the 10th session. All through the course of treatment, we did not report any side effects from the rTMS. Conclusions Catatonia is not an uncommon feature observed in psychiatric patients. Reports estimated that there are 90,000 cases of catatonia occur each year in US hospitals. These reports also stated that the prevalence of catatonia ranges from 7.6% to 38% in psychiatric patients with more than half of the patients with an underlying bipolar affective disorder without clear demarcation of the type of bipolar affective disorder. Yet there were reports that about 20% of depressed patients met the criteria of catatonia. Benzodiazepines and Electro-compulsive Therapy (ECT) have been used to treatment of catatonia. In our current case, rTMS, which is a relatively safe and non-invasive technique with minimal cognitive distorting effects as compared to standard current therapies, improved catatonic features without side effects. Further researches are needed to confirm our results and test its long term effect.