Catatonia in the medically ill: Differences and parallels in etiology, phenomenology and management

Author:

Espi Forcen Fernando1ORCID,Respino Matteo1,Eloge Joshua1,Baldwin Meghan1,Burns Katrina1,Patron Victor2,Hebert Charles1

Affiliation:

1. Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA

2. Department of Psychiatry, University of Chicago, Chicago, IL, USA

Abstract

Objective Catatonia is a disorder characterized by psychomotor symptoms. The etiology, symptomatology, response and outcome of catatonia in the medically ill has not been vigorously studied. Those who have catatonia associated with another mental disorder versus. catatonic disorder due to another medical condition may differ. The aim of this study is to study the causes, phenomenology and outcomes of medically ill patients with catatonia and explore differences among those who have catatonia associated with psychiatric illness vs. systemic medical illness. Method We studied the incidence of catatonic symptoms in medically hospitalized patients to identify any apparent differences in clinical manifestations due to distinctive etiologies. Specifically, we assessed if there are differences between those who had catatonia associated with another mental disorder versus those with catatonic disorder due to another medical condition in their phenomenology, management and likelihood of response to treatment. Results Of our 40 patients, 18 patients (45%) had catatonia associated with another mental disorder, 17 (42.5%) had catatonic disorder due to another medical condition, and in 5 patients (12.5%) the cause of catatonia was not identified. The most common catatonic symptoms regardless of etiology in our medically ill were mutism, followed by rigidity, and immobility. Bipolar disorder, schizophrenia, major depressive disorder, metabolic abnormalities, anti NMDAR encephalitis were the most frequent causes of catatonia in our medically ill patients. Compared to subjects with catatonic disorder due to another medical condition, those with catatonia associated with another mental disorder had more frequent mannerisms (Chi-square = 4.27; p = 0.039), waxy flexibility (Chi-square = 11.0; p < 0.01), and impulsivity (Chi-square = 4.12, p = 0.042). Nonsignificant trends were noted for posturing (Chi-square = 3.74, p = 0.053), perseveration (Chi-square = 3.37, p = 0.067), and stereotypy (Chi-square = 2.91, p = 0.088) also being more frequent in catatonia associated with a psychiatric cause. Discussion Our data supports phenomenological differences between medical and psychiatric causes of catatonia in the medically ill.

Publisher

SAGE Publications

Subject

Psychiatry and Mental health

Reference18 articles.

1. Systematic review of catatonia treatment

2. Catatonia Under-Diagnosis in the General Hospital

3. Catatonia as an internal medicine disease: infrequent or still underdiagnosed?

4. Fink M, Taylor MA. Catatonia: A clinician’s guide to diagnoses and treatment. 2nd ed. Cambridge: Cambridge University Press, 2006, pp. 1–18.

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