Journal Article Annotations
2016, 3rd Quarter

Catatonia

Annotations by Lex Denysenko, MD, FAPM
October 2016

Prevalence and symptomatology of catatonia in elderly patients referred to a consultation-liaison psychiatry service
The diagnostic criteria and structure of catatonia

Also of interest:

Fink M, Kellner CH, McCall WV: Optimizing ECT technique in treating catatonia
J ECT 2016; 32(3):149-150

The authors make the point that many practitioners, concerned about minimizing cognitive side effects of ECT in patients with recalcitrant depression, may error by weakening the electrical dose, making the treatment less effective in patients with catatonia. In cases of malignant or life-threatening catatonia, the authors recommend pre-treatment with flumazenil if patients are on heavy doses of benzodiazepines, daily ECT treatments with bitemporal electrode placement, and age-based suprathreshold dosing. Treatment should continue until catatonia lyses and the patient returns to precatatonic baseline.
Relevance: Malignant catatonia is a potentially lethal condition, wherein the benefit outweighs the risk of cognitive adverse effects. In contrast to a recent case series of 13 catatonic patients treated effectively with ultrabrief right unilateral lead placement that was referenced in the original monograph (PMID: 25243751) the authors of this editorial rely on their lifetime of clinical experience to recommend a treatment approach that maximizes chances of success
Javelot H, Michel B, Steiner R, Javelot T, Cottencin O: Zolpidem test and catatonia
J Clin Pharm Ther 2015; 40(6):699-701

Case report. The authors report on a complicated case of a patient with paranoid schizophrenia as well as catatonia recalcitrant to lorazepam and antipsychotics that best responded to the addition of zolpidem 10mg TID during three separate catatonic episodes.
Relevance: Zolpidem, which unlike benzodiazepines does not depress respiratory drive, may be an effective adjunctive treatment in recalcitrant cases of catatonia

PUBLICATION #1 — Catatonia

Prevalence and symptomatology of catatonia in elderly patients referred to a consultation-liaison psychiatry service

Kaelle J, Abujam A, Ediriweera H, Macfarlane MD
Australas Psychiatry 2016; 24(2):164-167.

Annotation

The finding: Prevalence of catatonia in the C-L setting in patients over the age of 65 was 6 in 108 patients (5.5%). Rigidity and immobility were the most common symptoms. Most had delirium as well as catatonia. The authors conclude that it was unclear if use of the Bush Francis Catatonia Screening instrument was successful in capturing any additional cases of catatonia that would not have been identified by standard routine psychiatric interview and examination.

Strength: Prospective study across 6 hospitals in a 6 month period.
Weaknesses: Subjects were consented, and 45 were unable to be consented, which may have affected results of the study. It is unclear who performed the catatonia screenings, how they were trained, and how cases of catatonia were confirmed. It is unclear if the subjects filled DSM-5 criteria for catatonia, or if their symptoms could be better explained by another disorder (example: Parkinson’s Plus syndrome, stroke).

Relevance: Catatonia in the elderly population has been estimated to be higher in prevalence than in all age adults in at least one prior study, and this prospective study supports this. Delirium and catatonia were both present in 50% of the subjects. A better/easier screening instrument for detecting catatonia in the general medical setting is needed.

PUBLICATION #2 — Catatonia

The diagnostic criteria and structure of catatonia

Wilson JE, Niu K, Nicolson SE, Levine SZ, Heckers S
Schizophr Res 2015; 164(1-3):256-262

Annotation

The finding: This study shows the Bush Francis Catatonia Rating Scale loses reliability when severity of catatonia was low. It proved difficult to reduce the symptoms to three factors and still maintain reliability, with 63% of the variance unexplained.

Strengths: Largest sample size yet for such a study. Study included subjects from variety of settings (inpatient, outpatient, and C-L settings). Included a large subset of patients with validated catatonia by treatment response. First study to use item response theory to estimate each element of catatonia scale in terms of utility and reliability.
Weaknesses: Sample size may still be too small to generate conclusive or generalizable results.

Relevance: This study supports a conclusion that further work on creating a more improved rating or screening instrument for catatonia in all settings is necessary. Further exploration of the core components of catatonia has yet to be fully discovered.