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| ====== Catatonia ====== | ====== Catatonia ====== | ||
| + | {{INLINETOC}} | ||
| ===== Primer ===== | ===== Primer ===== | ||
| **Catatonia** is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. | **Catatonia** is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. | ||
| ====Prevalence==== | ====Prevalence==== | ||
| - | Catatonia is typically diagnosed in an inpatient setting and can occur in up to 35% of individuals with schizophrenia. However, the //majority// of catatonia involve patients with depressive or bipolar disorders. | + | Catatonia is typically diagnosed in an inpatient setting and can occur in up to 35% of individuals with schizophrenia. Historically, catatonia was attributed most commonly to psychotic disorders. However, the //majority// of catatonia involve patients with depressive or bipolar disorders. Neurodevelopmental disorders (e.g. - autism) are also common, and up to 10% of individuals with autism spectrum disorders can experience catatonia. [([[https://pubmed.ncbi.nlm.nih.gov/10827884/|Wing, L., & Shah, A. (2000). Catatonia in autistic spectrum disorders. The British Journal of Psychiatry, 176(4), 357-362.]])] Finally, catatonia can be caused by a variety of medical conditions including [[cl:0-autoimmune-encephalitis|encephalitis]], [[cl:systemic-lupus-erythematosus|lupus]], and [[cl:tbi|traumatic brain injuries]]. |
| + | ===== Screening and Rating Scales ===== | ||
| + | <panel title="Psychometric Scales for Depression" no-body="true"> | ||
| + | ^ Name ^ Rater ^ Description ^ Download ^ | ||
| + | ^ Bush-Francis Catatonia Rating Scale (BFCRS) | Patient | The screening section marks items #1-14 as either "absent" or "present." The full scale rates items #1-23 on a scale of 0-3. The ratings are made based on the observed behaviors during the examination, with the exception of completing the items for "withdrawal" and "autonomic abnormality," which may be based upon either observed behaviours and/or chart documentation. Rate items only if well defined. If uncertain, rate the item as "0". [([https://pubmed.ncbi.nlm.nih.gov/8686483/|Bush, G., Fink, M., Petrides, G., Dowling, F., & Francis, A. (1996). Catatonia. I. Rating scale and standardized examination. Acta Psychiatrica Scandinavica, 93(2), 129-136.)])] | {{ :psychosis:bush-francis_catatonia_rating_scale.pdf|Download BFCRS}} | | ||
| + | </panel> | ||
| + | ==== Signs ==== | ||
| + | Patients can have various clusters of signs and symptoms including decreased psychomotor activity (mute, staring, immobile), abnormal motor movements (grasp, echolalia phenomena, rigidity) or increased psychomotor activity (agitation, impulsivity, combativeness). Catatonia can also be periodic with episodes of relapse and remission, with mild residual symptoms. | ||
| ===== Pathophysiology ===== | ===== Pathophysiology ===== | ||
| A variety of medical conditions may cause catatonia, especially neurological conditions (e.g., neoplasms, head trauma, cerebrovascular disease, encephalitis) and metabolic conditions (e.g., hypercalcemia, hepatic encephalopathy, homocystinuria, diabetic ketoacidosis). The associated physical examination findings, laboratory findings, and patterns of prevalence and onset reflect those of the etiological medical condition. | A variety of medical conditions may cause catatonia, especially neurological conditions (e.g., neoplasms, head trauma, cerebrovascular disease, encephalitis) and metabolic conditions (e.g., hypercalcemia, hepatic encephalopathy, homocystinuria, diabetic ketoacidosis). The associated physical examination findings, laboratory findings, and patterns of prevalence and onset reflect those of the etiological medical condition. | ||
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| ==Criterion A== | ==Criterion A== | ||
| The clinical picture is dominated by at least ''3'' of the following symptoms: | The clinical picture is dominated by at least ''3'' of the following symptoms: | ||
| - | - Stupor (i.e., no psychomotor activity; not actively relating to environment) | + | - **Stupor** (i.e. - no psychomotor activity; not actively relating to environment) |
| - | - Catalepsy (i.e., passive induction of a posture held against gravity) | + | - **Catalepsy** (i.e. - passive induction of a posture held against gravity) |
| - | - Waxy flexibility (i.e., slight, even resistance to positioning by examiner) | + | - **Waxy flexibility** (i.e. - slight, even resistance to positioning by examiner) |
| - | - Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]) | + | - **Mutism** (i.e. - no, or very little, verbal response [exclude if known aphasia]) |
| - | - Negativism (i.e., opposition or no response to instructions or external stimuli) | + | - **Negativism** (i.e. - opposition or no response to instructions or external stimuli) |
| - | - Posturing (i.e., spontaneous and active maintenance of a posture against gravity) | + | - **Posturing** (i.e. - spontaneous and active maintenance of a posture against gravity) |
| - | - Mannerism (i.e., odd, circumstantial caricature of normal actions) | + | - **Mannerism** (i.e. - odd, circumstantial caricature of normal actions) |
| - | - Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements) | + | - **Stereotypy** (i.e. - repetitive, abnormally frequent, non-goal-directed movements) |
| - | - Agitation, not influenced by external stimuli | + | - **Agitation** (not influenced by external stimuli) |
| - | - Grimacing | + | - **Grimacing** |
| - | - Echolalia (i.e., mimicking another’s speech) | + | - **Echolalia** (i.e. - mimicking another’s speech) |
| - | - Echopraxia (i.e., mimicking another’s movements) | + | - **Echopraxia** (i.e. - mimicking another’s movements) |
| </WRAP> | </WRAP> | ||
| <WRAP half column> | <WRAP half column> | ||
| - | <callout>Criterion A, B, C, D, and E must ALL be met to have a diagnosis of **Catatonic Disorder Due to Another Medical Condition**</callout> | + | <callout>Criterion A, B, C, D, and E must **ALL** be met to have a diagnosis of **Catatonic Disorder Due to Another Medical Condition**</callout> |
| ==Criterion B== | ==Criterion B== | ||
| There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. | There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. | ||
| ==Criterion C== | ==Criterion C== | ||
| - | The disturbance is not better explained by another mental disorder (e.g.,a manic episode). | + | The disturbance is not better explained by another mental disorder (e.g. - a manic episode). |
| ==Criterion D== | ==Criterion D== | ||
| The disturbance does not occur exclusively during the course of a delirium. | The disturbance does not occur exclusively during the course of a delirium. | ||
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| - | ===== Screening and Diagnosis ===== | ||
| - | Catatonic symptoms may be present in any of the following five psychotic disorders: brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, and substance/medication-induced psychotic disorder. It may also be present in some of the neurodevelopmental disorders, in all of the bipolar and depressive disorders, and in other mental disorders. | ||
| - | |||
| - | * Screening Tool: Use items 1-14 as "absent" or "present" | ||
| - | * Scale: Rate items 1-23 on a scale of 0-3 | ||
| - | * Ratings are made based on the observed behaviors during the examination, with the exception of completing the items for "withdrawal" and "autonomic abnormality," which may be based upon either observed behavior and/or chart documentation. Rate items only if well defined. If uncertain, rate the item as "0". [(http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.1996.tb09814.x/abstract)] | ||
| - | |||
| - | <button type="info" icon="fa fa-file">{{ :psychosis:bush-francis_catatonia_rating_scale.pdf |}}</button> | ||
| ===== Differential Diagnosis ===== | ===== Differential Diagnosis ===== | ||
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| * A separate diagnosis of catatonic disorder due to another medical condition is not given if the catatonia occurs exclusively during the course of a delirium or neuroleptic malignant syndrome. If the individual is currently taking neuroleptic medication, consideration should be given to medication-induced movement disorders (e.g., abnormal positioning may be due to neuroleptic-induced acute dystonia) or neuroleptic malignant syndrome (e.g., catatonic-like features may be present, along with associated vital sign and/or laboratory abnormalities). | * A separate diagnosis of catatonic disorder due to another medical condition is not given if the catatonia occurs exclusively during the course of a delirium or neuroleptic malignant syndrome. If the individual is currently taking neuroleptic medication, consideration should be given to medication-induced movement disorders (e.g., abnormal positioning may be due to neuroleptic-induced acute dystonia) or neuroleptic malignant syndrome (e.g., catatonic-like features may be present, along with associated vital sign and/or laboratory abnormalities). | ||
| + | ===== Malignant Catatonia ===== | ||
| ===== Treatment ===== | ===== Treatment ===== | ||
| Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines and electroconvulsive therapy.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260674/|Sienaert, P., Dhossche, D. M., Vancampfort, D., De Hert, M., & Gazdag, G. (2014). A clinical review of the treatment of catatonia. Frontiers in psychiatry, 5.]])] | Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines and electroconvulsive therapy.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260674/|Sienaert, P., Dhossche, D. M., Vancampfort, D., De Hert, M., & Gazdag, G. (2014). A clinical review of the treatment of catatonia. Frontiers in psychiatry, 5.]])] | ||
| + | |||
| + | ===== Prognosis ===== | ||
| + | Left untreated, patients with hypoactive or decreased psychomotor activity (the most common type of catatonia) can have impaired swallowing, dehydration, malnourishment, and aspiration. They are also at higher risk for sequelae from immobilization such as DVT, PE, contractures, pressure ulcers. | ||
| ===== Resources ===== | ===== Resources ===== | ||
| + | == Videos == | ||
| + | * [[https://youtu.be/_s1lzxHRO4U|YouTube: Catatonia]] | ||
| + | |||
| + | == For Providers == | ||
| + | * [[https://www.mdcalc.com/bush-francis-catatonia-rating-scale|MDCalc: Bush-Francis Catatonia Rating Scale]] | ||