Management of Catatonia at Bernese Jura Hospital, Mental Health Pole in Bellelay, Switzerland
Abstract
Makenga Bof Jean Claude, Biyong Issack, Bugnon Carine, Karamalla Akram, Masse Benjamin and Lucchelli Juan Pablo
Background: Catatonia is a neurogenic motor and behavioral syndrome characterized by a range of physical manifestations, from profound immobility to excessive motor activity. It is often associated with stupor and other behavioral abnormalities.
Objective: This study aimed to determine the prevalence of catatonia signs, evaluate the treatment methods used, and identify predictive factors for catatonia in affected patients.
Methods: This retrospective, descriptive, and analytical study included all patients diagnosed with catatonia based on DSM-5 criteria and treated at the Bernese Jura Hospital, Mental Health Center, between January 1, 2017, and December 31, 2020. Data were collected from medical records, and statistical analysis was performed using STATA version 16 software.
Results: A total of 27 patients with a median age of 59 years [49; 72] were included in the study. Excited catatonia was observed in 74.1% of patients, while delayed catatonia was present in 25.9%. Half of the patients were over 60 years of age. The most prominent catatonia signs included grimacing (85%), mannerisms (77%), stereotypy (66%), and severe psychomotor agitation (51%). The primary reasons for hospitalization were depression (41%), encephalitis or autoimmune disorders (33%), and metabolic disorders such as hyponatremia (11%). The most frequently used treatments were lorazepam (44%), diazepam (33%), and zolpidem (11%). Discharge diagnoses were predominantly bipolar I disorder (85%), other acute psychotic disorders with delusional features (81.5%), and unipolar major depressive disorder (29.6%).
Patients with excited catatonia predominantly exhibited three or more DSM-5 criteria. Remission of catatonia signs occurred within 24 hours for 75% of patients treated with lorazepam. Oxazepam achieved 100% remission in patients with excited catatonia. Lorazepam, zolpidem, and diazepam were effective for both types of catatonia, with 25% efficacy in delayed catatonia and 75% in excited catatonia. The risk of developing catatonia was 14 times higher in patients aged 40 and older, 7 times higher in men, and 2 times higher in patients who had taken antipsychotics for more than 24 hours.
Conclusion: This study highlights that long-term antipsychotic use can induce catatonia. The primary therapeutic approach remains the rapid administration of lorazepam. Severe psychomotor agitation, combined with other typical signs, confirms excited catatonia. Zolpidem is a viable alternative after the failure of other benzodiazepines, and electroconvulsive therapy should be considered for patients unresponsive to benzodiazepines or those with malignant features.