Catatonia: Becoming Increasingly Recognized

CatatoniaCatatonia is becoming increasingly recognized, pulling electroconvulsive therapy (ECT) into the spotlight with it.[1] Twenty years ago, one might have said that catatonia was no longer, with the exception of the rare patient with catatonic subtype of schizophrenia.1 However, today it is right back in the front and center, showing up in emergency departments, hospitals, and academic reports.1 It has even been updated in the DSM-5.1

What is catatonia? It is a syndrome of disturbed motor, mood, and systemic signs, including rigidity, immobility, mutism, staring, posturing, waxy flexibility, and the imitation of others’ actions or vocalizations.1 Oftentimes, it is accompanied by autonomic disturbances and fever.1 Catatonia can occur across the entire age spectrum, and severe forms may be fatal.1

Catatonia was previously considered to be associated almost exclusively with schizophrenia; however, it is now known to commonly occur in the context of mood disorders, medically ill patients, and children with severe forms of autism.1 In fact, the DSM-5 accepts catatonia as a specifier of 10 psychiatric diagnoses.1 Still, scholars believe it should be given its own independent status with a single numeric code.1

There have also been a significant influx of new publications on catatonia.1 On PubMed, more than 150 of the near 2,500 total citations for “catatonia” have been added since the beginning of 2012.1 Some of the publications address the description and treatment of catatonia in children, and hypothesize self-injurious behavior to be an analogue of the repetitive motor behaviors seen in adults with catatonia.1

Unfortunately, children with autistic catatonia are often critically ill.1 Their self-injurious behavior can be life-threatening and can make it impossible for them to be cared for by their families at home.1 They are often treated with every known behavioral and pharmacological intervention known, with limited success and high adverse-effects.1

However, the renewed recognition of catatonia has led to the clarification of appropriate treatments.1 Benzodiazepines are key to diagnosis and initial treatment of the syndrome, as many may respond to this group of medicines.1 However, proper medical management of any other associated illness is also extremely important.1

On the other hand, ECT has been widely recognized as the definitive treatment for catatonia for a long time.1 However, as the syndrome used to be so rare, this treatment was never so much more than an afterthought.1 Patients with catatonia respond dramatically well to ECT.1 Many can return to normal functioning, behavior, and health.1 A recent report suggests that right unilateral electrode placement of ECT may be extremely effective and better-tolerated, but for urgently ill patients, the more potent forms of ECT must still be used.1

It is great that catatonia is requesting attention, especially for the patients that suffer from this uncommon, yet not rare, clinical entity.1 More studies will no doubt be conducted to improve treatment and outcomes for all who suffer from the syndrome.

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