BMC Psychiatry | |
Symptom profile and short term outcome of catatonia: an exploratory clinical study | |
Abebaw Fekadu1  Benyam Worku2  | |
[1] Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, King’s College London, London, UK;Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia | |
关键词: Ethiopia; Low and middle income country; Catatonia syndrome; Catatonia; | |
Others : 1221351 DOI : 10.1186/s12888-015-0554-2 |
|
received in 2014-11-17, accepted in 2015-07-14, 发布年份 2015 | |
【 摘 要 】
Background
Catatonia is a potentially life-threatening but treatable neuropsychiatric condition. Although considered more common in low income countries, data is particularly sparse in these settings. In this study we explore the symptomatology, treatment, and short-term outcome of catatonia in Ethiopia, a low income country.
Methods
The study was a prospective evaluation of patients admitted with a DSM-IV diagnosis of catatonia. Diagnosis of Catatonia and its severity were further assessed with the Bush-Francis Catatonia Rating Scale (BFCRS).
Results
Twenty participants, 5 male and 15 female, were included in the study: 15 patients (75 %) had underlying mood disorders, 4 patients (20 %) had schizophrenia and 1 patient (5 %) had general medical condition. The most common catatonic symptoms, occurring in over two-thirds of participants, were mutism, negativism, staring and immobility (stupor). Eighteen (90 %) of the twenty patients were on multiple medications. Antipsychotics were the most commonly prescribed medications. ECT was required in seven patients (35.0 %). Dehydration, requiring IV rehydration, and infections were the most important complications ascribed to the catatonia. These occurred in seven patients (25 %). Almost all patients (n = 19/20) were discharged with significant improvement.
Conclusion
This study supports the growing consensus that catatonia is most often associated with mood disorders. Overall prognosis appears very good although the occurrence of life-threatening complications underlines the serious nature of catatonia. This has implication for “task-shifted” service scale up plans, which aim to improve treatment coverage by training non-specialist health workers to provide mental health care in low income countries. Further larger scale studies are required to clarify the nature and management, as well as, service requirements for catatonia.
【 授权许可】
2015 Worku and Fekadu.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150730031031968.pdf | 645KB | download | |
Fig. 2. | 36KB | Image | download |
Fig. 1. | 41KB | Image | download |
【 图 表 】
Fig. 1.
Fig. 2.
【 参考文献 】
- [1]Bush G, Fink M, Petrides G, Dowling F, Francis A: Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1999, 93:129-136.
- [2]Fink M, Taylor M: The many varieties of catatonia. Eur Arch Psychiatry ClinNeurosci 2001, 251:s8-13.
- [3]Taylor M, Fink M: Catatonia in psychiatric classification: a home of its own. Am J Psychiatr 2003, 160:1233-1241.
- [4]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th edition. APA, Washington, DC; 1994.
- [5]Fink M, Taylor M: Signs of Catatonia are Identifiable. In Catatonia: A Clinician’s Guide to Diagnosis and Treatment. Cambridge University Press, New York, NY; 2003:19-32.
- [6]Fricchione G, Bush G, Fozdar M, Francis A, Fink M: Recognition and treatment of the catatonic syndrome. J Intensive Care Med 1997, 12(3):135-147.
- [7]Barnes M, Saunders M, Walls T: The syndrome of Karl Ludwig Kahlbaum. J Neurol Neurosurg Psychiatry 1986, 49:991.
- [8]Stöber G: Genetics. In Catatonia: From Psychopathology to Neurobiology. Edited by Caroff S, Mann S, Francis A, Fricchione G. American Psychiatric Press, Washington, DC; 2004:173-188.
- [9]Northoff G: Neuroimaging and Neurophysiology. In Catatonia: From Psychopathology to Neurobiology. Edited by Caroff S, Mann S, Francis A, Fricchione G. American Psychiatric Press, Washington, DC; 2004:77-92.
- [10]Northoff G, Steinke R, Czcervenka C, Krause R, Ulrich S, Danos P, Kropf D, Otto H, Bogerts B, et al.: Decreased density of GABA-A receptors in the left sensorimotor cortex in akinetic catatonia: investigation of in vivo benzodiazepine receptor binding. J Neurol Neurosurg Psychiatry 1999, 67:445-451.
- [11]Northoff G, Krill W, Wenke J, Gille B. Major Differences in Subjective Experience of Akinetic States in Catatonic and Parkinsonian Patients. Cognitive neuropsychiatry 1998; 3:161-178.
- [12]Partl S, Pfuhlmann B, Jabs B: Stöber G: “My disease is one of the mind and difficult to define”: Robert Walser (1879–1956) and his mental illness. Nervenarzt 2011, 82(1):67-78.
- [13]Rosebush P, Hildebrand A, Furlong B, Mazurek M: Catatonic syndrome on a general psychiatric ward: frequency, clinical presentation and response to lorazepam. J Clin Psychiatr 1990, 51:357-362.
- [14]Johnson J: Catatonia: The tension insanity. Br J Psychiatr 1993, 162:733-738.
- [15]Kahlbaum K-L: Catatonia or Tonic Insanity. In Anthology of German Psychiatric Texts. Edited by Sass H. World Psychiatric Association, Ulm, Germany; 2007:106-124.
- [16]Fink M: Rediscovering catatonia, the biography of a treatable syndrome. Acta Psychiatr Scand 2012, 127(Suppl. 441):1-47.
- [17]Fink M, Shorter E, Taylor M: Catatonia is not schizophrenia: Kraepelin’s error and the need to recognize catatonia as an independent syndrome in medical nomenclature. Schizophr Bull 2010, 36(2):314-320.
- [18]Rosebush P, Mazurek M: Catatonia and Its Treatment. Schizophr Bull 2010, 36(2):239-242.
- [19]Ungvari G, Caroff S, Gerevich J: The catatonia conundrum: evidence of psychomotor phenomena as a symptom dimension in psychotic disorders. Schizophr Bull 2010, 36(2):231-238.
- [20]Caroff S, Mann S, Campbell E, Sullivan K: Epidemiology. In Catatonia: from Psychopathology to Neurobiology. Edited by Caroff SN MS, Francis A, Fricchione GL. American Psychiatric Publishing, Washington, DC; 2004:15-31.
- [21]Morrison J: Catatonia: retarded and excited types. Arch Gen Psychiatry 1973, 28:39-41.
- [22]Hearst E, Munoz R, Tuason V: Catatonia: its diagnostic validity. Dis Nerv Syst 1971, 32:453-456.
- [23]Peralta V, Cuesta M: The relationship between syndromes of the psychotic illness and familial liability to schizophrenia and major mood disorders. Schizophr Res 2007, 91(1-3):200-9.
- [24]Usman D, Olubunmi O, Taiwo O: Comparison of catatonia presentation in patients with schizophrenia and mood disorders in Lagos, Nigeria. Iran J Psychiatry 2011, 6:7-11.
- [25]Thakur A, Jagadheesan K, Dutta S, Sinhar V: Incidence of catatonia in children and adolescents in a paediatric psychiatric clinic. Aust N Z J Psychiatry 2003, 37:200-203.
- [26]Leff J: Psychiatry Around the Globe. Royal College of Psychiatrists, London; 1988.
- [27]Morrison J: Changes in subtype diagnosis of schizophrenia: 1920–1966. Am J Psychiatry 1974, 131(6):674-7.
- [28]Francis A: Update on catatonia. Psychiatr Times 2006, 23:23-24.
- [29]Organization WH: The International Pilot Study of Schizophrenia. In. vol. 1. World Health Organization, Geneva; 1973.
- [30]Hutchinson G, Takei N, Sham P, Harvey I, Murray R: Factor analysis of symptoms in schizophrenia: differences between White and Caribbean patients in Camberwell. Psychol Med 1999, 29(3):607-12.
- [31]Chalasani P, Healy D, Morriss R: Presentation and frequency of catatonia in new admissions to two acute psychiatric admission units in India and Wales: Cross-cultural comparison of catatonia in new admissions. Psychol Med 2005, 35:1667-1675.
- [32]Ungvari G, Chiu HFK, Chow L, Lau B, Tang W: Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study. Psychopharmacology (Berl) 1999, 142:393-398.
- [33]Berardi D, Amore M, Keck P: Clinical and pharmacologic risk factors for neuroleptic malignant syndrome: a case–control study. Biol Psychiatry 1998, 44(8):748-54.
- [34]Carroll B. Catatonic stupor: diagnosis and treatment. Federal Practitioner 2001;18:48-54.
- [35]Paparrigopoulos T, Tzavellas E, Ferentinos P: Catatonia as a risk factor for the development of neuroleptic malignant syndrome: report of a case following treatment with clozapine. World J Biol Psychiatry 2009, 10(1):70-3.
- [36]Caroff S, Ungvari G, Bhati M, Datto C, O’Reardon J: Catatonia and prediction of response to electroconvulsive therapy. Psychiatr Ann 2007, 37(1):57-64.
- [37]Hawkins J, Archer K, Strakowski S, Keck PE. Somatic treatment of catatonia. Int J Psychiatry Med. 1995;25:345-369.
- [38]Levenson J, Pandurangi A: Prognosis and Complications. In Catatonia: From Psychopathology to Neurobiology. Edited by Caroff S, Mann S, Francis A, Fricchione G. American Psychiatric Publishing, Washington, DC; 2004:161-172.
- [39]Fekadu A, Desta M, Alem A, Prince M: A descriptive analysis of admissions to Amanuel Psychiatric Hospital in Ethiopia. Ethiop J Health Dev 2007, 21:173-178.
- [40]Rajagopal S: Catatonia. Adv Psychiatr Treat 2007, 13:51-59.
- [41]Abrams R, Taylor M: Catatonia: a prospective clinical study. Arch Gen Psychiatry 1976, 33:579-581.
- [42]Daniels J: Catatonia: Clinical aspects and neurobiological correlates. J Neuropsychiatr Clin Neurosci 2009, 21:371-380.
- [43]Lee J, Scwartz D, Hallmayer J: Catatonia in a psychiatric intensive care facility: incidence and response to Benzodiazepines. Ann Clin Psychiatry 2000, 12:89-96.
- [44]Ungvari GA, Leung CM, Wong MK, Lau J: Benzodiazepines in the treatment of catatonic syndrome. Acta Psychiatr Scand 1994, 89:285-288.
- [45]Fiedorowicz J, Endicott J, Leon A, Solomon D, Keller M, Coryell W: Subthreshold hypomanic symptoms in progression from unipolar major depression to bipolar disorder. Am J Psychiatry 2011, 168:40-48.
- [46]Guggenheim F, Babigian H: Catatonic schizophrenia: epidemiology and clinical course. A 7-year register study of 798 cases. J Nerv Ment Dis 1974, 158:291-305.
- [47]Piccinelli M, Wilkinson G: Gender differences in depression. Crit Rev Br J Psychiatr 2000, 177:486-492.
- [48]Bush G, Fink M, Petrides G, Dowling F, Francis A: Catatonia. II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatr Scand 1996, 93:137-143.
- [49]World Health Organization: mhGAP Intervention Guide for Mental, Neurological and Substance use Disorders in Non-Specialized Health Settings. WHO Press, Geneva; 2010.
- [50]Petrides G, Malur C, Fink M: Convulsive Therapy. In Catatonia: From Psychopathology to Neurobiology. Edited by Caroff S, Mann S, Francis A, Fricchione G. American Psychiatric Press, Washington, DC; 2004:151-160.
- [51]Fekadu A, Kebede D, Alem A, Fekadu D, Mogga S, Negash A, Medhin G, Beyero T, Shibre T, et al.: Clinical outcome in bipolar disorder in a community-based follow-up study in Butajira, Ethiopia. Acta Psychiatr Scand 2006, 114(6):426-434.
- [52]Fekadu A, Thornicroft G: Global mental health: perspectives from Ethiopia. Glob Health Action 2014, 7:25447.
- [53]Moskowitz A: “Scared Stiff”: Catatonia as an evolutionary-based fear response. Psychol Rev 2004, 111:984-1002.