Catatonia in Medically Ill Patients

• Catatonia in medically ill patients is rare but often unrecognized. • Catatonia occurs with varying degrees of severity, with malignant catatonia on the severe side of the spectrum. • In the pediatric population, catatonia is exceedingly unrecognized and undertreated. • Pediatric catatonia is often associated with general medical illness, as well as autistic spectrum and developmental disorders. • Catatonic Disorder due to another medical condition (CD-AMC) is the most common form of catatonia in the medically ill population. • The clinical presentation of CD-AMC is similar to catatonia in patients with psychiatric illnesses. • Intravenous lorazepam is the preferred initial treatment for catatonia. • Amantadine or memantine may be helpful augmentation agents. • Electroconvulsive therapy (ECT) often produces remission when pharmacologic treatment options have failed. • Dopamine antagonists can be used if the patient with catatonia has shown a favorable response to certain agents in the past, with careful monitoring for progression to malignant catatonia. INTRODUCTION: Objective and methods: This monograph summarizes current knowledge related to the diagnosis, epidemiology, etiology, and management of catatonia in the medically ill population. Specifically, this monograph primarily discusses catatonia due to another medical condition (CD-AMC), previously known as catatonia due to a general medical condition (CDGMC) under DSM-IV-TR terminology. This monograph also discusses catatonia occurring in the setting of another mental disorder when encountered by a consultation psychiatry service in a general hospital setting. Malignant catatonia, otherwise known as the Neuroleptic Malignant Syndrome (NMS) is also discussed. A more thorough review of the pathophysiology of catatonia, and catatonia occurring in the setting of another mental disorder (such as bipolar disorder, major depression, neurodevelopmental disorder, or schizophrenia) is beyond the focus of this monograph. Readers are encouraged to consult the recommended readings for more detailed information on this topic (Appendix A). Catatonia is a neuropsychiatric syndrome with motor, vocal, affective, and behavioral peculiarities, including alterations in external (environmental) and internal (proprioceptive) awareness. Features may include mutism or impoverished/quiet speech, reduced interaction with the environment Catatonia most often occurs in patients with major depression or bipolar disorder. However, it is also seen in schizophrenia, or as a result of a medical condition. 1 When one includes NMS, then CD-AMC is the most common form of catatonia in the medically ill. 2 The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) recognizes that catatonia can occur in the context of another mental disorder or …