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June 20, 2018

Diagnosing and Treating Catatonia: Are Physicians Getting it Right?

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H. Samuel Landsman, MD

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire​

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The article recently published by my colleagues and me raises several points that should be highlighted. While catatonia has been de-coupled from schizophrenia (and has emerged from its “dark ages”) in the research sphere, this philosophical change has not fully permeated the clinical sphere. Although catatonic schizophrenia is a common concept among clinicians and laypersons, thought disorders are not the only cause of catatonia; mood disorders also lead to catatonia. Catatonia is a medical condition with numerous medical etiologies. It is both treatable and potentially fatal. Our purpose for writing about catatonia was to increase awareness among providers about the disorder and to underscore the breadth of conditions that may result in catatonia.

While catatonia is relatively uncommon, it is by no means rare. It can easily be confused with other conditions that have vastly different treatments, some of which may exacerbate or worsen the condition. This point is best illustrated by the use of neuroleptics to treat schizophrenia. Their strong dopamine blockade may induce or worsen catatonia. On the other hand, if a patient’s delirium is misdiagnosed as catatonia and lorazepam is started, it may worsen the delirium. Hence, we need to standardize the approach toward the examination of patients who can’t or won’t interact with others.

The patient described in our article had been diagnosed with conversion disorder after presenting with similar symptoms during past admissions. After recognition of catatonic symptoms—and confirmation by performing the Bush-Francis Catatonia Rating Scale—the patient responded to appropriate treatment for catatonia. This episode informed future care of this patient. After re-initiating appropriate treatment, our patient made a full and rapid recovery and is still doing quite well.

Financial disclosure:Dr Landsman has no relevant personal financial relationships to report.

Category: Medical Conditions , Mental Illness , Schizophrenia
Link to this post: https://www.psychiatrist.com/blog/diagnosing-and-treating-catatonia-are-physicians-getting-it-right/
Related to “Catatonia: An Approach to Diagnosis and Treatment”

2 thoughts on “Diagnosing and Treating Catatonia: Are Physicians Getting it Right?

  1. Thanks Mainak1. We should recognize the work of Fink and Taylor, and also Gelenberg for bringing this to our attention over the past several decades. Catatonia may be present in up to 6% of C/L patients, and certainly goes under-recognized. There is some emerging literature, however discussing whether we should be using the exclusion criteria for catatonia that “the symptoms cannot occur exclusively during the course of a delirium.” I wonder if many physicians are hesitant to treat (or do not think to check for signs of catatonia) because delirium is also present.

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