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2.
J Acad Consult Liaison Psychiatry ; 63(6): 607-618, 2022.
Article in English | MEDLINE | ID: mdl-35842127

ABSTRACT

BACKGROUND: Untreated catatonia is associated with serious medical complications that can necessitate urgent medical attention. Lorazepam and electroconvulsive therapy (ECT) are effective for catatonia across various psychiatric or medical diagnoses. In rare cases, ECT fails to achieve full response in catatonic symptoms, particularly in patients with chronic catatonia or primary psychotic disorder. Evidence on treating catatonia that does not respond to ECT is lacking. OBJECTIVE: Conduct a literature review on treatment of ECT-resistant catatonia which is defined as that reported lack of full response to ECT treatments. We present a case of a 52-year-old male with schizophrenia where catatonia did not respond to lorazepam and robust ECT but resolved after memantine titration. METHODS: A literature review was performed using Medline/PubMed with the following keywords: treatment-resistant, catatonia, electroconvulsive therapy. References in eligible articles and most recent systematic reviews on catatonia treatment were reviewed. RESULTS: Seventeen patients in 12 case reports were identified where the treatment of catatonia was described after failed ECT trials. Most had chronic catatonia and a diagnosis of schizophrenia. ECT parameters and ictal outcome measures were not consistently reported. Treatment modalities for ECT-resistant catatonia included amantadine, memantine, lorazepam augmentation to ECT, and antiepileptic and antipsychotic medications such as aripiprazole and clozapine. CONCLUSIONS: The literature review and new case suggest reconsideration of catatonia diagnosis, optimizing ECT treatments, cautious use of antipsychotics, consideration of lorazepam augmentation to ECT treatments, and/or use of N-methyl-D-aspartate receptor antagonists.


Subject(s)
Catatonia , Electroconvulsive Therapy , Male , Humans , Middle Aged , Catatonia/drug therapy , Electroconvulsive Therapy/adverse effects , Lorazepam/therapeutic use , Memantine/therapeutic use , Schizophrenia, Catatonic/complications , Schizophrenia, Catatonic/drug therapy
3.
Clin Neuropharmacol ; 43(3): 84-85, 2020.
Article in English | MEDLINE | ID: mdl-32384310

ABSTRACT

BACKGROUND: Catatonia is a severe condition in patients. Electroconvulsive treatment or medication with benzodiazepines and/or antipsychotics are regarded as standard treatment. CASE PRESENTATION: We report a case of a patient with catatonic features in whom electroconvulsive treatment and benzodiazepine and/or antipsychotic medications failed to achieve efficacy. Additional treatment with lithium ameliorated catatonia. CONCLUSION: We concluded that lithium is an optional treatment in patients in whom standard treatment failed.


Subject(s)
Lithium/therapeutic use , Schizophrenia, Catatonic/drug therapy , Antipsychotic Agents/therapeutic use , Aripiprazole/therapeutic use , Benzodiazepines/therapeutic use , Electroconvulsive Therapy , Female , Haloperidol/therapeutic use , Humans , Middle Aged
4.
Cochrane Database Syst Rev ; 8: CD006570, 2019 08 05.
Article in English | MEDLINE | ID: mdl-31425609

ABSTRACT

BACKGROUND: Catatonia is a debilitating disorder of movement and volition associated with schizophrenia and some other mental illnesses. People with catatonia are more likely to require hospitalisation and highly supervised care than those without the disorder. They also have an increased risk of secondary complications such as pneumonia, malnutrition and dehydration. The mainstay of treatment has been drug therapies and electroconvulsive therapy. OBJECTIVES: To compare the effects of benzodiazepines with other drugs, placebo or electroconvulsive therapy for catatonia in people with schizophrenia or other similar serious mental illnesses (SMIs). SEARCH METHODS: We updated our previous search (28 February 2007) by searching the Cochrane Schizophrenia Group's Study-Based Register of Trials (9 November 2016; 6 February 2019). This register is compiled by systematic searches of major resources (including CENTRAL, MEDLINE, Embase, AMED, BIOSIS, CINAHL, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. We also manually searched reference lists from studies selected by the search. SELECTION CRITERIA: All controlled clinical trials that randomised people who have schizophrenia or other similar SMI and experiencing catatonia to receive benzodiazepines or another relevant treatment. We included studies that met our inclusion criteria and reported usable data. We excluded those not meeting our inclusion criteria or those not reporting usable data. We contacted authors when we required further information; and if we received no response, we put those studies aside as 'awaiting assessment'. DATA COLLECTION AND ANALYSIS: Review authors extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis using a fixed-effect model. We completed a 'Risk of bias' assessment for the included study and generated a 'Summary of findings' table using GRADE. MAIN RESULTS: The searches found 130 citations, from which we could identify 22 possibly relevant studies. From these, we could only include one study. This study had a relatively small sample size of 17 participants who received lorazepam or oxazepam and were drug free for one week before the trial started. The only usable data reported by this study were clinically important change in symptoms of catatonia measured as 50% improvement on the Visual Analogue Scale (VAS). There was no difference in the numbers of participants showing a clinically important change in their catatonic symptoms (RR 0.95, 95% CI 0.42 to 2.16; participants = 17; studies = 1; very low quality evidence).No data were reported for other important outcomes of hospital stay, clinically important change in satisfaction with care, global state, adverse effects or general functioningWe did find a few studies meeting our inclusion criteria but they reported no usable data. We had to exclude these. Although poorly reported, these studies do illustrate that relevant studies have been undertaken - they are not impossible to design and conduct. AUTHORS' CONCLUSIONS: Analysis of the results from this review, which was a head-to-head comparison of two benzodiazepine monotherapies, does not show a clear difference in effect. No data were available for benzodiazepines compared to placebo or standard care. The lack of usable data and very low quality of data available makes it impossible to draw firm conclusions and further studies with a high-quality methodology and reporting are required in order to determine more definitively the outcomes associated with benzodiazepine use in the clinical management of catatonia in persons with schizophrenia and other SMI.


Subject(s)
Benzodiazepines/therapeutic use , Catatonia/drug therapy , Schizophrenia, Catatonic/drug therapy , Antipsychotic Agents/therapeutic use , Electroconvulsive Therapy , Humans , Mental Disorders/complications , Randomized Controlled Trials as Topic , Schizophrenia/drug therapy
5.
J Autism Dev Disord ; 48(10): 3637-3640, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29696528

ABSTRACT

There is paucity of empirical data regarding the use of either clozapine or electroconvulsive therapy (ECT) in the acute phase and maintenance treatment of schizophrenia in adults with intellectual disability. Herein we report the successful acute and long-term remission of psychotic symptoms and catatonia with the combination of clozapine and ECT in a 26-year-old female with moderate ID and treatment-resistant schizophrenia. To our knowledge, this is the first case example of the successful use of the combination of bilateral, standard-pulse ECT and clozapine in both acute and long-term treatment of treatment-resistant schizophrenia and catatonia in an adult with ID. Our report adds further support to the emerging evidence regarding the efficacy and safety of this combination in treatment-resistant schizophrenia.


Subject(s)
Antipsychotic Agents/therapeutic use , Clozapine/therapeutic use , Electroconvulsive Therapy , Intellectual Disability/therapy , Schizophrenia, Catatonic/therapy , Adult , Antipsychotic Agents/administration & dosage , Clozapine/administration & dosage , Female , Humans , Intellectual Disability/complications , Intellectual Disability/drug therapy , Schizophrenia, Catatonic/complications , Schizophrenia, Catatonic/drug therapy
7.
Asian J Psychiatr ; 28: 102-105, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28784360

ABSTRACT

The resurgence of catatonia following tapering of lorazepam is a common clinical phenomenon. However, there is limited evidence on the relationship between tapering method of lorazepam and resurgence of catatonic state. We report seven (0.6%) such patients who were found to have resurgence of catatonia. The mean age is 35.7 years; five of them had schizophrenia and other psychotic spectrum disorders. Five of them had resurgence within one week of stoppage, and three of them had multiple resurgences and required maintenance treatment with lorazepam. So gradual tapering and maintenance treatment with lorazepam might be effective in preventing resurgence of catatonia.


Subject(s)
Catatonia/drug therapy , GABA Modulators/administration & dosage , Lorazepam/administration & dosage , Psychotic Disorders/drug therapy , Schizophrenia, Catatonic/drug therapy , Adult , Female , Humans , Male , Recurrence
10.
Compr Psychiatry ; 66: 157-65, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26995249

ABSTRACT

OBJECTIVE: Relieving catatonia helps identify the underlying etiology and its treatment. However, catatonia may reemerge after some time, but there are few data on the relapses and recurrences of catatonia. We aimed to investigate the characteristics of patients with relapses or recurrences of catatonia as well as the efficacy of the lorazepam-diazepam protocol on them. METHODS: Patients with catatonia who had more than one episode of catatonia and were treated with the lorazepam-diazepam protocol were identified. Their medical charts were reviewed, and interview was conducted. RESULTS: Thirty patients were identified. Nineteen (63.3%) were diagnosed with schizophrenia, five (16.7%) with major depressive disorder, two (6.7%) with bipolar disorder, and four (13.3%) with general medical conditions. In the 68 relapses and relapses the lorazepam-diazepam protocol was used, full response was reported in 54 (79.4%) of them. Twelve of 19 (63.2%) patients with schizophrenia were treated with clozapine. Twenty (66.7%) out of 30 patients were maintained on oral lorazepam by the time of discharge. Literature review showed similar prevalence of schizophrenia in patients with more than one episode of catatonia, and a wide variety of treatment options. CONCLUSION: The lorazepam-diazepam protocol was mostly effective in managing relapses and recurrences of catatonia. Maintenance clozapine and oral lorazepam were beneficial in a significant number of patients.


Subject(s)
Catatonia/psychology , Adolescent , Adult , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Bipolar Disorder/psychology , Catatonia/drug therapy , Clozapine/therapeutic use , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/psychology , Diazepam/therapeutic use , Drug Therapy, Combination , Female , Humans , Hypnotics and Sedatives/therapeutic use , Lorazepam/therapeutic use , Male , Middle Aged , Recurrence , Schizophrenia, Catatonic/drug therapy , Schizophrenia, Catatonic/psychology , Young Adult
11.
Clin Schizophr Relat Psychoses ; 10(1): 37-40, 2016.
Article in English | MEDLINE | ID: mdl-24047761

ABSTRACT

Paroxysmal perceptual alteration (PPA) is the occurrence of brief and recurrent episodes of perceptual changes. It is mainly caused by the treatment of schizophrenia patients with antipsychotics. However, diagnosis of PPA is not very prevalent among psychiatrists, partly due to underrecognition or misunderstanding that it is a worsening of psychiatric symptoms. If psychiatrists do not understand PPA, they cannot treat it appropriately, and the patient's quality of life is impaired. We present a case of PPA in catatonic schizophrenia that was successfully treated by switching to aripiprazole from risperidone. We suggest that the disappearance of PPA in our case was due to both discontinuing risperidone, which completely blocks D2 receptors, and replacing it with aripiprazole, which is characterized as a partial agonist of D2 receptors. Treatment of PPA will improve medication adherence and quality of life. It is important to recognize PPA as a possible side effect of treatment with antipsychotics.


Subject(s)
Antipsychotic Agents/therapeutic use , Aripiprazole/therapeutic use , Perceptual Disorders/drug therapy , Risperidone/therapeutic use , Schizophrenia, Catatonic/drug therapy , Adult , Drug Substitution , Humans , Male , Perceptual Disorders/complications , Quality of Life , Schizophrenia, Catatonic/complications , Treatment Outcome
12.
Int J Psychiatry Med ; 50(3): 251-6, 2015.
Article in English | MEDLINE | ID: mdl-26443711

ABSTRACT

A patient with comorbid intellectual disability, catatonic schizophrenia, and recurrent oneiroid state of consciousness improved on long-acting risperidone and remains well at the three-year follow-up. We report a case treated with 50 mg long-acting risperidone administered every 14 days, who has been followed-up for three years. We studied his regional cerebral blood flow through technetium-99 m hexamethylpropyleneamine oxime single-photon emission computed tomography after two years of treatment. Symptoms of catatonic schizophrenia improved after two months of treatment, followed suit by oneiroid syndrome remission. Two years later, his brain perfusion was normal. No side effect has occurred since the patient was started on long-acting risperidone. Long-acting risperidone proved to be safe and effective in treating symptoms of catatonia and oneiroid syndrome.


Subject(s)
Antipsychotic Agents/therapeutic use , Intellectual Disability/complications , Intellectual Disability/drug therapy , Risperidone/therapeutic use , Schizophrenia, Catatonic/complications , Schizophrenia, Catatonic/drug therapy , Adult , Ambroxol , Antipsychotic Agents/pharmacokinetics , Brain/diagnostic imaging , Brain/drug effects , Dreams/psychology , Follow-Up Studies , Humans , Male , Radionuclide Imaging , Risperidone/pharmacokinetics , Syndrome , Treatment Outcome
15.
Neuropsychopharmacol Hung ; 16(1): 19-28, 2014 Mar.
Article in Hungarian | MEDLINE | ID: mdl-24687015

ABSTRACT

Catatonia was first described in the 19th century as a syndrome with motor, affective and behavioral symptoms. During the 20th century it was rather regarded as a rare motoric manifestation of schizophrenia and that classification has almost resulted in the disappearance of catatonia among patients outside of the schizophrenia spectrum. With the introduction of neuroleptics, the incidence of catatonic schizophrenia also declined which was attributed to effective treatment. Simultaneously, neuroleptic malignant syndrome was described, which shows many similarities with catatonia. Recently, several researchers suggested a common origin of the two disorders. In this paper we review case reports of the last five years, in which both neuroleptic malignant syndrome and catatonia had emerged as a diagnosis. Additionally, based on the relevant literature, we propose a common hypothetical pathomechanism with therapeutic implications for the two syndromes. Besides underlining the difficulties of differential diagnosis, the reviewed cases demonstrate a transition between the two illnesses. The similarities and the possible shifts may suggest a neuropathological and pathophysiological overlap in the background of the two syndromes. Electroconvulsive therapy and benzodiazepines seem to be an effective treatment in both syndromes. These two treatment approaches can be highly valuable in clinical practice, especially if one considers the difficulties of differential diagnosis.


Subject(s)
Antipsychotic Agents/adverse effects , Catatonia/diagnosis , Catatonia/physiopathology , Neuroleptic Malignant Syndrome/diagnosis , Neuroleptic Malignant Syndrome/physiopathology , Schizophrenia, Catatonic/drug therapy , Antipsychotic Agents/administration & dosage , Benzodiazepines/therapeutic use , Brain/physiopathology , Catatonia/drug therapy , Catatonia/therapy , Diagnosis, Differential , Electroconvulsive Therapy , Humans , Neuroleptic Malignant Syndrome/etiology , Neuroleptic Malignant Syndrome/therapy , Schizophrenia, Catatonic/diagnosis , Schizophrenia, Catatonic/physiopathology
16.
Article in Russian | MEDLINE | ID: mdl-24637815

ABSTRACT

Our study was based on the hypothesis that a non competitive antagonist of NMDA receptors can improve clinical effects of antipsychotic therapy in a subgroup of patients with schizophrenia with clinical signs of glutamatergic hyperfunction such as catatonic symptoms and disorganization. The study design was open and non-comparative. The duration of the study for each patient was 6 months, the target dosage of acatinol was 20 mg. Forty stable patients with schizophrenia with predominance of signs of disorganization and subcatatonic symptoms were included. The following instruments were used: PANSS, NSA, CGI, BACS, UKU. Adding of acatinol to the antipsychotic treatment improved clinical symptoms, cognitive functioning and social functioning and decreased the number of side effects. The drug was well-tolerated.


Subject(s)
Antipsychotic Agents/therapeutic use , Dopamine Agents/therapeutic use , Memantine/therapeutic use , Schizophrenia, Catatonic/drug therapy , Schizophrenia, Disorganized/drug therapy , Adult , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Dopamine Agents/administration & dosage , Dopamine Agents/adverse effects , Female , Humans , Male , Memantine/administration & dosage , Memantine/adverse effects , Middle Aged , Schizophrenia, Catatonic/diagnosis , Schizophrenia, Disorganized/diagnosis
17.
Gen Hosp Psychiatry ; 35(6): 682.e7-8, 2013.
Article in English | MEDLINE | ID: mdl-23993413

ABSTRACT

Olanzapine, a second-generation antipsychotic, is used for management in a number of psychiatric illnesses. Here we report two cases of olanzapine-induced facial edema which resolved spontaneously on stopping the drug. Although a benign side effect, it led to patient and caregiver distress.


Subject(s)
Antipsychotic Agents/adverse effects , Benzodiazepines/adverse effects , Edema/chemically induced , Face , Schizophrenia, Catatonic/drug therapy , Schizophrenia, Paranoid/drug therapy , Adolescent , Adult , Female , Humans , Male , Olanzapine
19.
BMJ Case Rep ; 20132013 Jul 29.
Article in English | MEDLINE | ID: mdl-23897375

ABSTRACT

A 36-year-old man with known schizophrenia, presented with increasingly bizarre behaviour. The development of catatonia and subsequent neuroleptic malignant syndrome in itself posed numerous therapeutic challenges. However, following resolution of neuroleptic malignant syndrome, the reintroduction of antipsychotics was not tolerated. This case report proposes a novel use for electroconvulsive therapy as a treatment of mental state, following resolution of neuroleptic malignant syndrome, to facilitate successful reintroduction of antipsychotics.


Subject(s)
Antipsychotic Agents/adverse effects , Electroconvulsive Therapy , Neuroleptic Malignant Syndrome/therapy , Schizophrenia, Catatonic/drug therapy , Adult , Humans , Male , Neuroleptic Malignant Syndrome/etiology
20.
BMJ Case Rep ; 20132013 May 22.
Article in English | MEDLINE | ID: mdl-23704432

ABSTRACT

A 38-year-old man with an underlying psychiatric illness presented with altered sensorium and abnormal behaviour. He was febrile at 38°C and weak looking; otherwise no other abnormalities were detected. A blood film conducted for malarial parasite (BFMP) revealed Plasmodium falciparum; hence a diagnosis of cerebral malaria was made. He was treated with antimalarial drugs for 2 days prior to being transferred out to the ward following clinical improvement. He subsequently developed episodes of stupor and refusal of feeding. Following an evaluation by the psychiatrist, a diagnosis of catatonic schizophrenia was made and he was started on oral sulpiride and benhexol. Unfortunately, he developed high-grade fever at 40°C with muscle rigidity and fasciculation. The diagnosis of neuroleptic malignant syndrome (NMS) was clinched and the antipsychotics were discontinued. However he succumbed to NMS several days later due to multiorgan failure.


Subject(s)
Antipsychotic Agents/adverse effects , Malaria, Cerebral/complications , Malaria, Falciparum/complications , Neuroleptic Malignant Syndrome/diagnosis , Neurotransmitter Agents/adverse effects , Schizophrenia, Catatonic/drug therapy , Adult , Antipsychotic Agents/therapeutic use , Delayed Diagnosis , Fatal Outcome , Humans , Malaria, Cerebral/drug therapy , Malaria, Cerebral/microbiology , Malaria, Falciparum/drug therapy , Malaria, Falciparum/microbiology , Male , Neuroleptic Malignant Syndrome/complications , Neurotransmitter Agents/therapeutic use , Schizophrenia, Catatonic/complications , Schizophrenia, Catatonic/diagnosis , Stupor/diagnosis , Stupor/etiology , Sulpiride/adverse effects , Sulpiride/therapeutic use , Trihexyphenidyl/adverse effects , Trihexyphenidyl/therapeutic use
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