Neuroleptic malignant syndrome or catatonia? Trying to solve the catatonic dilemma.

RATIONALE: A substantial overlap exists between catatonic phenomena and features of neuroleptic malignant syndrome. OBJECTIVES: The objective of this study is to examine whether catatonia can be distinguished from neuroleptic malignant syndrome and to identify symptoms that may have discriminatory power. METHODS: We conducted a literature search to identify relevant studies up to and including the year 2012. A total of 386 studies containing 490 case reports were included. To evaluate the discriminant value of each feature, we performed binominal regression analyses with the diagnosis as the dependent variable. First, all features were entered into the model as independent variables. In a second step, a stepwise backwards analysis was conducted to eliminate criteria with low discriminant value. RESULTS: The most common symptoms in patients with neuroleptic malignant syndrome were fever (87.7 %), rigor (85.9 %), laboratory evidence of muscle injury (70.5 %), and tachycardia (62.1 %) and in patients with catatonia were mutism (78.0 %), rigor (73.0 %), stupor (54.0 %), and agitation (49.0 %). Eleven variables with statistically significant discriminatory power remained after statistical analysis: diaphoresis (odds ratio (OR) 10.011), rigor (OR 9.550), fever (OR 7.317), tremor (OR 4.064), laboratory evidence of muscle injury (OR 3.542), leukocytosis (OR 3.081), negativism (OR 0.262), posturing (OR 0.241), waxy flexibility (OR 0.223), stupor (OR 0.158), and stereotypy (OR 0.122). CONCLUSIONS: Catatonia and neuroleptic malignant syndrome can be distinguished, at least on a descriptive level. There is a strong syndromal overlap. Our findings might be influenced by the fact that they are based on case reports, which reflect the respective authors' clinical opinion of the patient's condition.

[Changing attitude towards schizophrenia by psychiatric training of medical students]. / Veränderung der Einstellung zur Schizophrenie durch das Psychiatriepraktikum im Medizinstudium.

OBJECTIVE: The aim of the study was to examine if psychiatric training of medical students is appropriate to change their attitude towards schizophrenia and reduce stigma. METHOD: Students at Ulm University were asked to answer five questions regarding a short case vignette about a patient suffering from schizophrenia at the beginning and at the end of a two-week psychiatric training within their undergraduate medical education. For this purpose, the Attitudes to Mental Illness Questionnaire was used. Differences between attitudes before and after the training were examined (paired t-test) and effect sizes were calculated (Cohen's d). RESULTS: Data were available of 100 students, 34 men and 66 women. There was a statistically significant improvement in the total means of the AMIQ score from - 3.09 at the beginning to - 2.31 at the end of the psychiatric training. The effect size (d) was 0.35. No significant differences were found with respect to the participants' age and gender. CONCLUSION: A two-week psychiatric training appears to be an appropriate and effective teaching tool to reduce stigma. This is important because health care for patients with schizophrenia is strongly influenced by the practitioner's attitude towards them.