Phenomenology and Treatment of Catatonia: A Descriptive Study from North India

Article excerpt

Byline: Alakananda. Dutt, Sandeep. Grover, Subho. Chakrabarti, Ajit. Avasthi, Suresh. Kumar

Background: Studies on clinical features of catatonia in the Indian population are few in number. Aim: To study the phenomenology, clinical profile and treatment response of subjects admitted to the psychiatry inpatient with catatonia. Materials and Methods: Detailed treatment records of all the inpatients were scanned for the period January 2004 to December 2008. Patients with catatonia (diagnosed as two symptoms as per the Bush Francis Catatonia Rating scale) were included. Results: During the study period, 1056 subjects were admitted in the inpatient unit, of which 51 (4.8% of the total admissions) had catatonic features and had been rated on the Bush Francis Catatonia Rating scale. The mean age of the sample was 30.02 years (SD=14.6; range 13-69), with an almost equal gender ratio. Most of the patients presenting with catatonia were diagnosed as having psychotic disorders (40; 74.8%), of which the most common diagnosis was schizophrenia (27; 52.9%) of the catatonic subtype (20; 39.2%). Three subjects with primary diagnosis of a psychotic disorder had comorbid depression. Other diagnoses included mood disorders (7; 13.72%) and organic brain syndromes (04; 7.9%). According to the Bush Francis Rating scale, the common signs and symptoms exhibited by the subjects were mutism (94.1%), followed by immobility/stupor (78.5%), staring (78.4%), negativism (74.5%), rigidity (63%) and posturing/catalepsy (61.8%). All the patients were initially treated with lorazepam. Electroconvulsive therapy was required in most cases (42; 82.35%). Conclusion: The common symptoms of catatonia are mutism, immobility/stupor, staring, posturing, negativism and rigidity. The most common underlying psychiatric diagnosis was schizophrenia.

Introduction

Karl Ludwig Kahlbaum first described catatonia as a "symptom complex," [sup][1] and it is currently viewed as a syndrome of motor abnormality associated with disorders of mood, behavior or thought. It is reported to occur as a presenting complaint in 7-15% of acute psychiatric inpatients. [sup][2],[3]

Over the years, more than 40 signs have been ascribed to catatonia, with an overlap of definitions. Patients with catatonia may be hypokinetic, stuporous or hyperkinetic; they may posture, exhibit stereotypies and mannerisms, stare or grimace. They may be mute, echo words or phrases or verbigerate. Their behavior may also be stimulus bound in negativism, automatic obedience, waxy flexibility, mitgehen, gegenhalten or echo phenomena. [sup][1] The most common signs are mutism, posturing, negativism, staring, rigidity and echo phenomena. These signs occur in two principal forms: a retarded-stuporous variety and an excited-delirious variety. [sup][4] According to the DSM-IV criteria, the presence of two prominent signs for at least 24 h is sufficient for the diagnosis of catatonia. The diagnosis may be confirmed by symptomatic improvement after the acute administration of a challenge dose of lorazepam or amobarbital. Confirmation after lorazepam is reported in approximately 80% of the patients with catatonia. [sup][4],[5]

There are very few studies that have assessed the phenomenology of catatonia in India. Most of the data is in the form of case reports, in which catatonia due to various causes has been reported, [sup][6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] and some have reported use of electroconvulsive therapy (ECT) and lorazepam. [sup][11],[22],[23],[24],[25],[26],[27] Cases of periodic catatonia have also been reported from India. [sup][6],[10]

An earlier study from India showed that catatonic signs were present in nearly 40% inpatients diagnosed with mood and psychotic disorders, a significant proportion of which were schizophrenia and acute and transient psychotic disorders. [sup][28] However, the recent studies are in concordance with the general belief that the incidence of catatonia is declining as they have reported a lower incidence of catatonia in an inpatient setting. …