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. 2022 May 23:13:886662.
doi: 10.3389/fpsyt.2022.886662. eCollection 2022.

Catatonia Psychopathology and Phenomenology in a Large Dataset

Eleanor Dawkins  1 , Leola Cruden-Smith  1 , Ben Carter  2 , Ali Amad  3   4 , Michael S Zandi  5   6 , Glyn Lewis  7 , Anthony S David  8 , Jonathan P Rogers  1   7
Affiliations

Catatonia Psychopathology and Phenomenology in a Large Dataset

Eleanor Dawkins et al. Front Psychiatry. .

Abstract

Background: The external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received little attention. This study aimed to use a large dataset to describe the clinical signs of catatonia; to assess whether these signs are associated with underlying diagnosis and prognosis; and to describe the phenomenology of catatonia, particularly with reference to fear.

Methods: A retrospective descriptive cross-sectional study was conducted using the electronic healthcare records of a large secondary mental health trust in London, United Kingdom. Patients with catatonia were identified in a previous study by screening records using natural language processing followed by manual validation. The presence of items of the Bush-Francis Catatonia Screening Instrument was coded by the investigators. The presence of psychomotor alternation was assessed by examining the frequency of stupor and excitement in the same episode. A cluster analysis and principal component analysis were conducted on catatonic signs. Principal components were tested for their associations with demographic and clinical variables. Where text was available on the phenomenology of catatonia, this was coded by two authors in an iterative process to develop a classification of the subjective experience of catatonia.

Results: Searching healthcare records provided 1,456 validated diagnoses of catatonia across a wide range of demographic groups, diagnoses and treatment settings. The median number of catatonic signs was 3 (IQR 2-5) and the most commonly reported signs were mutism, immobility/stupor and withdrawal. Stupor was present in 925 patients, of whom 105 (11.4%) also exhibited excitement. Out of 196 patients with excitement, 105 (53.6%) also had immobility/stupor. Cluster analysis produced two clusters consisting of negative and positive clinical features. From principal component analysis, three components were derived, which may be termed parakinetic, hypokinetic and withdrawal. The parakinetic component was associated with women, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders. 68 patients had phenomenological data, including 49 contemporaneous and 24 retrospective accounts. 35% of these expressed fear, but a majority (72%) gave a meaningful narrative explanation for the catatonia, which consisted of hallucinations, delusions of several different types and apparently non-psychotic rationales.

Conclusion: The clinical signs of catatonia can be considered as parakinetic, hypokinetic and withdrawal components. These components are associated with diagnostic and prognostic variables. Fear appears in a large minority of patients with catatonia, but narrative explanations are varied and possibly more common.

Keywords: anxiety; catatonia; cluster analysis; fear; phenomenology; principal component; psychopathology; subjective experience.

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Conflict of interest statement

MZ declares honoraria for a lecture from Eisai Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Number of catatonic features per patient (measured at first episode).
FIGURE 2
FIGURE 2
Frequency of individual items of the Bush-Francis Catatonia Screening Instrument.
FIGURE 3
FIGURE 3
Cluster analysis dendrogram of the Bush-Francis Catatonia Screening Instrument (Ward’s linkage).
FIGURE 4
FIGURE 4
Scree plot of eigenvalues for principal components of the Bush-Francis Catatonia Screening Instrument.
See this image and copyright information in PMC

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