Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

doi:10.1177/02698811231158232

Practice Guideline

. 2023 Apr;37(4):327-369.

doi: 10.1177/02698811231158232. Epub 2023 Apr 11.

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

Jonathan P Rogers^{1

2}, Mark A Oldham³, Gregory Fricchione^{4

5}, Georg Northoff⁶, Jo Ellen Wilson^{7

8}, Stephan C Mann⁹, Andrew Francis¹⁰, Angelika Wieck^{11

12}, Lee Elizabeth Wachtel^{13

14}, Glyn Lewis¹, Sandeep Grover¹⁵, Dusan Hirjak¹⁶, Niraj Ahuja¹⁷, Michael S Zandi^{18

19}, Allan H Young^{2

20}, Kevin Fone²¹, Simon Andrews²², David Kessler²³, Tabish Saifee¹⁹, Siobhan Gee^{24

25}, David S Baldwin²⁶, Anthony S David²⁷

Affiliations

¹ Division of Psychiatry, University College London, London, UK.
² South London and Maudsley NHS Foundation Trust, London, UK.
³ Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
⁴ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
⁵ Harvard Medical School, Boston, MA, USA.
⁶ Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.
⁷ Veterans Affairs, Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
⁸ Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
⁹ Private Practice, Harleysville, PA, USA.
¹⁰ Penn State Medical School, Hershey Medical Center, PA, USA.
¹¹ Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
¹² Institute of Population Health, University of Manchester, Manchester, UK.
¹³ Kennedy Krieger Institute, Baltimore, Maryland, USA.
¹⁴ Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
¹⁵ Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, CH, India.
¹⁶ Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
¹⁷ Regional Affective Disorders Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK.
¹⁸ Queen Square Institute of Neurology, University College London, London, UK.
¹⁹ National Hospital for Neurology and Neurosurgery, London, UK.
²⁰ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
²¹ School of Life Sciences, Queen's Medical Centre, The University of Nottingham, Nottingham, UK.
²² Patient and Retired Physician, Liverpool, UK.
²³ Centre for Academic Mental Health, University of Bristol, Bristol, UK.
²⁴ Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK.
²⁵ Faculty of Life Sciences and Medicine, King's College London, London, UK.
²⁶ Clinical Neuroscience, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
²⁷ Institute of Mental Health, University College London, London, UK.

PMID: 37039129
PMCID: PMC10101189
DOI: 10.1177/02698811231158232

Practice Guideline

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

Jonathan P Rogers et al. J Psychopharmacol. 2023 Apr.

. 2023 Apr;37(4):327-369.

doi: 10.1177/02698811231158232. Epub 2023 Apr 11.

Authors

Affiliations

¹ Division of Psychiatry, University College London, London, UK.
² South London and Maudsley NHS Foundation Trust, London, UK.
³ Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
⁴ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
⁵ Harvard Medical School, Boston, MA, USA.
⁶ Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.
⁷ Veterans Affairs, Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
⁸ Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
⁹ Private Practice, Harleysville, PA, USA.
¹⁰ Penn State Medical School, Hershey Medical Center, PA, USA.
¹¹ Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
¹² Institute of Population Health, University of Manchester, Manchester, UK.
¹³ Kennedy Krieger Institute, Baltimore, Maryland, USA.
¹⁴ Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
¹⁵ Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, CH, India.
¹⁶ Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
¹⁷ Regional Affective Disorders Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK.
¹⁸ Queen Square Institute of Neurology, University College London, London, UK.
¹⁹ National Hospital for Neurology and Neurosurgery, London, UK.
²⁰ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
²¹ School of Life Sciences, Queen's Medical Centre, The University of Nottingham, Nottingham, UK.
²² Patient and Retired Physician, Liverpool, UK.
²³ Centre for Academic Mental Health, University of Bristol, Bristol, UK.
²⁴ Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK.
²⁵ Faculty of Life Sciences and Medicine, King's College London, London, UK.
²⁶ Clinical Neuroscience, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
²⁷ Institute of Mental Health, University College London, London, UK.

PMID: 37039129
PMCID: PMC10101189
DOI: 10.1177/02698811231158232

Abstract

The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.

Keywords: Catatonia; benzodiazepine; catatonic schizophrenia; electroconvulsive therapy; guideline; neuroleptic malignant syndrome; treatment.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: NA, SA, ASD, AF, S Grover, DH, DK, GL, SCM, GN, LEW, TS, JEW, S Gee and AW declare no conflicts of interest.

MAO is one of the creators of the free videographic educational resources for the Bush-Francis Catatonia Rating Scale mentioned in the guideline.

DSB is President of the BAP and KF is the Past President of the BAP.

GF is a consultant for Revival Therapeutics.

JPR is supported by the Wellcome Trust.

GL is supported by the Wellcome Trust and NIHR.

MSZ declares salary support to support research time from the NIHR UCLH BRC. MSZ declares honoraria for one lecture each for each of the four mentioned in the last 3 years: Norwegian Neurological Society; Copenhagen Neuropsychological Society, Rigshospitalet; Cygnet Healthcare; and UCB Pharma. MSZ declares travel and hotel support for a stay in Florence from the European Association of Neurology (EAN) for an EAN meeting on autoimmune encephalitis in April 2022. MSZ represents neurology in the UK for the Association of British Neurologists for matters related to Covid in meetings with NHS England and Royal College of Physicians.

AY is the Editor of Journal of Psychopharmacology and Deputy Editor, BJPsych Open. He has given paid lectures and has been on advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Boehringer Ingelheim, Eli Lilly, LivaNova, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage, Novartis and Neurocentrx. He is the principal investigator on the Restore-Life VNS registry study (funded by LivaNova); ESKETINTRD3004: ‘An Open-label, Long-term, Safety and Efficacy Study of Intranasal Esketamine in Treatment-resistant Depression’, ‘The Effects of Psilocybin on Cognitive Function in Healthy Participants’ and ‘The Safety and Efficacy of Psilocybin in Participants with Treatment-Resistant Depression (P-TRD)’. He is the UK Chief Investigator for Compass: COMP006 & COMP007 studies and for Novartis MDD study MIJ821A12201. He has received grant funding (past and present) from NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK); Janssen (UK), and EU Horizon 2020. He has no shareholdings in pharmaceutical companies.

Figures

**Figure 1.**
Quick reference algorithm for the management of catatonia.

See this image and copyright information in PMC

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References

1. Abrams A, Braff D, Janowsky D, et al.. (1978) Unresponsiveness of catatonic symptoms to naloxone. Pharmakopsychiatr Neuropsychopharmakol 11: 177–179. DOI: 10.1055/s-0028-1094576. - DOI - PubMed
1. Abrams R, Taylor MA. (1976) Catatonia: A prospective clinical study. Arch Gen Psychiatr 33: 579–581. DOI: 10.1001/ARCHPSYC.1976.01770050043006. - DOI - PubMed
1. Adnet P, Lestavel P, Krivosic-Horber R. (2000) Neuroleptic malignant syndrome. BJA: Br J Anaesth 85: 129–135. DOI: 10.1093/bja/85.1.129. - DOI - PubMed
1. Ahmed A, Paramjit C, Bahar A. (2009) The treatment-resistant catatonia patient. Curr Psychiatry 8: 66.
1. Ahmed GK, Elbeh K, Karim AA, et al.. (2021) Case report: Catatonia associated with post-traumatic stress disorder. Front Psychiatry 12: 740436. DOI: 10.3389/FPSYT.2021.740436. - DOI - PMC - PubMed

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[1] Abrams A, Braff D, Janowsky D, et al.. (1978) Unresponsiveness of catatonic symptoms to naloxone. Pharmakopsychiatr Neuropsychopharmakol 11: 177–179. DOI: 10.1055/s-0028-1094576. - DOI - PubMed

[2] Abrams A, Braff D, Janowsky D, et al.. (1978) Unresponsiveness of catatonic symptoms to naloxone. Pharmakopsychiatr Neuropsychopharmakol 11: 177–179. DOI: 10.1055/s-0028-1094576. - DOI - PubMed

[3] Abrams R, Taylor MA. (1976) Catatonia: A prospective clinical study. Arch Gen Psychiatr 33: 579–581. DOI: 10.1001/ARCHPSYC.1976.01770050043006. - DOI - PubMed

[4] Abrams R, Taylor MA. (1976) Catatonia: A prospective clinical study. Arch Gen Psychiatr 33: 579–581. DOI: 10.1001/ARCHPSYC.1976.01770050043006. - DOI - PubMed

[5] Adnet P, Lestavel P, Krivosic-Horber R. (2000) Neuroleptic malignant syndrome. BJA: Br J Anaesth 85: 129–135. DOI: 10.1093/bja/85.1.129. - DOI - PubMed

[6] Adnet P, Lestavel P, Krivosic-Horber R. (2000) Neuroleptic malignant syndrome. BJA: Br J Anaesth 85: 129–135. DOI: 10.1093/bja/85.1.129. - DOI - PubMed

[7] Ahmed A, Paramjit C, Bahar A. (2009) The treatment-resistant catatonia patient. Curr Psychiatry 8: 66.

[8] Ahmed A, Paramjit C, Bahar A. (2009) The treatment-resistant catatonia patient. Curr Psychiatry 8: 66.

[9] Ahmed GK, Elbeh K, Karim AA, et al.. (2021) Case report: Catatonia associated with post-traumatic stress disorder. Front Psychiatry 12: 740436. DOI: 10.3389/FPSYT.2021.740436. - DOI - PMC - PubMed

[10] Ahmed GK, Elbeh K, Karim AA, et al.. (2021) Case report: Catatonia associated with post-traumatic stress disorder. Front Psychiatry 12: 740436. DOI: 10.3389/FPSYT.2021.740436. - DOI - PMC - PubMed

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Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

Affiliations

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

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