[Catatonia - About four clinical cases and literature review]

Abstract

Introduction: Catatonia is a neuropsychiatric syndrome characterized by the presence of at least three out of the twelve following signs: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypies, agitation, grimacing, echolalia, and echopraxia. We will describe four cases of catatonia that occurred over one year in a single medicine department.

Clinical cases: All four patients were over 60 years old. The causes of catatonia were diverse: hemorrhagic shock occurring in the context of mixed dementia, schizoaffective disorder, a severe major depressive episode, and a depressive syndrome associated with Lewy body disease. Three out of four patients were treated with electroconvulsive therapy (ECT), and all evolved towards remission. The diagnoses were consistently established by a liaison psychiatrist.

Discussion: Before the recruitment of liaison psychiatrists in the institution, this diagnosis had not been considered in the department. The cause of catatonia can be psychiatric (75 to 80% of cases) and/or non-psychiatric (20 to 25% of cases). In two thirds of organic cases, it is a condition of the central nervous system. Symptomatic treatment with benzodiazepine allows for remission of symptoms in more than two thirds of cases. In the absence of response to benzodiazepines, treatment with electroconvulsive therapy is indicated. Catatonia can progress to death, following possible complications or in cases of severe dysautonomia (malignant catatonia).

Conclusion: Catatonia is underdiagnosed and undertreated. Despite a relatively high prevalence, well-defined diagnostic criteria, and a symptomatic treatment that is often very effective, the prognosis of catatonia can be poor in the absence of treatment. Psychiatrists should be consulted whenever there is doubt regarding a clinical presentation.

Keywords: Benzodiazepine; Catatonia; Catatonie; Consult liaison psychiatry; Electroconvulsive therapy; Neuropsychiatrie; Neuropsychiatry; Psychiatrie de liaison; Électroconvulsivothérapie.