Acute Catatonia on Medical Wards: A Case Series

Elisabeth Doran; John D. Sheehan

Disclosures

J Med Case Reports. 2018;12(206) 

In This Article

Background

Catatonia is a behavioral syndrome which presents with an inability to move normally. It is associated with mood disorders and schizophrenia, as well as with medical and neurological conditions. The presence of catatonia denotes the severity of the underlying illness. Acute medical and neurological conditions, as well as drug withdrawal and toxic drug states, can trigger catatonia.[1]

According to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), catatonia is associated with a mental disorder and is diagnosed when the clinical picture is dominated by at least three of the following: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, agitation, stereotypy, grimacing, echolalia, or echopraxia (Table 1).[2]

The awareness of catatonia among general medical doctors and even psychiatrists is relatively poor, and it is often seen as an historical diagnosis.[3] Due to this low level of awareness catatonia is likely to be underdiagnosed. If patients in catatonic states are not diagnosed their condition is likely to progress with a risk of increased morbidity and a potentially fatal outcome. As catatonia is treatable, timely diagnosis and treatment significantly improves patient outcomes. Patients suffering from catatonia are at high risk of developing medical complications such as dehydration, malnutrition, deep vein thrombosis, pulmonary embolism, pressure ulcers, contractures, constipation, urinary tract infections, and aspiration pneumonia.[4]

Between December 2015 and June 2016 three cases of catatonia were diagnosed and successfully treated in the Mater Misericordiae University Hospital (MMUH), Dublin. We feel that it is not well known among medical doctors, that patients, particularly if they have a history of psychiatric illness, can be at risk of becoming catatonic when acutely unwell.

All patients or next of kin of the patients have provided written informed consent for the publication of their cases.

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