Catatonia: What Should Psychiatrists Know and Why?-View Presentation

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In a comprehensive seminar at the Cleveland Clinic, a multidisciplinary team discussed the complexities of diagnosing and managing catatonia, with contributions from experts including psychiatrists Andrew Francis, Scott Beach, and Greg Frischone. Francis outlined catatonia's historic and diagnostic criteria, noting its fluctuation between retarded and excited forms. He emphasized the role of observable and elicitable signs in diagnosis, while also describing the use and development of the Bush-Francis Catatonia Rating Scale, a tool fundamental to identifying and monitoring catatonia symptoms.<br /><br />Beach then turned to treatment strategies, highlighting benzodiazepines and electroconvulsive therapy (ECT) as primary interventions, while noting the absence of a randomized controlled trial definitively proving benzodiazepines' efficacy. He discussed the lorazepam challenge as both a diagnostic and therapeutic approach, stressing the importance of consistent administration to prevent catatonia recurrence. For resistant cases, third-line treatments include NMDA antagonists and, cautiously, atypical antipsychotics.<br /><br />Barnett presented on the complications of catatonia, such as an increased risk of DVT/PE, pressure ulcers, and a general heightened mortality risk, including suicide. He underscored the economic burden and prevalence of catatonia, citing national data indicating its significant healthcare costs.<br /><br />The discussion wrapped up with insights into the subjective experience of catatonia, highlighting the fear associated with the condition, and potential future avenues of treatment based on GABA and NMDA receptor involvement. Audience questions addressed practical challenges in treating atypical and geriatric catatonia presentations.

Keywords

Cleveland Clinic

catatonia

diagnosis

management

Andrew Francis

Scott Beach

Greg Frischone

Bush-Francis Catatonia Rating Scale

benzodiazepines

electroconvulsive therapy

lorazepam challenge

NMDA antagonists

economic burden

GABA receptor