Femke M Dessens1, Judith van Paassen2, David J van Westerloo3, Nic J van der Wee4, Irene M van Vliet5, Martijn S van Noorden6. 1. Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: F.M.Dessens@lumc.nl. 2. Department of Intensive Care Medicine of Leiden University Medical Center, Leiden, The Netherlands. Electronic address: J.van_Paassen@lumc.nl. 3. Department of Intensive Care Medicine of Leiden University Medical Center, Leiden, The Netherlands. Electronic address: D.J.van_Westerloo@lumc.nl. 4. Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: N.J.A.van_der_Wee@lumc.nl. 5. Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: I.M.van_Vliet@lumc.nl. 6. Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: M.S.van_Noorden@lumc.nl.
Abstract
OBJECTIVE: Catatonia is an underdiagnosed syndrome that may occur in severely ill patients. The malignant subtype, consisting of motor symptoms, autonomic instability and fever, is associated with high mortality rates, though exact current mortality rates are unknown. This subtype requires a fast detection and treatment with high doses of a benzodiazepine or electroconvulsive therapy (ECT), preferably in an intensive care unit (ICU) setting. METHOD: Case series and qualitative literature review. RESULTS: This paper presents four patients admitted to the ICU of an academic hospital diagnosed with malignant catatonia. All patients received ECT after an ineffective trial of high-dose intravenous benzodiazepine treatment. The duration of ECT ranged from 6 to 23 treatments after which the catatonic features partially or fully remitted. In addition, we have reviewed the diagnostic challenges, neurobiology, possible causes, differential diagnosis and treatment options of catatonia, focusing on the treatment with ECT and the importance of detection and multidisciplinary collaboration. CONCLUSION: Malignant catatonia is an underdiagnosed, potentially life-threatening syndrome that requires fast recognition and prompt treatment, preferably in an ICU setting.
OBJECTIVE:Catatonia is an underdiagnosed syndrome that may occur in severely ill patients. The malignant subtype, consisting of motor symptoms, autonomic instability and fever, is associated with high mortality rates, though exact current mortality rates are unknown. This subtype requires a fast detection and treatment with high doses of a benzodiazepine or electroconvulsive therapy (ECT), preferably in an intensive care unit (ICU) setting. METHOD: Case series and qualitative literature review. RESULTS: This paper presents four patients admitted to the ICU of an academic hospital diagnosed with malignant catatonia. All patients received ECT after an ineffective trial of high-dose intravenous benzodiazepine treatment. The duration of ECT ranged from 6 to 23 treatments after which the catatonic features partially or fully remitted. In addition, we have reviewed the diagnostic challenges, neurobiology, possible causes, differential diagnosis and treatment options of catatonia, focusing on the treatment with ECT and the importance of detection and multidisciplinary collaboration. CONCLUSION:Malignant catatonia is an underdiagnosed, potentially life-threatening syndrome that requires fast recognition and prompt treatment, preferably in an ICU setting.