What is the best treatment for malignant catatonia? Scroll down to take the quiz.
The correct answer is B. ECT and lorazepam
Catatonia as a syndrome may arise from multiple etiologies and can lead to medical complications that result in significant morbidity and mortality, making rapid diagnosis and treatment a priority. Medical complications abound, and the mortality rate for malignant catatonia despite better recognition and treatment is still 9% to 10%.1
The diagnosis of catatonia relies on the recognition of its sometimes unusual symptoms. Three subtypes of catatonia are conceptualized in Figure 1 (above): stuporous, excited, and malignant. Catatonic withdrawal or stuporous catatonia, includes motoric immobility, staring, mutism, rigidity, withdrawal and refusal to eat, along with more bizarre features such as posturing, grimacing, negativism, waxy flexibility, echophenomena, stereotypy, verbigeration, and automatic obedience. Excited catatonia is characterized by purposeless and excessive motor activity that includes disorganized pressured speech, flight of ideas, verbigeration, disorientation and/or confusion, and confabulation.
Catatonic signs of malignant subtype are accompanied by fever and dysautonomia. Malignant catatonia is associated with increased morbidity and mortality. A specific example of malignant catatonia is neuroleptic malignant syndrome, induced by dopamine-blocking agents or withdrawal of a dopamine or gamma-aminobutyric acidA (GABAA) agonist. Another variant, known as manic delirium or delirious mania, exists with features of both excited and malignant catatonia. Periodic catatonia can present with alternating stuporous and excited forms.
For more on this topic, see Neuropsychiatry of Catatonia: Clinical Implications, on which this quiz is based.
1. Tuerlings JH, van Waarde JA, Verwey B. A retrospective study of 34 catatonic patients: analysis of clinical care and treatment. Gen Hosp Psychiatry. 2010;32:631-635.