WEBB FELLOW: Clinical & Biological Differences in Patients with Catatonia Associated to a Medical Condition and due to Psychiatric Disease: A Population Based Historical Cohort Study

Friday, November 8, 2024

11:05 AM – 12:20 PM EST

Location: Brickell

Presenting Author(s)

Laura Duque, MD

Neuropsychiatry Fellow
Massachusetts General Hospital
Boston, Massachusetts

PDF

Co-Author(s)

MG

Mohammad Ghafouri, MD

Research Fellow
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Rochester, Minnesota
CF

Christopher Fuguet, MD

Resident
Mayo Clinic
Minnetonka, Minnesota
KP

Kemuel Philbrick, MD, FACLP

Medical director, Hospital C/L Service
Mayo Clinic
Rochester, Minnesota
JP

John Port, MD PhD

Professor
Mayo Clinic
Rochester, Minnesota
RS

Rodolfo Savica, MD PhD

Professor
Mayo Clinic
Rochester, Minnesota
TR

Teresa Rummans, MD

Professor of Psychiatry
Mayo Clinic
rochester, Minnesota
BS

Balwinder Singh, MD, FAPA

Assistant Professor
Mayo Clinic
Rochester, Minnesota

Abstract:
Background: Catatonia is a complex neuropsychiatric syndrome characterized by a range of disruptions in motor, affective, and behavioral functioning, often leading to considerable morbidity and mortality. Prompt intervention is crucial, involving the correction of relevant medical factors alongside specific treatments such as lorazepam and electroconvulsive therapy (ECT). Although catatonia is commonly linked with psychiatric disorders, such as mood and psychotic disorders, catatonia frequently stems from numerous neurological and medical conditions. Notably, catatonia emerging from acute medical conditions and psychiatric disorders may represent distinct clinical presentations, each potentially impacting on symptom severity and response to treatment differently.

Objective: This study aimed to distinguish clinical phenotypes of catatonia, notably delineating between catatonia arising from medical conditions and those stemming from psychiatric disorders. We evaluated these groups through a comprehensive analysis of presentation and examination characteristics, symptom severity, treatment responses, as well as evaluating structural and metabolic variables. Our central hypothesis was that catatonia due to a medical condition and due to psychiatric disorder represent distinct phenotypes with unique clinical profiles and responses to treatment.

Method: We conducted a retrospective study involving adult patients admitted with catatonia at the Mayo Clinic in Rochester, Minnesota, from May 1, 2001, to May 1, 2021. Catatonia cases were identified with the Mayo Data Explorer, using ICD-9/10 codes and natural language processing, confirming each case through manual chart review. The underlying causes of catatonia were determined through a comprehensive review of medical records. Catatonia severity was assessed using the Bush-Francis Catatonia Rating Scale (BFCRS) and the Clinical Global Impression (CGI), while demographic and clinical data were collected through detailed chart examination.