Catatonia in 26 patients with bipolar disorder: clinical features and response to electroconvulsive therapy.

Abstract

OBJECTIVES:

We describe the clinical characteristics and short-term outcomes of a sample of inpatients with bipolar disorder with severe catatonic features resistant to pharmacological treatment.

METHODS:

The study involved 26 catatonic patients, resistant to a trial of benzodiazepines, and then treated with electroconvulsive therapy (ECT). All patients were evaluated prior to and one week following the ECT course using the Bush-Francis Catatonia Rating Scale (BFCRS) and the Clinical Global Impression (CGI).

RESULTS:

In our sample, women were over-represented (n = 23, 88.5%), the mean (± standard deviation) age was 49.5 ± 12.5 years, the mean age at onset was 28.1 ± 12.8 years, and the mean number of previous mood episodes was 5.3 ± 2.9. The mean duration of catatonic symptoms was 16.7 ± 11.8 (range: 3-50) weeks, and personal history of previous catatonic episodes was present in 10 patients (38.5%). Seventeen (65.4%) patients showed abnormalities at cerebral computerized tomography and/or magnetic resonance imaging and neurological comorbidities were observed in 15.4% of the sample. Stupor, rigidity, staring, negativism, withdrawal, and mutism were observed in more than 90% of patients. At the end of the ECT course, 21 patients (80.8%) were classified as responders. The BFCRS showed the largest percentage of improvement, with an 82% reduction of the initial score. The number of previous mood episodes was significantly lower and the use of anticholinergic and dopamine-agonist medications was significantly more frequent in non-responders than in responders.

CONCLUSIONS:

Our patients with bipolar disorder had predominantly retarded catatonia, frequent previous catatonic episodes, indicating a recurrent course, and high rates of concomitant brain structure alterations. However, ECT was a very effective treatment for catatonia in this patient group that was resistant to benzodiazepines.

• Authors: Pierpaolo Medda, Cristina Toni, Federica Luchini, Michela Giorgi Mariani, Mauro Mauri, Giulio Perugi
• Journal: Bipolar disorders (Bipolar Disord) Vol. 17 Issue 8 Pg. 892-901 (Dec 2015) ISSN: 1399-5618 [Electronic] Denmark
• PMID: 26643014 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Psychotropic Drugs

Topics

• Adult
• Bipolar Disorder (complications, diagnosis, epidemiology, psychology)
• Catatonia (diagnosis, etiology, psychology, therapy)
• Drug Resistance
• Electroconvulsive Therapy (methods)
• Female
• Humans
• Male
• Middle Aged
• Psychiatric Status Rating Scales
• Psychotropic Drugs (therapeutic use)
• Recurrence
• Treatment Outcome