Catatonic features: differential diagnosis and treatments at an emergency unit

During a 2-year period, 34 patients of catatonic features in Chinese ethnic background Taiwanese were brought to the emergency unit of Chang Gung Memorial Hospital at Linkou. The ratios of the causes of catatonic features by schizophrenic disorders, mood disorders, neuroleptic-induced disorders, and general medical conditions were 26, 9, 24 and 41%, respectively. After the treatments of antipsychotics, benzodiazepam, or electroconvulsive therapy (ECT), 24 patients (70.6%) showed complete remission, seven patients (20.6%) showed partial remission, and three patients (8.8%) showed no response (two died). Additionally, a suggestive period is proposed in order to distinguish acute and insidious onset catatonic conditions to help clinicians in deciding on probability immediately. The patients were grouped into four diagnostic categories; namely, schizophrenic disorders, mood disorders, neuroleptic-induced disorders, and general medical conditions for comparison. One-way ANOVA and Duncan's multiple-range test were used for continuous variables, and the Chi-squared test was used for categorical variables. The mean duration of 'insidious onset catatonic condition' (including schizophrenic disorders and general medical conditions) before seeking medical help was longer than 3.33 weeks, while the mean duration of 'acute catatonic condition' (including mood disorders and neuroleptic-induced disorders) was shorter than 1.83 weeks. These findings suggest that 2-3 weeks would be a cut-off point for acute or insidious onsets of catatonic conditions.