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Malignant Catatonia: A Review for the Intensivist.

Jennifer Connell^1,2, Mark Oldham³, Pratik Pandharipande^1,4

¹Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.

Journal of Intensive Care Medicine

|July 21, 2022

Summary

Catatonia is a serious condition involving psychomotor and behavioral changes. Prompt recognition and treatment, especially for malignant catatonia, are vital to prevent potentially fatal outcomes.

Keywords:

Catatonia critical illness delirium multidisciplinary critical care

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Area of Science:

Neurology
Psychiatry
Critical Care Medicine

Background:

Catatonia is a complex syndrome with diverse psychomotor, neurological, and behavioral manifestations.
It can present as akinetic stupor or severe motor excitement, often co-occurring with psychiatric disorders, medical illnesses, delirium, or coma.
Malignant catatonia, a life-threatening subtype, features significant autonomic instability.

Purpose of the Study:

To highlight the critical importance of recognizing and managing catatonia, particularly malignant catatonia.
To inform intensivists about the under-recognized nature and potential fatality of malignant catatonia.
To emphasize the need for prompt diagnosis and treatment in critically ill patients.

Main Methods:

Review of clinical presentation and characteristics of catatonia.
Discussion of predisposing and precipitating factors, especially in critical illness settings.
Overview of treatment strategies including benzodiazepines, underlying condition management, and electroconvulsive therapy.

Main Results:

Catatonia presents with a wide spectrum of motor and behavioral symptoms.
Malignant catatonia is characterized by severe autonomic dysfunction and carries a high risk of mortality.
While benzodiazepines and treating underlying causes are primary treatments, some forms may be refractory.

Conclusions:

Early identification and intervention for catatonia are crucial for improving patient outcomes.
Malignant catatonia requires immediate attention due to its potentially fatal course.
Intensivists must be aware of catatonia as a significant and potentially under-diagnosed condition in critical care.