(COVID-19) SARS-CoV-2-catatonia syndrome: does it exist? Longitudinal evidence

Catatonia is a complex neurobehavioral syndrome related with several psychiatric and medical conditions. The underlying pathophysiological mechanism is the dysfunction of cortical-subcortical motor regulation systems, including GABA, dopamine, and glutamate, or increased and sympathetic freezing response may be some of the mechanisms. The pathogenesis of neuropsychiatric complications related to COVID-19 is associated with nervous system damage due to systemic inflammation and cytokine storm. In catatonia, evidence of acute phase activation has been shown rarely. In this study, we aimed to investigate the relationship between COVID-19 and catatonia, which has been reported as case reports in the literature.

This study has been designed as a retrospective chart review. The data was collected by three psychiatrists for the period of four years, separated into before and after the released first case (11/03/2020) from emergency psychiatry department, outpatient and inpatient clinics of Erenköy Training and Research Hospital for Mental Health and Neurological Disorders. The keywords when searching in the hospital database were "catatonia", "catatonia-syndrome", and all catatonia symptoms in DSM-5. After the pandemia started, we searched for COVID-19 infection additionally.

Forty patients were included in the study, consisting of 20 females (50.00%) and 20 males (50.00%). There was no significant difference in pre-(n:18) and post-COVID 19 (n:22) cases according to age, gender, underlying cause, treatment applied in two groups (p<0.05). In addition, symptom diversity of catatonia was not statistically significant in both groups (p<0.05). In the post-pandemic period, 2 cases were diagnosed with COVID-19 in the last month.

Postinfectious COVID-19 catatonia is a rare neuropsychiatric complication of COVID-19. The result of our study supports the unclear role of acute phase reactants in catatonia. Neuropsychiatric symptomatology is broad in postinfectious COVID-19. As understanding of the pathogenesis remains fairly limited, symptomatic management is an appropriate strategy.