Journal Article Annotations
2020, 4th Quarter
Annotations by Maalobeeka Gangopadhyay, MD
PUBLICATION #1 — Catatonia
57 patients with catatonia were divided between a single 4mg pr 2mg lorazepam dose administered intravenously. Patients’ Bush Francis Catatonia Rating Scale score was calculated pre and post administration. No significant difference in effectiveness was noted between the two groups irrespective of catatonia severity scores. Effectiveness was defined as a 50% reduction in severity of score: 67.6% responded in 2mg arm and 45% showed a response in 4mg arm. The investigators found certain symptoms seemed to respond better at the 2mg dose than the 4mg dose.
Strengths and limitations:
Each patient was examined in detail by an outpatient team as well as the emergency and acute care service psychiatrist; standardized instruments were used to document catatonia symptoms and severity. The investigator was blinded. One limitation of the study was that it was one point in time, and patients were not followed to see if they needed subsequent dose administrations or how long their catatonia persisted. That catatonia was diagnosed by the outpatient team and then referred might lead to some selection bias, particularly as patients presenting directly to the acute service with catatonia were not included.
When a patient presents with catatonia, starting with a 2mg iv administration of lorazepam can be just as effective as a 4mg administration; the latter dose may be reserved for patients with history of catatonia or younger age.
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Prospective cohort study):
This paper combines 16 adult cases of OCD with catatonia and illustrates symptom variety, treatment strategies, and response. The series describes treatment resistance to benzodiazepines or ECT alone and reinforces the need to treat underlying OCD aggressively as well. It is theorized that before the occurrence of the catatonia, patient experience a spike in anxiety symptoms.
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Letter to the Editor: Systematic review of case studies
This is a pediatric case series of 4 patients with non-NMDA autoimmune encephalopathy and catatonia treated with ECT; each case describes the workup and treatment for psychiatric symptoms, catatonia, and autoimmune pathology. Recommendations in autoimmune-associated catatonia are organized by workup, choice of anesthetics and muscle relaxants when administering ECT, the application and frequency of ECT, and need for multidisciplinary care.
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