“Clinical profile of Organic Catatonia- a case series”

BACKGROUND: Catatonia is a motor syndrome associated with various psychiatric and medical disorders. Studies show that 20-39% of patients with catatonia have an underlying organic aetiology which is often under diagnosed in non-psychiatric settings. Although no specific guidelines are available, lorazepam and electroconvulsive therapy (ECT) have been the mainstay in the management of organic catatonia. We aim to report the clinical correlates and outcome in patients presenting with catatonia secondary to physical illness. METHODOLOGY: This was a retrospective file review study of 7 patients with a diagnosis of organic catatonia between January 2016 and September 2021. We extracted sociodemographic details, clinical features, and details of medical co-morbidities, biochemical investigations, electroencephalogram and neuroimaging findings, and treatment response. RESULTS: Seven patients (4 female and 3 male) with a mean age of 30.14 (SD 8.38) years presented with organic catatonia. The median duration of symptoms was 10 (IQR 44) days. Mutism (n=7) and staring (n=7) were the most common catatonic symptoms. Five out of 7 patients responded to lorazepam with a mean dose of 8 (SD 3.26) mg, and the remaining 2 received ECT and had poor outcome. CONCLUSION: Organic catatonia is often under diagnosed and poses varied treatment challenges due to co-morbid physical illness. Treatment with lorazepam appears to be promising as first line option. Safety of ECT in organic catatonia needs further evaluation. KEY MESSAGES: 1. Organic catatonia poses varied diagnostic and therapeutic challenges in comparison to its psychiatric counterpart. 2. Lorazepam is promising in the management of organic catatonia, while the safety of electroconvulsive therapy needs further evaluation.