Comparison of International Therapy Guidelines with Regard to the Treatment of Malignant Catatonia

Carlos Schönfeldt-Lecuona; Maximilian Cronemeyer; Lilli Hiesener; Bernhard J. Connemann; Maximilian Gahr; Alexander Sartorius; Viktoria Mühlbauer

doi:10.1055/a-1007-1949

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2020; 53(01): 14-20
DOI: 10.1055/a-1007-1949

Review

Comparison of International Therapy Guidelines with Regard to the Treatment of Malignant Catatonia

Carlos Schönfeldt-Lecuona

¹Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany

,

Maximilian Cronemeyer

¹Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany

,

Lilli Hiesener

¹Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany

,

Bernhard J. Connemann

¹Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany

,

Maximilian Gahr

¹Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany

,

Alexander Sartorius

²Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

,

Viktoria Mühlbauer

¹Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany

³Geriatric Universitary Clinic Ulm, Agaplesion Bethesda, Geriatric Center Ulm/Alb-Donau, Germany

› Author Affiliations

Abstract

Objective Malignant catatonia (MC) is an extremely rare, life-threatening disorder. It is characterized by catatonic symptoms accompanied by autonomic instability, hyperthermia, and changes in laboratory values. In many cases, MC is not recognized as such. Evidence-based guidelines are essential to ensure quality of treatment, but what do current national and international guidelines recommend?

Method Online search for international guidelines from English-, French-, Italian-, and German-speaking countries whose medical care meets high standards addressing the treatment of MC. These were analyzed and compared regarding statements on MC, recommendations, and strength of scientific evidence.

Results Fifteen of the identified guidelines were included. Only 5 of 15 comment on the treatment of MC. As for other rare diseases, no detailed recommendations are available. Suggested therapies are limited to benzodiazepines and electroconvulsive therapy. Levels of evidence and grades of recommendation are predominantly low.

Conclusion Many international guidelines do not mention MC. It is not possible to derive a clear algorithm for the treatment of MC from most current guidelines. A thorough update of most guidelines appears to be necessary. Lack of awareness and knowledge of MC among physicians and medical professionals might lead to inadequate or delayed care, worsened outcome, or death.

Key words

malignant catatonia - febrile catatonia - guideline - therapy - treatment

Full Text

References

References
1 Kahlbaum KL. Die Katatonie oder das Spannungsirresein. Berlin: Verlag August Hirschwald; 1874
2 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association; 2013
3 Philbrick KL, Rummans TA. Malignant catatonia. J Neuropsychiatry Clin Neurosci 1994; 6: 1-13
4 Calmeil LF. Dictionnaire de Medecine ou Repertoire General des Sciences. Medicales sous le Rapport Theorique et Practique. 2nd ed. Paris; Bechet: 1832
5 Stauder KH. Die tödliche Katatonie. Arch Für Psychiatr Nervenkrankh 1934; 102: 614-634
6 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition (DSM-IV) Washington, DC: American Psychiatric Association; 1994
7 Mann SC, Caroff SN, Campbell EC. et al. Malignant Catatonia. In: Frucht SJ, Fahn S. eds Movement Disorder Emergencies: Diagnosis and Treatment. Totowa, NJ: Humana Press; 2005: 53-67
8 Solmi M, Pigato GG, Roiter B. et al. Prevalence of catatonia and its moderators in clinical samples: results from a meta-analysis and meta-regression analysis. Schizophr Bull 2018; 20: 1133-1150
9 Espinola-Nadurille M, Ramirez-Bermudez J, Fricchione GL. et al. Catatonia in neurologic and psychiatric patients at a tertiary neurological center. J Neuropsychiatry Clin Neurosci 2016; 28: 124-130
10 Hafner H. Akute lebensbedrohliche Katatonie. Nervenarzt 1982; 53: 385-394
11 Koziel-Schminda E. “Ostra Smierteina Katatonia” Typu Staudera O Przebiegu Letalnym (Analiza Materialow Kliniczynch I Sekcyjnch Szpitala W Kochborowie Z Lat 1950–1970). Psychiatr Pol 1973
12 Arnold OH, Stepan H. Untersuchungen zur Frage der akuten tödliche Katatonie. Wien Z Für Nervenheilkd 1952; 4: 235-287
13 Northoff G, Eckert J, Fritze J. Glutamatergic dysfunction in catatonia? Successful treatment of three acute akinetic catatonic patients with the NMDA antagonist amantadine. J Neurol Neurosurg Psychiatry 1997; 62: 404-406
14 Scottish Intercollegiate Guidelines Network.Harbour RT, Forsyth L. SIGN 50: A guideline developer’s handbook. Ediburgh, Scotland: Scottish Intercollegiate Guidelines Network 2008; Accessed on July 12 2019; Available at http://www.sign.ac.uk/pdf/sign50.pdf
15 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Leitlinie “Schizophrenie” der DGPPN 2006; Accessed on March 1, 2019. Available at https://www.awmf.org/leitlinien/detail/ll/038-009.html
16 Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde. S3-Behandlungsleitlinie Schizophrenie 2006; Accessed on March 1, 2019. Available at https://www.dgppn.de/leitlinien-publikationen/leitlinien.html
17 Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde. Update der S3-Praxisleitlinie in Psychiatrie und Psychotherapie zur Behandlung von Schizophrenie 2018; Accessed on March 1, 2019. Available at https://www.awmf.org/leitlinien/detail/anmeldung/1/ll/038-009.html
18 Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde. S2k-Leitlinie Notfallpsychiatrie 2018; Accessed on March 1, 2019. Available at https://www.awmf.org/leitlinien/detail/anmeldung/1/ll/038-023.html
19 Singh D, Chander V, Chopra K. Rhabdomyolysis. Methods Find Exp Clin Pharmacol 2005; 27: 39-48
20 Österreichische Gesellschaft für Neuropsychopharmakologie und Biologische Psychiatrie. Schizophrenie: aktuelle Behandlungsleitlinien 2016; Accessed on March 1, 2019. Available at https://oegpb.at/2015/04/19/schizophrenie-aktuelle-behandlungsleitlinien
21 World Federation of Societies of Biological Psychiatry. Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance 2012; Accessed on March 1, 2019. Available at https://www.wfsbp.org/educational-activities/wfsbp-treatment-guidelines-and-consensus-papers
22 American Psychiatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia 2004; Accessed on March 1, 2019. Available at https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines
23 Schweizerische Gesellschaft für Psychiatrie und Psychotherapie. Behandlungsempfehlungen Schizophrenie 2016; Accessed on January 3, 2019. Available at https://www.psychiatrie.ch/sgpp/fachleute-und-kommissionen/behandlungsempfehlungen
24 Schizophrenia Patient Outcomes Research Team (PORT). Translating Research Into Practice: The Schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations 2009; Accessed on March 1, 2019. Available at https://academic.oup.com/schizophreniabulletin/article/24/1/1/1877858?searchresult=1
25 The National Institute for Health Care Excellence (NICE). Psychosis and schizophrenia in adults: prevention and management 2014; Accessed on March 1, 2019. Available at https://www.nice.org.uk/guidance/cg178
26 The National Institute for Health Care Excellence (NICE). Psychosis and schizophrenia in children and young people: recognition and management 2016; Accessed on March 1, 2019. Available at https://www.nice.org.uk/guidance/cg155
27 Grover S, Chakrabarti S, Kulhara P. et al. Clinical practice guidelines for management of schizophrenia. Indian J Psychiatry 2017; 59: 19
28 Canadian Psychiatric Association. Clinical Practice Guidelines – Treatment of Schizophrenia. 2005; Accessed on March 1, 2019. Available at http://ww1.cpa-apc.org/French_Site/Publications/Clinical_Guidelines/schizophrenia/november2005/Assesments.asp
29 The Royal Australian and New Zealand College of Psychiatrists. Clinical Practice Guidelines for the Management of Schizophrenia and related disorders 2016; Accessed on March 1, 2019. Available at https://www.ranzcp.org/publications/Guidelines-and-resources-for-practice/Schizophrenia-CPG-and-associated-resources
30 Haute Autorité de Santé. Guide médecin sur les schizophrénies 2007; Accessed on March 1, 2019. Available at https://www.has-sante.fr/portail/jcms/c_565630/fr/ald-n23-schizophrenies
31 Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin. Leitlinien der Intensiv- und Notfallmedizin. Accessed on March 1 2019; Available at https://www.divi.de/empfehlungen/leitlinien-intensivmedizin
32 Svenska psykiatriska föreningen. ECT: kliniska riktlinjer [för elektrokonvulsiv behandling]. Sundsvall; Stockholm: Svenska psykiatriska föreningen; Gothia fortbildning; 2014
33 Dansk Psykiatrisk Selskab. ECT-vejledning 2011;Accessed on July 8, 2019. Available at http://dpsnet.dk/wp-content/uploads/2015/01/dps_ect_vejledning__2011_med_t.pdf
34 Pfizer: Fachinformation Tavor 1,0/2,5 mg Expidet. 2016; Accessed on March 1, 2019. Available at http://fachinformation.srz.de/pdf/pfizerpharma/tavorexpidet.pdf
35 Pfizer: Fachinformation Tavor 0,5 mg/1,0 mg/Tabs 2,0 mg/2,5 mg Tabletten. 2016; Accessed on March 1, 2019. Available at http://fachinformation.srz.de/pdf/pfizerpharma/tavor.pdf
36 Pfizer: Fachinformation Tavor pro injectione 2 mg. 2019; Accessed on March 1, 2019. Available at https://www.pfizermed.de/fileadmin/produktdatenbank/pdf/002573_freigabe.pdf
37 GmbH JC. Fachinformation Haldol-Janssen, Tropfen zum Einnehmen, 2 mg/mL Lösung 2017; Available at https://s3.eu-central-1.amazonaws.com/prod-cerebro-ifap/media_all/80187.pdf
38 neuraxpharm GmbH: Fachinformation Haloperidol-neuraxpharm 1 mg. 2013; Accessed on March 1, 2019. Available at https://s3.eu-central-1.amazonaws.com/prod-cerebro-ifap/media_all/50509.pdf
39 ratiopharm GmbH: Fachinformation Haloperidol-ratiopharm 5 mg Injektionslösung. 2017; Accessed on March 1, 2019. Available at https://www.gelbe-liste.de/produkte/beipackzettel_Haloperidol-ratiopharm-5-mg-Injektionsloesung.pdf/1167625b-062c-495b-b7c0-2dcdc4a39c01
40 Hirjak D, Sartorius A, Kubera KM. et al. Antipsychotikaassoziierte motorische Symptome bei schizophrenen Psychosen – Teil 2. Nervenarzt 2019; 90: 12-24