Pharmacopsychiatry 2020; 53(01): 14-20
DOI: 10.1055/a-1007-1949
Review
© Georg Thieme Verlag KG Stuttgart · New York

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

Carlos Schönfeldt-Lecuona
1  Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
,
Maximilian Cronemeyer
1  Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
,
Lilli Hiesener
1  Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
,
Bernhard J. Connemann
1  Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
,
Maximilian Gahr
1  Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
,
Alexander Sartorius
2  Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
Viktoria Mühlbauer
1  Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
3  Geriatric Universitary Clinic Ulm, Agaplesion Bethesda, Geriatric Center Ulm/Alb-Donau, Germany
› Author Affiliations
Further Information

Publication History

received 09 May 2019
revised 18 July 2019

accepted 27 August 2019

Publication Date:
26 September 2019 (online)

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.