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

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

• 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