Correlational Analysis of Socio-demographic and Clinical Profile in Determining the Treatment Response in Patients with Catatonia in the Psychiatric Inpatient Department of a Rural Tertiary Care Centre in Eastern India

Abstract

Introduction: Catatonia, a poorly understood syndrome challen-ging the clinician’s diagnostic and management skills, has scarce literatures regarding the clinical correlates and determining factors towards treatment response. Aim: To find the correlates of socio-demographic, clinical profile, catatonic features and identifying determining factors of treatment response to lorazepam and Modified Electroconvulsive Therapy (MECT) in catatonia. Materials and Methods: This cross-sectional study was conducted at the Department of Psychiatry, North Bengal Medical College, Siliguri, West Bengal, India from January 2020 to February 2021. The catatonia cases satisfying the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were studied. A total of 66 patients were evaluated using the 23-item Bush Francis Catatonia Rating Scale (BFCRS) for severity and later grouped into lorazepam responder (Group I) and non responders (Group II) who received MECT. Background diagnoses using DSM-5 was made after symptom resolution. Statistical analyses like Chi-square and student’s t-test to compare frequencies and means respectively, Pearson’s and Spearman’s correlation test for bivariate correlation and linear and logistic regression to predict factors for treatment outcome were employed using Statistical Package for the Social Sciences (SPSS) 16.0 with a p-value <0.05 considered significant. Results: Among 66 patients, group I had total 54 patients (mean age=25.25±7.03 years) and group II had 12 patients (mean age=23.25±4.30 years). Schizophrenia spectrum disorders were the major underlying psychiatric diagnosis. The MECT was needed in 58.33% of patients with positive family history of psychiatric disorders as compared to 14.81% who responded to lorazepam (p-value=0.001). Severity of catatonia measured by the total BFCRS Scores was higher in the Group II (p-value <0.001). Positive family history (Spearman’s rho=-0.512, p-value <0.001) and longer hospital stay (Spearman’s correlation coefficient=0.344; p-value=0.005) had significant correlation to catatonic severity. The BFCRS subscale bivariate correlational analysis showed high scores on immobility, mutism, staring, grimacing, rigidity, negativism, withdrawal and autonomic abnormality correlated significantly with MECT response. High scores on stereotypy, waxy flexibility and excitement correlated significantly with lorazepam response. Conclusion: Lorazepam was effective in most cases. Higher scores on BFCRS, positive family history of psychiatric illness, presence of mutism, rigidity, immobility, withdrawal and negativism correlated with lorazepam resistance and MECT response. Waxy flexibility, stereotypy and excitement correlated to lorazepam response. Severity of catatonic symptoms and positive family history were the determining factor for non response to Lorazepam. This could provide insight into the management strategies and treatment protocol in catatonia.

Keywords

• electroconvulsive therapy
• immobility
• lorazepam
• mutism
• waxy flexibility