New guidelines on catatonia aim to create a step-change in management

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For the first time, the British Association for Psychopharmacology (BAP) has produced a guideline on catatonia. Catatonia is a severe psychiatric disorder that has been associated with a wide range of medical complications. Yet recognition and management remain poor.

Twenty-two experts from across three continents examined the latest research on this important condition and have developed a series of recommendations ranging from diagnosis and investigation to treatment. According to the lead author, Dr Jonathan Rogers of University College London, the guidelines “aim to create a step-change in the management of a neglected condition”.

Unlike many psychiatric conditions, treatment of catatonia can have surprisingly fast results, sometimes within minutes. The main group of medications recommended for catatonia are benzodiazepines, which are cheap and widely available but can have a dramatic effect, with 66 – 100% being effectively treated in a number of studies. Electroconvulsive therapy (ECT), in which an electrically induced seizure is produced under general anaesthetic, is also highly effective.

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The guidelines are among the most comprehensive ever published on catatonia, referencing more than 500 research articles in the literature. There is attention to particular groups who may have special requirements, such as children, older adults, women in pregnancy or the postnatal period and those with autism spectrum disorder.

As well as emphasising the importance of using tried and tested treatments for catatonia, the guidelines also draw on the latest evidence linking catatonia to neurological problems, such as epilepsy and autoimmune encephalitis. There are recommendations on the use of brain scans, brain wave tests and tests for autoantibodies in certain cases.

However, the guidelines note that the evidence behind many of their recommendations is largely based on small studies rather than proper clinical trials. According to Dr Rogers, “It’s really unfortunate that there is so little high-quality research on one of the most severe conditions in all of psychiatry.”

The guidelines aim to improve practice in the UK and abroad, while catalysing further research into even more effective treatments.


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