Published online Feb 19, 2022. doi: 10.5498/wjp.v12.i2.348
Peer-review started: May 30, 2021
First decision: July 14, 2021
Revised: July 27, 2021
Accepted: January 20, 2022
Article in press: January 20, 2022
Published online: February 19, 2022
Processing time: 262 Days and 23.3 Hours
Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated, even though its classification has evolved in recent years. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. The underrecognition of catatonia in older patients is also frequent, and research in this population is scarce.
To conduct a systematic review of the literature on catatonia in older people to ascertain its clinical characteristics across settings.
Following the PRISMA guidelines, MEDLINE, EMBASE, and PsycINFO databases were searched from inception to December 2021, with a strategy aimed at identifying all articles published on catatonia in older adults. Titles and abstracts were scanned and selected independently by two authors. Papers investigating issues related to catatonia and/or catatonic symptoms in older people, with English abstracts available, were included. References of selected articles were revised to identify other relevant studies.
In total, 1355 articles were retrieved. After removing duplicates, 879 remained. Of the 879 identified abstracts, 669 were excluded because they did not meet the inclusion criteria. A total of 210 articles underwent full text review, and 51 were eliminated for various reasons. Fourteen more articles were selected from the references. Overall, 173 articles were reviewed: 108 case reports, 35 case series, 11 prospective cohort studies, 6 case-control studies, 3 retrospective cohort studies and 10 reviews. We found several particular aspects of catatonia in this population. Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. Older patients, compared to younger patients, have a higher risk of developing catatonia with benzodiazepine (BZD) withdrawal, in bipolar disorder, and in the general hospital. Age, together with other risk factors, was significantly associated with the incidence of deep venous thrombosis, neuroleptic malignant syndrome poor outcome, other complications and mortality. Treatment with BZDs and electroconvulsive therapy is safe and effective. Prompt treatment of its cause is essential to ensure a good prognosis.
Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. The risk of developing catatonia in some settings and conditions, as well as of developing complications, is high in this population. Symptomatic treatment is safe and effective, and timely etiologic treatment is fundamental.
Core Tip: Catatonia in older people is underrecognized and undertreated, as demonstrated by the scarce bibliography published in this age group, in which the prevalence is high and the etiology usually multifactorial. Catatonia can frequently present together with delirium. General medical conditions and neurological disorders have a very important role in its etiology. Older people could have a higher risk of developing catatonia in bipolar disorder, the general hospital and with benzodiazepine (BZD) withdrawal. Also, they have a higher risk of developing complications secondary to this condition. BZDs and electroconvulsive therapy have been proven to be safe and effective symptomatic treatments, but the correct identification and treatment of the etiology are crucial for a full recovery.