Catatonia, a condition recognized since the 1800s, remains difficult to diagnose and treat. A systematic review of 20 studies involving 25 patients who received ketamine or esketamine for catatonia found that 80% of patients responded to treatment and 44% achieved remission, with no worsening of catatonic or psychotic symptoms. Only one patient stopped treatment due to intolerable dissociative effects. Most patients were female (61.9%), with an average age of 44.4 years, and had underlying mood disorders. The evidence suggests ketamine may be effective for catatonia, even in patients with psychotic disorders, where it has traditionally been considered contraindicated. The authors advocate reevaluating this contraindication, noting potentially greater benefits for those with mood disorders.
Psychiatry's focus on discrete behavioral constructs has increased reliability but fragmented the understanding of mental life as a coherent whole, creating a paradox of 'more data, less coherence.' The authors revisit Karl Jaspers' concept of the whole of psychic life and propose five guiding principles—relationality, historicity, subjectivity, intentionality, and indeterminacy—to translate classical phenomenology into a framework usable in contemporary psychiatry, statistics, and neuroscience. They develop tools to isolate patterns of experience without treating them as autonomous entities, allowing reductionism as a local method rather than a global framework. The framework aims to restore context to clinical practice and integrate subjective experience with biological data.