Catatonia Psychopathology and Phenomenology in a Large Dataset.
Eleanor Dawkins, Leola Cruden-Smith, Ben Carter, Ali Amad, Michael S Zandi, Glyn Lewis, Anthony S David, Jonathan P Rogers
Frontiers in Psychiatry 2022 DOI: 10.3389/fpsyt.2022.886662 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective descriptive cross-sectional study Peer reviewed |
|---|---|
| Sample size | 1,456 |
| Population | Patients with validated diagnoses of catatonia from a secondary mental health trust in London, United Kingdom |
| Topics | Anxiety Philosophy of mind |
| Keywords | Catatonia Cluster analysis Fear Principal component Psychopathology Subjective experience |
| Citations | 37 |
| Key findings | Catatonic signs cluster into parakinetic, hypokinetic, and withdrawal components, each associated with distinct demographic and clinical variables, and while fear is present in a large minority, most patients provide a meaningful narrative explanation for their catatonia. |
Abstract
The external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received little attention. This study aimed to use a large dataset to describe the clinical signs of catatonia; to assess whether these signs are associated with underlying diagnosis and prognosis; and to describe the phenomenology of catatonia, particularly with reference to fear. A retrospective descriptive cross-sectional study was conducted using the electronic healthcare records of a large secondary mental health trust in London, United Kingdom. Patients with catatonia were identified in a previous study by screening records using natural language processing followed by manual validation. The presence of items of the Bush-Francis Catatonia Screening Instrument was coded by the investigators. The presence of psychomotor alternation was assessed by examining the frequency of stupor and excitement in the same episode. A cluster analysis and principal component analysis were conducted on catatonic signs. Principal components were tested for their associations with demographic and clinical variables. Where text was available on the phenomenology of catatonia, this was coded by two authors in an iterative process to develop a classification of the subjective experience of catatonia. Searching healthcare records provided 1,456 validated diagnoses of catatonia across a wide range of demographic groups, diagnoses and treatment settings. The median number of catatonic signs was 3 (IQR 2-5) and the most commonly reported signs were mutism, immobility/stupor and withdrawal. Stupor was present in 925 patients, of whom 105 (11.4%) also exhibited excitement. Out of 196 patients with excitement, 105 (53.6%) also had immobility/stupor. Cluster analysis produced two clusters consisting of negative and positive clinical features. From principal component analysis, three components were derived, which may be termed parakinetic, hypokinetic and withdrawal. The parakinetic component was associated with women, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders. 68 patients had phenomenological data, including 49 contemporaneous and 24 retrospective accounts. 35% of these expressed fear, but a majority (72%) gave a meaningful narrative explanation for the catatonia, which consisted of hallucinations, delusions of several different types and apparently non-psychotic rationales. The clinical signs of catatonia can be considered as parakinetic, hypokinetic and withdrawal components. These components are associated with diagnostic and prognostic variables. Fear appears in a large minority of patients with catatonia, but narrative explanations are varied and possibly more common.
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|---|---|---|---|
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| The Phenomenology of Lucid Dreaming: An Online Survey Respondents to an online survey about lucid dreams | 2014 | Online survey | n = 684 |
| The neurophenomenology of early psychosis: An integrative empirical study. Ultra-high risk for psychosis patients, first episode psychosis patients, and healthy... | 2019 | Cross-sectional | n = 123 |
| Spontaneous Spiritual Awakenings: Phenomenology, Altered States, Individual Differences, and Well-Being People reporting their most powerful Spontaneous Spiritual or Kundalini Awakening | 2021 | Mixed within and between-participants self-report survey design | n = 152 |