Catatonia in the elderly

Catatonia in geriatric patients has been insufficiently investigated. We reviewed 71 case descriptions from 45 studies to clarify the phenomenology, diagnosis, etiology, and treatment of catatonia in the elderly. In elderly patients, catatonia is frequently observed in association with general medical conditions. In patients with a history of depression or schizophrenia, physicians occasionally overlook the medical conditions because they believe the previous psychosis to be the cause of the catatonic features. Despite historical discussions of a relation between the disorders, the number of patients with catatonia and a prior diagnosis of schizophrenia or another psychotic disorder is not large. A diagnosis of catatonia should be considered in cases of atypical "collapse" in elderly patients with a previous psychiatric history of mood disorder. Catatonia due to anxiety/adjustment disorder is quite rare, whereas catatonia in association with neuroleptic malignant syndrome is fairly common. For early commencement of treatment, early detection of catatonia in the elderly is important. In studies of psychotropic drug treatment, many authors observed a beneficial response to lorazepam in catatonic patients. For medication-refractory patients, electroconvulsive therapy should be considered. It is important to prevent the development of venous thrombosis as a serious complication in stuporous catatonic patients.