ECT for Catatonia: Data from the Nationwide Inpatient Sample

Out on PubMed, in JECT, is this data analysis:

ECT Utilization in the Treatment of Catatonic Patients in the United States: A Nationwide In-Patient Sample Analysis.

Trivedi C, Manikkara G, Zhang M, Mansuri Z, Jain S.J ECT. 2021 Mar 4. doi: 10.1097/YCT.0000000000000753. Online ahead of print.PMID: 33661185

The abstract is copied below:

Introduction: Primary objective was to evaluate baseline characteristics for catatonic patients treated with and without electroconvulsive therapy (ECT). We also studied the trends of ECT utilization in catatonia patients.

Methods: The Nationwide Inpatient Sample data were used to compare patients and hospital-level characteristics between catatonic patients treated with and without ECT in the United States. Multivariate and trend analysis were performed.

Results: Electroconvulsive therapy was performed in 8.3% in patients with the diagnosis of catatonia (n = 24,311; mean age, 43.1; 38% White; 52.1% male). Racially, more patients in the ECT group were White (47% vs 38%) and had a comorbid diagnosis of major depressive disorder. In the multivariate analysis, the odds of receiving ECT was more with increase in age (P = 0.007). Urban area hospitals had 3 times higher odds of receiving ECT (P = 0.001) compared with rural hospitals. The odds of receiving ECT for catatonia were the highest for large bed hospitals compared with small/medium size (P < 0.001). In the trend analysis, catatonia patients undergoing ECT decreased initially from 7.0% in 2002 to 2005 to 5.2% in 2006 to 2009. After that, there was an upward trend with 10.6% patients undergoing ECT in the quarter 2014 to 2017. There was an upward trend in ECT utilization for catatonic patients with comorbid bipolar disorders and psychotic disorders.

Conclusions: Electroconvulsive therapy is underutilized for catatonia treatment in the United States. White catatonic patients are most likely to get ECT at an urban large bed hospital. In recent years, there is an upward trend in the use of ECT. Additional controlled clinical trials are warranted.

and a figure:

This is an interesting, if somewhat confusing, analysis of data from the Nationwide Inpatient Sample. The main takeaways are that ECT use for catatonia is low, but increasing, and that the likelihood of receiving ECT increases with age, better insurance, being non-minority, in a large, urban hospital setting, not in the western part of the USA. The dataset covers 16 years and 1/5 of admissions; if I have done the arithmetic correctly, that means about 7,500 catatonia diagnoses in the US annually. This is a far cry from the 90,000 estimate in the introduction from the literature. Of course, catatonia is grossly underdiagnosed, but the wide range of estimated prevalence rates may also have to do with the broad spectrum of illness: isolated catatonic symptoms in a depressed patient on the one hand (possibly overlapping with "psychomotor retardation"), all the way to full-blown malignant catatonia.

Common or not so common, catatonia has emerged as the centerpiece of ECT effectiveness, helping to get the FDA reclassification to Class II and leading to a revitalized ECT literature. Max Fink has played a pivotal role in this story.