Catatonia and COVID: Case Series From India

Out on PubMed, from clinicians in India, is this report:

Concurrent catatonia and COVID-19 infection - An experiential account of challenges and management of cases from a tertiary care psychiatric hospital in India.

Sakhardande KA, Pathak H, Mahadevan J, Muliyala KP, Moirangthem S, Reddi VSK.Asian J Psychiatr. 2022 Jan 4;69:103004. doi: 10.1016/j.ajp.2022.103004. Online ahead of print. PMID: 35016069  

The abstract is copied below:

Catatonia has been reported as one among many neuropsychiatric manifestations associated with COVID-19 infection. Catatonia and COVID-19 co-occurrence remain clinical concerns, often posing challenges pertaining to diagnosis, and especially management. Limited information is available regarding the appropriate approaches to the management of catatonia in COVID-19 infection, particularly with reference to the safety and efficacy of benzodiazepines and Electro-convulsive therapy (ECT). We present our experience of five patients with catatonia consequent to heterogeneous underlying causes and concurrent COVID-19 infection, who received care at the psychiatric COVID unit of our tertiary care psychiatric hospital. An interesting observation included varying underlying causes for catatonia and the potential role that COVID-19 infection may have played in the manifestation of catatonia. In our experience, new-onset catatonia with or without pre-existing psychiatric illness and concurrent COVID-19 can be safely and effectively managed with lorazepam and/or ECTs. However, critical to the same is the need to implement modified protocols that integrate pre-emptive evaluation for COVID-19 disease and proactive monitoring of its relevant clinical parameters, thereby permitting judicious and timely implementation of catatonia-specific treatment options.

Keywords: Benzodiazepines; COVID; Catatonia; ECT; Electroconvulsive therapy; Neuropsychiatric. The article is here.And from the text:

This is an interesting case series from the NIMHANS in Bangalore, India. The unifying theme is catatonic symptoms and COVID positivity, although beyond that, they are quite diverse. In only one patient, does it seem likely that the COVID infection was the cause of the catatonia. Nonetheless, the authors are careful to note the complexities of neuropsychiatric presentations in the presence of systemic viral infection, and that we are still early on in the learning curve about how COVID may affect the CNS.The description of sophisticated, multidisciplinary care is also interesting, and the quick prescription of ECT (with good results) to 3 of the 5 patients is noteworthy. Note also that the COVID protocol of the time included ivermectin.Catatonia scholars/students will want to read every detail of these cases, as will developing COVID/neuropsychiatry scholars, ~15 minutes.