The use of atypical antipsychotics in the treatment of catatonia.
OBJECTIVE
Evidence indicates that classical antipsychotics may aggravate non-malignant and malignant catatonia (MC). Atypical antipsychotics are less likely to cause movement disorders than classical antipsychotics and they are being frequently prescribed in disorders that can be associated with catatonia. Therefore, the important question that arises is whether atypical antipsychotics have a role to play in the treatment of catatonia.


METHODS
A Medline search was performed to locate papers on the use of atypical antipsychotics in catatonia published between 1970 and 31st December 2004.


RESULTS
The literature on the use of atypical antipsychotics in catatonia consists of case reports and retrospective studies. In most cases of non-MC a reduction of the catatonic symptoms is reported upon treatment with atypical antipsychotics. Cases of MC relate mainly to the neuroleptic malignant syndrome (NMS), which is considered as an iatrogenic stuporous variant of MC caused by antipsychotics.


CONCLUSIONS
There are indications that atypical antipsychotics may be useful in non-MC. As a consequence, one should not only focus on the possible extrapyramidal and autonomic side effects of these drugs, but also on the possible beneficial effects on certain brain functions and on the catatonic symptomatology. However, randomized controlled trials are needed to evaluate the effect of these drugs, and caution is advisable, since cases of NMS have been linked to treatment with atypical antipsychotics. There is no evidence to prescribe atypical antipsychotics in MC.
Van Den Eede
Filip
F
Collaborative Antwerp Psychiatric Research Institute, CAPRI, University of Antwerp (UA), Campus Drie Eiken/Building T, Universiteitsplein 1, 2610 Antwerp, Belgium.
Van Hecke
Jan
J
Van Dalfsen
Arjen
A
Van den Bossche
Bart
B
Cosyns
Paul
P
Sabbe
Bernard G C
BG
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002389:Catatonia / Q000188:drug therapy*; D006801:Humans; D009459:Neuroleptic Malignant Syndrome / Q000209:etiology
D014150:Antipsychotic Agents