title: Guidelines for preventing common medical complications of catatonia: case report and literature review.
abstract: OBJECTIVE
  Comprehensive hospital-based care for individuals with catatonia relies on preventive approaches to reduce medical morbidity and mortality. Without syndrome-specific guidelines, psychiatrists must draw from measures used for general medical and surgical inpatients. We employ a prototypical case to highlight medical complications of catatonia and review preventive guidelines for implementation in the inpatient setting.
  
  
  METHODS
  Searches of the PubMed and Ovid databases were conducted from September-November 2013 using keywords relevant to 4 medical complications of catatonia: deep vein thrombosis/pulmonary embolism, pressure ulcers, muscle contractures, and nutritional deficiencies. A complementary general web-browser search was performed to help ensure that unpublished guidelines were considered.
  
  
  METHODS
  A search for deep vein thrombosis/pulmonary embolism guidelines yielded 478 articles that were appraised for relevance, and 6 were chosen for review; the pressure ulcer guideline search yielded 5,665 articles, and 5 were chosen; the muscle contractures guideline search yielded 1,481 articles, and 3 were chosen; and the nutritional deficiencies guideline search yielded 16,937 articles, and 4 were chosen.
  
  
  METHODS
  Guidelines were reviewed for content and summarized in a manner relevant to the audience. No quantitative analyses were conducted.
  
  
  RESULTS
  Guidelines for deep vein thrombosis/pulmonary embolism prophylaxis support use of anticoagulant therapies for patients with catatonia who are at lower risk for acute bleeding. Pressure ulcer prevention hinges on frequent skin evaluation, use of support surfaces, and repositioning. Muscle contracture data are less clear and must be extrapolated from studies of patients with neurologic injuries. Early initiation of enteral nutrition should be considered in patients with prolonged immobility.
  
  
  CONCLUSIONS
  As medical complications are common with catatonia, implementation of preventive measures is imperative.
authors.affiliation: 3811 0'Hara St, Pittsburgh, PA 15213 clinebellkd@upmc.edu.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Clinebell
authors.forename: Pierre N
authors.initials: PN
authors.lastname: Azzam
authors.forename: Priya
authors.initials: P
authors.lastname: Gopalan
authors.forename: Roger
authors.initials: R
authors.lastname: Haskett
mesh_terms: D000368:Aged; D002389:Catatonia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003131:Combined Modality Therapy; D003286:Contracture / Q000209:etiology* / Q000517:prevention & control*; D003299:Cooperative Behavior; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008140:Lorazepam / Q000008:administration & dosage / Q000009:adverse effects; D044342:Malnutrition / Q000209:etiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000209:etiology* / Q000517:prevention & control*; D011655:Pulmonary Embolism / Q000209:etiology* / Q000517:prevention & control*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D008140:Lorazepam