title: Catatonia in 26 patients with bipolar disorder: clinical features and response to electroconvulsive therapy.
abstract: OBJECTIVE
  We describe the clinical characteristics and short-term outcomes of a sample of inpatients with bipolar disorder with severe catatonic features resistant to pharmacological treatment.
  
  
  METHODS
  The study involved 26 catatonic patients, resistant to a trial of benzodiazepines, and then treated with electroconvulsive therapy (ECT). All patients were evaluated prior to and one week following the ECT course using the Bush-Francis Catatonia Rating Scale (BFCRS) and the Clinical Global Impression (CGI).
  
  
  RESULTS
  In our sample, women were over-represented (n = 23, 88.5%), the mean (± standard deviation) age was 49.5 ± 12.5 years, the mean age at onset was 28.1 ± 12.8 years, and the mean number of previous mood episodes was 5.3 ± 2.9. The mean duration of catatonic symptoms was 16.7 ± 11.8 (range: 3-50) weeks, and personal history of previous catatonic episodes was present in 10 patients (38.5%). Seventeen (65.4%) patients showed abnormalities at cerebral computerized tomography and/or magnetic resonance imaging and neurological comorbidities were observed in 15.4% of the sample. Stupor, rigidity, staring, negativism, withdrawal, and mutism were observed in more than 90% of patients. At the end of the ECT course, 21 patients (80.8%) were classified as responders. The BFCRS showed the largest percentage of improvement, with an 82% reduction of the initial score. The number of previous mood episodes was significantly lower and the use of anticholinergic and dopamine-agonist medications was significantly more frequent in non-responders than in responders.
  
  
  CONCLUSIONS
  Our patients with bipolar disorder had predominantly retarded catatonia, frequent previous catatonic episodes, indicating a recurrent course, and high rates of concomitant brain structure alterations. However, ECT was a very effective treatment for catatonia in this patient group that was resistant to benzodiazepines.
authors.affiliation: Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Medda
authors.affiliation: Institute of Behavioural Science, "G. De Lisio", Pisa, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Toni
authors.affiliation: Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Luchini
authors.affiliation: Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Giorgi Mariani
authors.affiliation: Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Mauri
authors.affiliation: Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.|Institute of Behavioural Science, "G. De Lisio", Pisa, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002389:Catatonia / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy; D004351:Drug Resistance; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs
keywords: bipolar disorder; catatonia; electroconvulsive therapy (ECT)