title: Alcohol and Sedative-Hypnotic Withdrawal Catatonia: Two Case Reports, Systematic Literature Review, and Suggestion of a Potential Relationship With Alcohol Withdrawal Delirium.
abstract: Withdrawal from alcohol and sedative-hypnotics can be complicated by seizures, hallucinations, or delirium. Withdrawal catatonia is another, less commonly discussed complication that clinicians should appreciate.
  
  
  
  We present a case of alcohol withdrawal catatonia and a case of benzodiazepine withdrawal catatonia and offer a systematic review of previous cases of alcohol or sedative-hypnotic withdrawal catatonia. We outline clinical features that suggest a potential link between withdrawal catatonia and withdrawal delirium.
  
  
  
  We identified 26 cases of withdrawal catatonia in the literature-all principally with catatonic stupor-with an average age of 56 years (range: 27-92) and balanced prevalence between sexes. Withdrawal catatonia tends to occur only after chronic use of alcohol or sedative-hypnotic agents with a typical onset of 3-7 days after discontinuation and duration of 3-10 days. Withdrawal catatonia is responsive to benzodiazepines or electroconvulsive therapy. Features that suggest a parallel between withdrawal catatonia and withdrawal delirium include time course, neurobiologic convergence, efficacy of benzodiazepines and electroconvulsive therapy, typical absence of abnormal electroencephalographic findings, and phenotypic classification suggested by a recent literature in sleep medicine.
  
  
  
  Alcohol and sedative-hypnotic withdrawal may present with catatonia or catatonic features. The clinical and neurobiologic convergence between withdrawal catatonia and withdrawal delirium deserves further attention. In view of these similarities, we propose that withdrawal delirium may represent excited catatonia: these new viewpoints may serve as a substrate for a better understanding of the delirium-catatonia spectrum.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT. Electronic address: mark.oldham@yale.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Oldham
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Desan
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000209:etiology* / Q000628:therapy; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002389:Catatonia / Q000209:etiology* / Q000628:therapy; D002492:Central Nervous System Depressants / Q000009:adverse effects; D002998:Clonazepam / Q000009:adverse effects*; D004565:Electroconvulsive Therapy; D000431:Ethanol / Q000009:adverse effects; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013375:Substance Withdrawal Syndrome / Q000209:etiology* / Q000628:therapy
chemical_list: D002492:Central Nervous System Depressants; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D000431:Ethanol; D002998:Clonazepam
keywords: alcohol withdrawal delirium; benzodiazepine withdrawal; catatonia; delirium tremens; sedative-hypnotic withdrawal; state dissociation.