From the Guidelines
For patients presenting with catatonia, a comprehensive laboratory workup should be performed to identify potential underlying causes, including complete blood count, comprehensive metabolic panel, thyroid function tests, vitamin B12 and folate levels, urinalysis, and urine toxicology screen, as recommended by recent guidelines 1.
Key Laboratory Tests
- Complete blood count to rule out underlying infections or inflammatory conditions
- Comprehensive metabolic panel to assess liver and kidney function, as well as electrolyte imbalances
- Thyroid function tests to evaluate for thyroid dysfunction, which can contribute to catatonia
- Vitamin B12 and folate levels to assess for potential deficiencies
- Urinalysis to evaluate for urinary tract infections or other renal issues
- Urine toxicology screen to assess for substance use or withdrawal
Additional Tests to Consider
- Erythrocyte sedimentation rate and C-reactive protein to evaluate for underlying inflammatory conditions
- Antinuclear antibodies to assess for autoimmune disorders
- Cerebrospinal fluid analysis to evaluate for central nervous system infections or inflammation
- Autoimmune encephalitis panels, particularly anti-NMDA receptor antibodies, to assess for autoimmune encephalitis
- Blood cultures if infection is suspected
Rationale
These tests are essential because catatonia can result from various medical conditions, including metabolic disturbances, autoimmune disorders, infections, medication side effects, or primary psychiatric disorders. Early identification of the underlying cause is crucial for appropriate treatment, as management strategies differ significantly depending on etiology. While benzodiazepines and electroconvulsive therapy are often effective treatments regardless of cause, addressing the underlying condition is necessary for complete resolution and prevention of recurrence, as supported by recent studies 1.
From the Research
Diagnostic Approach
When a patient presents with catatonia, a thorough diagnostic approach is necessary to identify any underlying medical or psychiatric conditions.
Bloodwork Recommendations
- There is no specific bloodwork recommended for catatonia in the provided studies 2, 3, 4, 5, 6.
- However, in cases where catatonia is associated with systemic lupus erythematosus (SLE), serologies and other diagnostic tests may be necessary to assess the underlying condition 4, 5.
- A systematic approach to assessment, such as the ABCDE (airway, breathing, circulation, disability, exposure) approach, may be useful in evaluating acutely unwell patients with catatonia 6.
Treatment Considerations
- Benzodiazepines, such as lorazepam, are often used as a first-line treatment for catatonia 2, 3, 4, 5.
- Electroconvulsive therapy (ECT) may be considered in cases where catatonia is refractory to benzodiazepines 2, 3, 5.
- Immunomodulatory treatments may be necessary to manage underlying conditions, such as SLE 5.