From the Guidelines
Fevers in catatonia require immediate attention and treatment, with lorazepam 1-2mg IV/IM every 4-6 hours as the first-line treatment, and electroconvulsive therapy (ECT) should be considered if there is no response within 24-48 hours. According to the practice parameter for the use of ECT with adolescents 1, ECT may be used to treat catatonia, and it is essential to consider it as a treatment option in severe cases. The study highlights the importance of realistic treatment goals, with the greatest improvement expected in affective symptoms and general functioning.
When managing fevers in catatonia, it is crucial to provide supportive care, including IV fluids, temperature management, and monitoring of vital signs. Underlying causes of catatonia should be investigated and treated simultaneously, including infections, autoimmune disorders, or primary psychiatric conditions. The fever in malignant catatonia results from dysregulation of the autonomic nervous system and increased muscle activity leading to hyperthermia. Without proper treatment, malignant catatonia can progress to rhabdomyolysis, renal failure, and death, with mortality rates historically reaching 20-30% 1.
Key considerations in the treatment of fevers in catatonia include:
- Prompt initiation of lorazepam 1-2mg IV/IM every 4-6 hours
- Consideration of ECT if there is no response to lorazepam within 24-48 hours
- Supportive care, including IV fluids, temperature management, and monitoring of vital signs
- Investigation and treatment of underlying causes of catatonia
- Realistic treatment goals, with the greatest improvement expected in affective symptoms and general functioning, as highlighted in the practice parameter for the use of ECT with adolescents 1.
From the Research
Fevers in Catatonia
- There is limited information available on fevers specifically in catatonia from the provided studies.
- Catatonia is a neuropsychiatric disorder characterized by motor, affective, and cognitive-behavioural signs, which can last from hours to days 2.
- The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors 3.
- Fever is a common symptom in various medical conditions, including infections, which can be associated with catatonia 4, 3, 2.
- In patients with fever, a high C-reactive protein (CRP) level and normal white blood cell (WBC) count can be observed, and this is not necessarily indicative of an underlying malignant neoplasm or hematologic illness 5.
- The treatment of catatonia often involves the use of benzodiazepines, such as lorazepam, that can be used in combination therapy with antipsychotics, and definitive treatment may be found with electroconvulsive therapy (ECT) 4, 3, 2.