Epidemiology and Neuropsychiatry of Catatonia

1.1 Background Catatonia is a severe form of psychomotor disturbance associated with a range of general medical and psychiatric disorders. After almost 150 years, most of the existing literature relies on case reports and series. This has resulted in gaps in the epidemiology and neuropsychiatry of this condition. 1.2 Aims In this thesis, I aim to characterise the epidemiology, neuroimmunology, structural neuroimaging findings and EEG findings in catatonia. 1.3 Methods I conducted a narrative review of studies related to the immunological findings in catatonia and related conditions, informed by several systematic literature searches. I used anonymised electronic healthcare records from South London to further examine the epidemiology, inflammatory markers and neuroimaging of catatonia. Inpatients with catatonia were compared to inpatients without catatonia. To characterise the EEG findings, I conducted a systematic review and bivariate meta-analysis to determine its diagnostic test accuracy in determining the aetiology of catatonia. 1.4 Results A literature review found that various viral, bacterial and parasitic infections have occasionally been reported in association with catatonia. The most commonly reported form of autoimmune catatonia is NMDAR encephalitis. Using electronic healthcare records, I found that the incidence of catatonia was approximately 1 per 10,000 person-years. Serum NMDAR antibodies were more common in patients with catatonia than in a psychiatric comparison group, but other inflammatory markers were not comparably increased. Abnormalities on structural MRI scans occurred in 34% of patients with catatonia, but there was no difference in adjusted comparisons to other psychiatric patients. Neurological and other general medical conditions in the literature were usually found to be distinguishable from psychiatric catatonia using clinical electroencephalography. 1.5 Conclusions Catatonia remains an important problem in clinical and academic neuropsychiatry. There is promise for neuroimmunological and electroencephalographic biomarkers. Future research requires prospective design, relevant comparison groups and identification of more homogeneous subgroups

Catatonia and epilepsy: An underappreciated relationship

Catatonia is currently conceived in the major diagnostic manuals as a syndrome with a range of possible psychiatric and general medical underlying conditions. It features diverse clinical signs, spanning motor, verbal and behavioural domains and including stupor, catalepsy, mutism, echolalia, negativism and withdrawal. The existing literature suggests that seizure activity may underlie catatonia in approximately 2% of cases. There are three possible temporal relationships between catatonia and seizure activity: (1) ictal catatonia, in which catatonia is a presentation of non-convulsive status epilepticus; (2) postictal catatonia, in which catatonia follows a seizure, and (3) interictal catatonia, in which catatonia and seizures occur in the same individual without any clear temporal relationship between them. Electroencephalographic (EEG) abnormalities are common in catatonia, even in those cases with a presumed primary psychiatric origin, and often consist of generalised background slowing. Paradoxically, electroconvulsive therapy is an effective treatment for catatonia. There are several converging pieces of evidence suggesting that there may be underlying seizure activity in more cases of catatonia than has hitherto been recognised, though identification of these seizures may require intracranial EEG recording

Effectiveness of antipsychotic drug therapy for treating psychosis in people with epilepsy: A systematic review

Individuals with epilepsy are at risk of developing preictal, ictal, postictal and interictal psychoses. Antipsychotic drugs (APDs) are the main class of drugs used to treat psychosis and schizophrenia. The efficacy and safety of APDs as a treatment for epileptic psychosis is not well understood. This systematic review aimed to assess the effectiveness and adverse effects of APDs for treating psychosis in people with epilepsy. We adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched MEDLINE, Embase, PsycInfo, and AMED (Allied and Complementary Medicine) from database inception to June 20, 2023. We contacted experts in the field and performed citation searches to identify additional records. Title, abstract, full-text review, and data analysis were conducted in duplicate, with conflicts resolved by discussion among authors. Given the considerable heterogeneity of study designs, meta-analysis was not deemed appropriate; instead, the results were tabulated in a narrative synthesis. The Joanna Briggs Institute Risk of Bias tool and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework were used to assess study quality. We identified 13 studies with a total of 1180 participants. In the four case series included, the psychotic symptoms of 25 of 28 patients treated with APDs partially improved or fully resolved. Three of the four cohort studies reported an association between antipsychotic use and longer duration of psychotic episodes, two found similar results in both APD and non-APD groups, and two did not report control psychosis outcomes. When reported, seizure frequency was observed to remain unchanged or decrease following APD treatment. The evidence on the effectiveness of antipsychotics in the treatment of psychosis in epilepsy is inconclusive and may reflect confounding by indication. However, most studies suggest that antipsychotics were not associated with a marked worsening in seizure frequency. It remains unclear whether antipsychotics should be used in epilepsy, and well-controlled cohort studies and randomized controlled trials are necessary to draw definitive conclusions

Assessing deficit irrigation strategies for corn using simulation

Citation: Kisekka, I., Aguilar, J. P., Rogers, D. H., Holman, J., O'Brien, D. M., & Klocke, N. (2016). Assessing deficit irrigation strategies for corn using simulation. Transactions of the Asabe, 59(1), 303-317. doi:10.13031/trans.59.11206Declining groundwater levels in the Ogallala aquifer due to withdrawals exceeding annual recharge result in diminished well capacities that eventually become incapable of meeting full crop water needs. Producers need recommendations for deficit irrigation strategies that can maximize net returns in most years under low well capacities. The objectives of this study were to (1) calibrate and validate the CERES-Maize model in DSSAT-CSM v4.6 under southwest Kansas soils and climatic conditions and (2) apply the calibrated model to assess three factors related to irrigation management: (i) the optimum plant-available water threshold to initiate irrigation for maximizing net returns, (ii) the effect of percentage soil water depletion at planting on yield, seasonal transpiration, water productivity, extractable soil water at maturity, and net returns, and (iii) the effect of late irrigation season termination on extractable soil water at physiological maturity, yield, and net returns. The CERES-Maize model in DSSAT-CSM v4.6 in conjunction with short-term experimental data and 63 years (1950 to 2013) of historical weather data were used in this study. The calibrated model was able to predict end of season grain yield with acceptable accuracy (NSE > 0.9, 0.13 < %RMSE < 0.19), indicating that the model could be used for assessing alternative management strategies for optimizing the use of limited water for irrigating corn in southwest Kansas. Irrigation scheduling based on a 50% plant-available water threshold maximized net returns compared to initiating irrigation at greater soil water content at corn prices ranging from $0.10 to$0.26 kg-1. Accounting for inter-annual variations in weather and irrigation downtime due to repairs, 14 to 17 irrigation applications of 25 mm of water each would be needed to maintain soil water at 50% of plant-available water during the season. Having soil water in the top 1.2 m of the soil profile between 0% and 25% depleted at planting maximized net returns, although it also resulted in more extractable soil water at physiological maturity. Terminating irrigation 90 or 95 days after planting depending on corn price maximized net returns and resulted in the lowest amount of extractable soil water at physiological maturity, implying that opportunities exist to mine stored soil water toward the end of the season even under deficit irrigation. We recommend that late season irrigation termination be done in conjunction with soil water monitoring and management- allowable depletion techniques to minimize potential reduction in yields. Before adopting any of the management strategies assessed in this study, producers should consider the unique yield potential constraints for their farm. The concepts explored in this analysis, which combined experimental data, computer simulation, and long-term weather data to generate optimum management recommendations, could be applied in other areas with constrained water supplies for irrigation. © 2016 American Society of Agricultural and Biological Engineers

Catatonia in the peripartum: A cohort study using electronic health records

BACKGROUND: Due to limited existing literature available on the presentation and treatment of catatonia in the peripartum, this retrospective descriptive cohort study aimed to examine demographic data, catatonic features, diagnoses pre- and post-catatonic episodes, treatment and the presence of obstetric complications. METHODS: Individuals with catatonia were identified in a previous study using anonymised electronic healthcare records from a large mental health trust in South-East London. The presence of features from the Bush-Francis Catatonia Screening Instrument was coded by the investigators and longitudinal data were extracted from structured fields and free text. RESULTS: 21 individuals were identified from the larger cohort, each of whom experienced one episode of catatonia in the postpartum period, and all had had an inpatient psychiatric admission. 13 patients (62 %) presented after their first pregnancy and 12 (57 %) experienced obstetric complications. 11 (53 %) attempted breastfeeding and 10 (48 %) received a diagnosis of a depressive disorder following the episode of catatonia. The majority presented with immobility or stupor, mutism, staring and withdrawal. All were treated with antipsychotics and 19 (90 %) received benzodiazepines. CONCLUSIONS: This study suggests that signs and symptoms of catatonia during the peripartum are similar to other catatonic presentations. However, the postpartum may be a period of high risk for catatonia and obstetric factors, such as birth complications, may be relevant