Catatonia a manifestation of serious mental Illness: prevalence, presentation, management, and outcomes in a mental health unit

Abstract

Catatonia is a psychomotor abnormality that may be caused by severe physical or mental illness or by substances. It has a wide-ranging prevalence from less than 10% to just over 60%, worldwide. This thesis investigated multiple aspects of catatonia in an acute mental health unit setting. Critical aspects examined include the psychological experience of catatonia and assessment, prevalence, presentation, management, and treatment outcomes of catatonia. The research design was a prospective descriptive triangulation study that used a mixed quantitative and qualitative approach. The theoretical framework applied in this thesis was a positivist paradigm approach to explore the quantitative data collected, with application of deductive reasoning, supported by statistical analysis to detect correlations between catatonia and demographic and clinical data. The research explored the experience of a person with catatonia from the beginning to the end of the catatonic episode, inclusive of neglected areas such as the patient’s psychological and experiences. Sources of information included participant reports, clinical notes, and assessments conducted using screening tools for catatonia. Key knowledge gaps on catatonia were identified as target areas for this thesis. These are the prevalence of catatonia in a South African setting; the use of assessment tools like the Bush Francis Catatonia Screening Instrument (BFCSI), the Bush Francis Catatonia Rating Scale (BFCRS), and the Diagnostic and Statistical Manual (5th Edition; DSM-5) in this setting; interventions for catatonia; treatment outcomes; and the subjective experiences of catatonia, as described by patients. To date, there have been five publications produced from this thesis. The first paper was on the protocol for the research and was published in the British Medical Journal (BMJ) Open and presented the literature review, research design, and methodology for the planned Abstract ii research on catatonia (which has ultimately been presented in this current thesis). This paper also identified the aforementioned critical knowledge gaps. The second paper was published in the Biomedicine Central (BMC) International Journal of Mental Health Systems. This paper described a 6-month prevalence rate of catatonia of 11.9%, and concluded that the BFCSI and BFCRS had the highest inter-rater reliability (IRR) and pick-up rate when screening for catatonia, while the DMS-5 had low IRR, and the lowest correlation with the BFCSI and BFCRS. The 12-month prevalence rate was found to be 18.3% and was described in the third paper which was published in the PLOS One Psychiatry. Both lorazepam and electroconvulsive therapy (ECT) were found to be the most widely used treatment at the study site, with good response rates and outcomes. The results were published in the 4th paper in SAGE Open. The fifth paper was on the subjective and psychological experience and published in the BMC Psychology journal. It described the psychological and subjective experience of catatonia as narrated by participants which is characterised by intense experiences of fear, anxiety, and sadness that manifested as extreme withdrawal, combined with obedience or submission. This research has yielded new knowledge with potential applications at a regional, national, and global level. New knowledge yielded includes the need for screening of patients for catatonia across all acute settings, the need for training of both medical and nursing personnel in the assessment of catatonia, the effectiveness of screening and assessment tools, effective interventions for catatonia and outcomes. The descriptions of catatonia at an emotional, cognitive, and behavioural level also highlight the need to develop psychological strategies and targeted psychological interventions to complement the current management strategies.Thesis (PhD) -- Faculty of Health Sciences, 202