Catatonia as a Presentation of Autoimmune Encephalitis: A Systematic Review and Meta-analysis

Background:

Catatonia is a complex psychomotor syndrome with serious morbidity and mortality. Earlier classified as a subtype of Schizophrenia, it has now been associated with a range of psychiatric and medical illnesses (Rasmussen, 2016). Thus, in patients presenting with Catatonia diagnosis and treatment of the underlying disorder remains a challenge. Much research has been carried out to explore catatonia as the presenting symptom in different medical disorders, though evidence on the prevalence of catatonia in autoimmune encephalitis is still lacking and requires serious consideration for a possible differential in patients presenting with catatonia.

Methods:

Literature on “(Autoimmune Encephalitis) OR (Encephalitis) AND (Catatonia)” was searched on PubMed, Web of Science, PsycINFO, Embase, MEDLINE, ProQuest, and Cochrane Database. Studies identified for screening (n=30) were imported to EndNote X9 Library and duplicates were removed. Nf13 studies reporting the prevalence of Catatonia in cases of Autoimmune Encephalitis were retrieved. Studies were screened for bias using Egger’s and Begg’s rank tests. Pooled prevalence was calculated using the Random effects Model and the Confidence intervals were plotted.

Results:

The pooled prevalence of Catatonia in patients of Autoimmune Encephalitis was found to be 38% [95% CI: 10-52%] with I² being 95.635%. Male gender and age seemed to have no significant correlation with a higher prevalence of catatonia. In studies that have involved treatment, early presentation and appropriate treatment were key prognostic factors in the management of both Catatonia and Autoimmune Encephalitis.

Discussion:

Researchers have recently started exploring Catatonia as a presenting symptom of Autoimmune Encephalitis. Anti-NMDAR Encephalitis which is one of the most prevalent encephalitis has been found to be closely associated with Catatonia with prevalence in included studies ranging from 5 to 75%. Some studies have also shown that Autoimmune Encephalitis patients with Catatonia present distinct clinical features during the disease course and are prone to experience more relapses and long-term morbidity and mortality than those without catatonia, thus making it an important prognostic factor which was also confirmed by our Review (Wu, 2023)(Espinola-Nadurille, 2019).

Conclusion:

As in many patients with Autoimmune Encephalitis, the initial presentation is most commonly at a psychiatric service, it becomes imperative for the care providers to be aware of Catatonia as a common presenting symptom of Autoimmune Encephalitis for avoiding diagnostic and therapeutic errors. This will further help in providing continuing psychiatric care to treat disabling symptoms and prevent further life-threatening complications of this condition (Warren, 2021).

References:

1. 
   

   Rasmussen SA, Mazurek MF, Rosebush PI. Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology. World J Psychiatry. 2016;6(4):391-398.
   
   

2. 
   

   Wu H, Wu C, Zhou Y, Huang S, Zhu S. Catatonia in adult anti-NMDAR encephalitis: an observational cohort study. BMC Psychiatry. 2023;23(1):94.
   
   

3. 
   

   Espinola-Nadurille M, Flores-Rivera J, Rivas-Alonso V, et al. Catatonia in patients with anti-NMDA receptor encephalitis. Psychiatry Clin Neurosci. 2019;73(9):574-580.
   
   

4. 
   

   Warren N, O'Gorman C, McKeon G, Swayne A, Blum S, Siskind D. Psychiatric management of anti-NMDAR encephalitis: a cohort analysis. Psychol Med. 2021;51(3):435-440.