Use of Creatine Kinase Levels in the Detection of Emerging Catatonia: A Single Center 10-year Retrospective Analysis for the Identification of a Pre-Malignant Catatonia Presentation Pattern

Background:

Despite being well documented in medical literature, catatonia continues to pose diagnostic challenges that may delay detection and treatment. All three subtypes of catatonia can give rise to potentially serious medical complications, with malignant catatonia (MC) the most frequently implicated in catatonia-related adverse events.1 Catatonia has been shown to be associated with elevated creatine kinase (CK) levels and has potential as a diagnostic tool for clinicians.2,3 In this context, we conducted a 10-year retrospective review of all patients treated at our center for catatonia to investigate the predictive utility of CK levels and the average time to catatonia diagnosis after admission.

Methods:

In conjunction with an IRB-approved protocol, our institution’s electronic medical record database was searched for hospitalized patients meeting the criteria of being diagnosed with at least one of the identified catatonia-related ICD-9 or ICD-10 codes between January 2012 - 2022. Stratification of data for catatonia diagnosis resulted in a final patient population of 181. Manual chart reviews were conducted to ratify diagnoses, CK levels, average time to diagnose catatonia, and demographic data. CK values were then uniformly transformed to percent change to evaluate for temporal trends and subsequently pooled for final analysis for correlative strength via nonlinear regression.

Results:

A total of 119 patients (65.7%) were found to have elevated CK levels throughout their admission. In the 62 patients in whom CK levels were never found to be elevated, the average time to diagnosis after admission was 5.5 days whereas in the 119 patients in whom CK levels were elevated, the time to diagnosis was 1.8 days (p < 0.001). Patients with elevated levels were found to be significantly younger than patients with normal CK levels (37.8 vs 45.0 years, p< 0.05). Nonlinear regression of pooled inter-sample percent change of CK levels generated a model with moderate correlation (R2=0.542). Analysis of nonlinear regression modeling using least squares for appropriateness of fit suggested no significant deviation from the model (p= 0.3614).

Discussion:

Our results indicate a role for CK level detection in the early suspicion of catatonia as we observed a clear trend of delayed catatonia diagnosis when CK levels were not utilized. It is important to note, however, that patients with normal CK may have exhibited an atypical earlier presentation of catatonia which delayed diagnosis.

Conclusion:

In patients suspected of having catatonia, evaluating CK level trends may allow for improved patient outcomes with timely diagnosis and treatment when observing for emergence of catatonia. However, further studies are necessary to assess and stratify the utility of CK levels in catatonia and examine atypical presentations of catatonia and their relation to CK levels.

References:

1. Taylor MA, Fink M. Catatonia in psychiatric classification: A home of its own. Am J Psychiatry. 2003; 160: 1233-1241.

2. Moghadam-Kia S, Oddis CV, Aggarwal R. Approach to asymptomatic creatine kinase elevation. Cleve Clin J Med. 2016; 83: 37-42.

3. Northoff G, Wenke J, Pflug B. Increase of serum creatine phosphokinase in catatonia: An investigation in 32 acute catatonic patients. Psychol Med. 1996; 26: 547-553.