Concurrent catatonia and COVID-19 infection - An experiential account of challenges and management of cases from a tertiary care psychiatric hospital in India

Catatonia has been reported as one among many neuropsychiatric manifestations associated with COVID-19 infection. Catatonia and COVID-19 co-occurrence remain clinical concerns, often posing challenges pertaining to diagnosis, and especially management. Limited information is available regarding the appropriate approaches to the management of catatonia in COVID-19 infection, particularly with reference to the safety and efficacy of benzodiazepines and Electro-convulsive therapy (ECT). We present our experience of five patients with catatonia consequent to heterogeneous underlying causes and concurrent COVID-19 infection, who received care at the psychiatric COVID unit of our tertiary care psychiatric hospital. An interesting observation included varying underlying causes for catatonia and the potential role that COVID-19 infection may have played in the manifestation of catatonia. In our experience, new-onset catatonia with or without pre-existing psychiatric illness and concurrent COVID-19 can be safely and effectively managed with lorazepam and/or ECTs. However, critical to the same is the need to implement modified protocols that integrate pre-emptive evaluation for COVID-19 disease and proactive monitoring of its relevant clinical parameters, thereby permitting judicious and timely implementation of catatonia-specific treatment options.

Automated summary

Catatonia is a neuropsychiatric manifestation associated with COVID-19 infection. Management of catatonia in COVID-19 infection remains a clinical challenge, with limited information on the safety and efficacy of benzodiazepines and Electro-convulsive therapy (ECT). This study presents the experience of managing five patients with catatonia and COVID-19 infection, highlighting the varying underlying causes for catatonia and the potential role of COVID-19 in its manifestation. The study suggests that new-onset catatonia in COVID-19 patients can be effectively managed with lorazepam and/or ECT, with the need for modified protocols integrating pre-emptive evaluation for COVID-19 and proactive monitoring of relevant clinical parameters.