FATAL PULMONARY-EMBOLISM IN THE CATATONIC SYNDROME - 2 CASE-REPORTS AND A LITERATURE-REVIEW

Background: Catatonia is associated with excess early mortality when i t is unrecognized or inadequately treated. The characteristics of the lethal catatonia subtype are now well described, but the excess mortal ity of the remaining patients with catatonic syndrome, particularly fr om pulmonary embolism, appears to be inadequately recognized. The fata l risk of the catatonic Syndrome is reviewed. Method: Two new case rep orts of sudden death from pulmonary embolism in catatonic syndrome are presented. The world literature on morbidity, mortality, and pulmonar y embolism in catatonia was reviewed by a search of MEDLINE and PsychI nfo from 1966 to the present. Additional older references were discove red by screening bibliographies from articles produced by the searches . Results: Twenty cases of autopsy-confirmed pulmonary embolism were f ound in patients with catatonic syndrome. Catatonic patients were more likely to die of pulmonary embolism and die earlier than patients wit h other types of schizophrenia. Death from pulmonary embolism did not occur until after the second week of catatonic symptoms and often occu rred without warning. Conclusion: Risk of a fatal pulmonary embolism i s inherent in persistent catatonic symptoms and may explain the observ ed excess early mortality. Prompt resolution of the catatonic syndrome with benzodiazepines, barbiturates, or electroconvulsive therapy is t he best way to reduce risk of pulmonary embolism. The prophylactic val ue of physical therapy or anticoagulation merits further investigation . Despite the absence of controlled trials of treatment effectiveness, the catastrophic outcome of acute pulmonary embolism warrants early a nd vigorous intervention in catatonic patients.