Exploring the Operational Criteria for Catatonia: Is Psychiatric Disease a Risk Factor for it’s Development?

Abstract

Catatonia is a poorly understood form of brain dysfunction characterized by marked and at times contradictory changes in muscle tone, motor behavior, affect and volition. It has been described in the context of non-affective psychotic and affective psychiatric disorders, however more recently it has been recognized as occurring secondarily to major medical disease and in the context of critical illness, especially co-morbid with delirium. Due to the complex and heterogeneous nature of catatonia along with recent changes in diagnostic criteria, some have questioned whether the structure of catatonia is known. This dissertation explores the operational criteria for catatonia, including whether psychiatric disease is a risk factor for its development. This work is made up of three manuscripts. First in a descriptive systematic review of the clinical and research literature we explored the operational criteria for catatonia. Secondly in a nested prospective cohort study of critically ill patients we explored whether pre-critical illness psychiatric illness is a risk factor for catatonia in the context of a critical illness. Finally, in a case control design of catatonia patients from a DNA biobank (BioVU) we evaluated the genetic architecture of catatonia first in a genome wide association study followed by a polygenic risk score analysis utilizing common psychiatric phenotypes that are comorbid with catatonia.