Fatal pulmonary embolism in the catatonic syndrome

Two case reports and a literature review

William Vaughn McCall, S. C. Mann, F. E. Shelp, S. N. Caroff

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background: Catatonia is associated with excess early mortality when it is unrecognized or inadequately treated. The characteristics of the lethal catatonia subtype are now well described, but the excess mortality of the remaining patients with catatonic syndrome, particularly from pulmonary embolism, appears to be inadequately recognized. The fatal risk of the catatonic syndrome is reviewed. Method: Two new case reports of sudden death from pulmonary embolism in catatonic syndrome are presented. The world literature on morbidity, mortality, and pulmonary embolism in catatonia was reviewed by a search of MEDLINE and PsychInfo from 1966 to the present. Additional older references were discovered by screening bibliographies from articles produced by the searches. Results: Twenty cases of autopsy-confirmed pulmonary embolism were found in patients with catatonic syndrome. Catatonic patients were more likely to die of pulmonary embolism and die earlier than patients with other types of schizophrenia. Death from pulmonary embolism did not occur until after the second week of catatonic symptoms and often occurred without warning. Conclusion: Risk of a fatal pulmonary embolism is inherent in persistent catatonic symptoms and may explain the observed excess early mortality. Prompt resolution of the catatonic syndrome with benzodiazepines, barbiturates, or electroconvulsive therapy is the best way to reduce risk of pulmonary embolism. The prophylactic value 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 and vigorous intervention in catatonic patients.

Original languageEnglish (US)
Pages (from-to)21-25
Number of pages5
JournalJournal of Clinical Psychiatry
Volume56
Issue number1
StatePublished - Jan 1 1995
Externally publishedYes

Fingerprint

Pulmonary Embolism
Catatonia
Mortality
Barbiturates
Electroconvulsive Therapy
Bibliography
Sudden Death
Benzodiazepines
MEDLINE
Autopsy
Schizophrenia
Morbidity

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Fatal pulmonary embolism in the catatonic syndrome : Two case reports and a literature review. / McCall, William Vaughn; Mann, S. C.; Shelp, F. E.; Caroff, S. N.

In: Journal of Clinical Psychiatry, Vol. 56, No. 1, 01.01.1995, p. 21-25.

Research output: Contribution to journalArticle

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