Abstract

Objective: Substance use has increasingly been linked to the onset of catatonic episodes; however, no large observational studies have examined this association. This study aimed to identify catatonic episodes temporally associated with acute intoxication, withdrawal or chronic substance use, investigate which substances were involved, and compare clinical characteristics of substance-related and non-substance-related catatonic episodes. Methods: This study retrospectively identified all catatonic episodes recorded in an electronic case register hosted at a large secondary mental health trust in London, UK. Episodes were categorized as substance-related if the clinical record reported either a positive urine drug screen, an ICD-10 diagnosis of a mental or behavioral disorder due to substance use, or documented substance use between two weeks prior to the catatonic episode and the date of the catatonic episode. Results: 108 of 2130 catatonic episodes (5.1%) were deemed substance-related. The number of contemporaneously reported substance-related episodes increased between 2007 and 2016 [r = 0.72, p = 0.02]. Episodes in the context of acute intoxication (n = 54) were most frequently related to cannabis (n = 31) or cocaine (n = 5) use, whilst those in the context of drug withdrawal (n = 8) were most commonly related to alcohol, opioids and benzodiazepines. There were 50 episodes of catatonia associated with chronic substance use without intoxication or withdrawal, of which the majority were related to cannabis use (n = 37). 21 episodes had overlapping intoxication, withdrawal and chronic use of different substances within an episode. Compared to catatonic episodes not related to substance use, episodes of substance-related catatonia occurred in individuals who were younger (mean age 31.3 years [SD 12.2] vs 35.7 years [SD 16.3], p = 0.01) and more likely to be men (74.0% vs 54.3%, p < 0.001). The clinical features of catatonia were similar between the two groups. Conclusions: A relatively small proportion of catatonic episodes were temporally associated with reported substance use within their electronic records. Substance-related catatonic episodes were mostly related to cannabis use, but other substances including cocaine, alcohol, opioids and benzodiazepines were sometimes implicated. This is likely an underestimate of substance-related catatonia use due to issues with documentation and appropriate investigation.

摘要

目标：物质使用越来越多地与紧张症发作联系起来；然而，没有大型观察性研究检验过这种关联。本研究旨在确定与急性中毒、戒断或慢性物质使用暂时相关的紧张症发作，调查涉及哪些物质，并比较与物质相关和非物质相关的紧张症发作的临床特征。方法：这项研究回顾性地确定了在英国伦敦一家大型二级心理健康信托机构托管的电子病例登记簿中记录的所有紧张症发作。如果临床记录报告尿液药物筛查阳性、ICD-10 诊断为因物质使用导致的精神或行为障碍，或记录在紧张症发作前两周和日期之间的物质使用情况，则将发作归类为物质相关紧张症发作。结果： 2130 次紧张症发作中有 108 次 (5.1%) 被认为与物质有关。2007 年至 2016 年间，同时报告的物质相关事件的数量有所增加 [ r  = 0.72，p  = 0.02]。在急性中毒的情况下发作（n = 54）最常与大麻（n  = 31）或可卡因（n  = 5）使用有关，而那些在戒毒情况下（n  = 8）最常与酒精、阿片类药物和苯二氮卓类药物有关。有 50 次与慢性物质使用相关的紧张症发作，没有中毒或戒断，其中大部分与大麻使用有关（n  = 37）。21 集在一个集中有重叠的中毒、戒断和长期使用不同的物质。与与物质使用无关的紧张症发作相比，与物质相关的紧张症发作发生在更年轻的个体中（平均年龄 31.3 岁 [SD 12.2] vs 35.7 岁 [SD 16.3]，p = 0.01) 并且更有可能是男性 (74.0% 对 54.3%, p  < 0.001)。两组间紧张症的临床特征相似。结论：相对较小比例的紧张症发作在时间上与其电子记录中报告的物质使用相关。与物质有关的紧张症发作主要与吸食大麻有关，但有时也涉及其他物质，包括可卡因、酒精、阿片类药物和苯二氮卓类药物。由于文件和适当调查的问题，这可能低估了与物质相关的紧张症的使用。