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Clinical and Research Report
Published Online: 9 May 2024

Generalized Periodic Discharges Associated With Catatonia and Delirium: A Case Series

James Luccarelli, M.D., D.Phil. [email protected], Joshua R. Smith, M.D., Gregory Fricchione, M.D., and M. Brandon Westover, M.D., Ph.D.Authors Info & Affiliations
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
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https://doi.org/10.1176/appi.neuropsych.20230174
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Abstract

Objective:

Generalized periodic discharges are a repeated and generalized electroencephalography (EEG) pattern that can be seen in the context of altered mental status. This article describes a series of five individuals with generalized periodic discharges who demonstrated signs and symptoms of catatonia, a treatable neuropsychiatric condition.

Methods:

Inpatients with a clinical diagnosis of catatonia, determined with the Bush-Francis Catatonia Rating Scale (BFCRS), and EEG recordings with generalized periodic discharges were analyzed in a retrospective case series.

Results:

Five patients with catatonia and generalized periodic discharges on EEG were evaluated from among 106 patients with catatonia and contemporaneous EEG measurements. Four of these patients showed an improvement in catatonia severity when treated with benzodiazepines, with an average reduction of 6.75 points on the BFCRS.

Conclusions:

Among patients with generalized periodic discharges, catatonia should be considered, in the appropriate clinical context. Patients with generalized periodic discharges and catatonia may benefit from treatment with empiric trials of benzodiazepines.

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Information & Authors

Information

Published In

Go to The Journal of Neuropsychiatry and Clinical Neurosciences
Go to The Journal of Neuropsychiatry and Clinical Neurosciences
The Journal of Neuropsychiatry and Clinical Neurosciences
Preprint

History

Received: 3 October 2023
Revision received: 20 November 2023
Revision received: 21 December 2023
Revision received: 15 January 2024
Accepted: 6 February 2024
Published online: 9 May 2024

Keywords

  1. Antiepileptic Drugs
  2. Benzodiazepines
  3. Case Series
  4. Catatonia
  5. Electroencephalography
  6. Generalized Periodic Discharges

Authors

Details

James Luccarelli, M.D., D.Phil. [email protected]
Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover).
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Joshua R. Smith, M.D.
Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover).
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Gregory Fricchione, M.D.
Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover).
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M. Brandon Westover, M.D., Ph.D.
Departments of Psychiatry (Luccarelli, Fricchione) and Neurology (Westover), Harvard Medical School, Boston; Department of Psychiatry, Massachusetts General Hospital, Boston (Luccarelli, Fricchione); Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center at Village of Vanderbilt, and Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tenn. (Smith); Department of Neurology, Beth Israel Deaconess Medical Center, Boston (Westover).
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Notes

Send correspondence to Dr. Luccarelli ([email protected]).

Competing Interests

Dr. Luccarelli has received funding from Harvard Medical School Dupont Warren Fellowship and Livingston Awards, and he holds equity in Revival Therapeutics. Dr. Smith has received support from Axial and Roche for clinical trial work. Dr. Fricchione has served as a consultant for Revival Therapeutics; he has received royalties from Adya Health; and he has received honoraria or royalties from American Psychiatric Association Publishing, Belvoir Press, Johns Hopkins University Press, and the University of Chicago Press. Dr. Westover is a co-founder of Beacon Biosignals.

Funding Information

Supported by the National Institute of Child and Human Development (grant 1P50HD103537 to Dr. Smith); the National Science Foundation (grant 2014431 to Dr. Westover); NIH (grants R01NS102190, R01NS102574, R01NS107291, RF1AG064312, RF1NS120947, R01AG073410, R01HL161253, R01NS126282, and R01AG073598 to Dr. Westover); and NIMH (grant T32MH112485 to Dr. Luccarelli).

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