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      Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

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          Abstract

          The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.

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          Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018

          Problem/Condition Autism spectrum disorder (ASD). Period Covered 2018. Description of System The Autism and Developmental Disabilities Monitoring (ADDM) Network conducts active surveillance of ASD. This report focuses on the prevalence and characteristics of ASD among children aged 8 years in 2018 whose parents or guardians lived in 11 ADDM Network sites in the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. In 2018, children met the case definition if their records documented 1) an ASD diagnostic statement in an evaluation (diagnosis), 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Results For 2018, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 16.5 in Missouri to 38.9 in California. The overall ASD prevalence was 23.0 per 1,000 (one in 44) children aged 8 years, and ASD was 4.2 times as prevalent among boys as among girls. Overall ASD prevalence was similar across racial and ethnic groups, except American Indian/Alaska Native children had higher ASD prevalence than non-Hispanic White (White) children (29.0 versus 21.2 per 1,000 children aged 8 years). At multiple sites, Hispanic children had lower ASD prevalence than White children (Arizona, Arkansas, Georgia, and Utah), and non-Hispanic Black (Black) children (Georgia and Minnesota). The associations between ASD prevalence and neighborhood-level median household income varied by site. Among the 5,058 children who met the ASD case definition, 75.8% had a diagnostic statement of ASD in an evaluation, 18.8% had an ASD special education classification or eligibility and no ASD diagnostic statement, and 5.4% had an ASD ICD code only. ASD prevalence per 1,000 children aged 8 years that was based exclusively on documented ASD diagnostic statements was 17.4 overall (range: 11.2 in Maryland to 29.9 in California). The median age of earliest known ASD diagnosis ranged from 36 months in California to 63 months in Minnesota. Among the 3,007 children with ASD and data on cognitive ability, 35.2% were classified as having an intelligence quotient (IQ) score ≤70. The percentages of children with ASD with IQ scores ≤70 were 49.8%, 33.1%, and 29.7% among Black, Hispanic, and White children, respectively. Overall, children with ASD and IQ scores ≤70 had earlier median ages of ASD diagnosis than children with ASD and IQ scores >70 (44 versus 53 months). Interpretation In 2018, one in 44 children aged 8 years was estimated to have ASD, and prevalence and median age of identification varied widely across sites. Whereas overall ASD prevalence was similar by race and ethnicity, at certain sites Hispanic children were less likely to be identified as having ASD than White or Black children. The higher proportion of Black children compared with White and Hispanic children classified as having intellectual disability was consistent with previous findings. Public Health Action The variability in ASD prevalence and community ASD identification practices among children with different racial, ethnic, and geographical characteristics highlights the importance of research into the causes of that variability and strategies to provide equitable access to developmental evaluations and services. These findings also underscore the need for enhanced infrastructure for diagnostic, treatment, and support services to meet the needs of all children.
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            The Environment and Disease: Association or Causation?

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              Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017

              Therapeutic drug monitoring (TDM) is the quantification and interpretation of drug concentrations in blood to optimize pharmacotherapy. It considers the interindividual variability of pharmacokinetics and thus enables personalized pharmacotherapy. In psychiatry and neurology, patient populations that may particularly benefit from TDM are children and adolescents, pregnant women, elderly patients, individuals with intellectual disabilities, patients with substance abuse disorders, forensic psychiatric patients or patients with known or suspected pharmacokinetic abnormalities. Non-response at therapeutic doses, uncertain drug adherence, suboptimal tolerability, or pharmacokinetic drug-drug interactions are typical indications for TDM. However, the potential benefits of TDM to optimize pharmacotherapy can only be obtained if the method is adequately integrated in the clinical treatment process. To supply treating physicians and laboratories with valid information on TDM, the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued their first guidelines for TDM in psychiatry in 2004. After an update in 2011, it was time for the next update. Following the new guidelines holds the potential to improve neuropsychopharmacotherapy, accelerate the recovery of many patients, and reduce health care costs.
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                Author and article information

                Journal
                J Psychopharmacol
                J Psychopharmacol
                JOP
                spjop
                Journal of Psychopharmacology (Oxford, England)
                SAGE Publications (Sage UK: London, England )
                0269-8811
                1461-7285
                11 April 2023
                April 2023
                : 37
                : 4
                : 327-369
                Affiliations
                [1 ]Division of Psychiatry, University College London, London, UK
                [2 ]South London and Maudsley NHS Foundation Trust, London, UK
                [3 ]Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
                [4 ]Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
                [5 ]Harvard Medical School, Boston, MA, USA
                [6 ]Mind, Brain Imaging and Neuroethics Research Unit, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
                [7 ]Veterans Affairs, Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
                [8 ]Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
                [9 ]Private Practice, Harleysville, PA, USA
                [10 ]Penn State Medical School, Hershey Medical Center, PA, USA
                [11 ]Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
                [12 ]Institute of Population Health, University of Manchester, Manchester, UK
                [13 ]Kennedy Krieger Institute, Baltimore, Maryland, USA
                [14 ]Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
                [15 ]Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, CH, India
                [16 ]Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
                [17 ]Regional Affective Disorders Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
                [18 ]Queen Square Institute of Neurology, University College London, London, UK
                [19 ]National Hospital for Neurology and Neurosurgery, London, UK
                [20 ]Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
                [21 ]School of Life Sciences, Queen’s Medical Centre, The University of Nottingham, Nottingham, UK
                [22 ]Patient and Retired Physician, Liverpool, UK
                [23 ]Centre for Academic Mental Health, University of Bristol, Bristol, UK
                [24 ]Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
                [25 ]Faculty of Life Sciences and Medicine, King’s College London, London, UK
                [26 ]Clinical Neuroscience, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
                [27 ]Institute of Mental Health, University College London, London, UK
                Author notes
                [*]Jonathan P Rogers, UCL Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Road, Bloomsbury, London, W1T 7NF, UK. Email: jonathan.rogers@ 123456ucl.ac.uk
                Author information
                https://orcid.org/0000-0002-4671-5410
                https://orcid.org/0000-0001-5205-8245
                https://orcid.org/0000-0003-1020-6777
                Article
                10.1177_02698811231158232
                10.1177/02698811231158232
                10101189
                37039129
                20989299-622b-427e-9404-095927bd679e
                © The Author(s) 2023

                This article is distributed under the terms of the Creative Commons Attribution 4.0 Lficense ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Funding
                Funded by: National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, ;
                Funded by: National Institute for Health Research, FundRef https://doi.org/10.13039/501100000272;
                Funded by: Wellcome Trust, FundRef https://doi.org/10.13039/100010269;
                Award ID: 220659/Z/20/Z
                Funded by: National Institute on Aging, FundRef https://doi.org/10.13039/100000049;
                Award ID: K23AG072383
                Funded by: Canadian Institutes of Health Research, FundRef https://doi.org/10.13039/501100000024;
                Funded by: Janssen Pharmaceuticals, FundRef https://doi.org/10.13039/100008897;
                Funded by: National Institute of Mental Health, FundRef https://doi.org/10.13039/100000025;
                Funded by: UCLH Biomedical Research Centre, FundRef https://doi.org/10.13039/501100012317;
                Funded by: National Institutes of Health, FundRef https://doi.org/10.13039/100000002;
                Award ID: MH070560
                Funded by: CCS Depression Research Fund, ;
                Funded by: office of rural health, FundRef https://doi.org/10.13039/100019294;
                Funded by: Michael Smith Foundation for Health Research, FundRef https://doi.org/10.13039/501100000245;
                Funded by: British Medical Association, FundRef https://doi.org/10.13039/501100000374;
                Funded by: vgh and ubc hospital foundation, FundRef https://doi.org/10.13039/100014823;
                Funded by: Veterans Affairs (VA) Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, ;
                Funded by: WEDC, ;
                Funded by: Deutsche Forschungsgemeinschaft, FundRef https://doi.org/10.13039/501100001659;
                Award ID: DFG HI 1928/5-1
                Funded by: Deutsche Forschungsgemeinschaft, FundRef https://doi.org/10.13039/501100001659;
                Award ID: HI 1928/6-1
                Funded by: Stanley Medical Research Institute, FundRef https://doi.org/10.13039/100007123;
                Funded by: Medical Research Council, FundRef https://doi.org/10.13039/501100000265;
                Funded by: National Alliance for Research on Schizophrenia and Depression, FundRef https://doi.org/10.13039/100009670;
                Funded by: Horizon 2020 Framework Programme, FundRef https://doi.org/10.13039/100010661;
                Funded by: Royal College of Physicians of Edinburgh, FundRef https://doi.org/10.13039/100012923;
                Categories
                BAP Guidelines
                Custom metadata
                ts1

                Pharmacology & Pharmaceutical medicine
                catatonia,catatonic schizophrenia,guideline,treatment,benzodiazepine,electroconvulsive therapy,neuroleptic malignant syndrome

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