Original ArticlesSerum iron in catatonia and neuroleptic malignant syndrome
Introduction
The finding of decreased serum iron levels in neuroleptic malignant syndrome (NMS) (Rosebush and Mazurek 1991) has evoked discussion over its diagnostic significance and the putative role of iron modulatory effects on dopamine receptors in the pathogenesis of NMS White and Brown 1990, Weller and Kornhuber 1993. In support of the hypothesis that NMS is a severe variant of catatonia Fink 1995, Carroll and Goforth 1995 reported a similar decrease of serum iron in three of 12 catatonic episodes. NMS eventually developed in two of the three episodes, while the third one without exposure to neuroleptics did not progress to NMS. Serum iron was not remeasured after the catatonic episodes resolved. The authors suggested that decreased serum iron levels in catatonia predict those who will evolve into NMS, but cautioned the need for confirmatory studies with larger sample sizes and postresolution serum iron levels.
This study replicates the finding of reduced serum iron levels in acute catatonia in a larger sample, and it intends to examine the predictive value of low serum iron in the progression of catatonia to NMS and explore other potential diagnostic and therapeutic significance of serum iron in catatonia.
Section snippets
Methods and materials
During a 3-year period, 50 patients with catatonia were seen in two psychiatric intensive care units at Tokanui Hospital, New Zealand (23-bed Intensive Psychiatric Care Unit, 39 patients) from June 1993 to October 1995 and at Graylands Hospital, Western Australia (five-bed Acute Care Unit, 11 patients) from December 1995 to July 1996. All patients admitted to the two psychiatric hospital locked facilities during the specified periods were under the care of the author or the care of psychiatric
Results
Of 716 patients (506 male, 210 female of 1257 admissions) admitted to the Tokanui Hospital unit during the 28-month period, 39 patients [20 male, 19 female, aged 16–73, mean age 33.5 years (SD = 14.3); Patients 1–39] had one or more catatonic episode. This represented 5% of the patient population. As not all admissions were screened for catatonia, milder cases would have been missed. Eleven [7 male, 4 female, aged 23–59, mean age 36.1 years (SD = 10); Patients 40–50] of 86 patients (42 male, 44
Discussion
Catatonia is a behavioral neurological syndrome of diverse etiology (Taylor 1990), generally regarded as having two states—retardation (stupor) and excitement (Morrison 1973). Lethal catatonia, a life-threatening condition first described in the preneuroleptic era (Stauder 1934), is characterized by relentless catatonic excitement, delirium, hyperpyrexia, and autonomic dysfunction leading to stuporous exhaustion. Less frequently the disorder follows primarily a stuporous course (Mann et al 1986)
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