Abstract
To the Editor
Catatonia is a frequent, complex and severe syndrome involving motor, affective, behavioural and vegetative symptoms (a video describing the symptomatology of catatonia is available at: http://tiny.cc/catatonia_symptoms) (Fink, 2013). In this letter, we wish to draw attention to the lack of consideration for catatonia in correctional environments. Indeed, data on the topic are scarce: only a few case reports are available in the scientific literature despite the range of arguments that suggest catatonia’s important prevalence in correctional settings.
First, many disorders that have been showed to be associated with catatonia are highly prevalent in prisoners. Psychiatric conditions that are more likely to cause catatonia, such as bipolar disorders, major depressive disorders and psychotic disorders, are more frequent among prisoners in comparison with the general population. The same observation can be made for non-psychiatric conditions that are related to catatonia, such as traumatic brain injuries or epileptic seizures, or even viral encephalitis (e.g. herpes simplex) (Fazel and Baillargeon, 2011).
Second, substance use disorders are frequently observed in correctional settings (Fazel and Baillargeon, 2011). As a result, active abuse of substances, and also the abrupt discontinuation of psychoactive substances often leading to forced withdrawal, pose major clinical challenge for psychiatrists in correctional environments. Interestingly, both acute intoxication (e.g. cocaine, methadone, cannabis and synthetic cannabinoids) and withdrawal (e.g. cannabis and alcohol) have been incriminated to potentially induce catatonia.
Third, patients recently incarcerated may undergo abrupt discontinuation of their medication as a result of lacking continuity of care between community and the correctional facilities. This can be particularly problematic for treatments such as benzodiazepines or clozapine, for which there is clear evidence that withdrawal can lead to catatonia (Lander et al., 2018).
This set of arguments suggests that, although understudied, catatonia could be very common in correctional facilities. Research in this area should thus be encouraged to clearly establish its prevalence. The potential implications in terms of prevention, screening and diagnosis are important particularly because catatonia is potentially lethal if not diagnosed early (Fink, 2013). Attention to environmental stressors of incarceration also offers great opportunities for a better understanding of this syndrome whose pathophysiology remains unclear.
It is now time to consider catatonia behind bars.
