The role of coagulation marker fibrin D-dimer in early diagnosis of catatonia

Catatonia is a common but under-diagnosed neuropsychiatric syndrome characterized by the occurrence in a single patient of concomitant affective, motor and behavioral symptoms with a hazardous outcome (called lethal catatonia: LC). Deaths by thromboembolic disease have been previously reported in LC. A 2-year prospective study was carried out to examine D-dimer levels, an early and sensitive coagulation marker, in patients with catatonic disorders. Twenty-five acute catatonic patients and 50 psychiatric control patients – matched on age, gender, psychiatric diagnosis, general psychopathology and neuroleptic medication matched – were investigated and considered in relation to D-dimer blood levels and other biological variables (serum iron, creatine phosphokinase, leukocytosis). All catatonic patients had high D-dimer levels and mean levels were significantly higher in catatonics than in non-catatonic patients, independently of age, gender, immobility, comorbid diagnosis, general psychopathology and neuroleptic medication. No significant association was observed with other biological parameters investigated. These preliminary and exploratory results suggest that catatonia is associated with early coagulation activation.