Use of Measuring Creatinine Kinase in Detection of Emerging Catatonia: Literature Review and Case Series Report

Catatonia, particularly malignant catatonia (MC), continues to manifest in severe sequalae such as hyperthermia, rhabdomyolysis, cardiovascular collapse and failure, and even death as, although identification of the syndrome has significantly improved once its developed, several precarious factors continue to inhibit prompt and efficacious treatment. In this context, we evaluated the cases of six patients who were treated at our center for eventual MC manifestation with the aim of elucidating a pre-MC sensitive presentation pattern, common finding, or other granular data point that may have predictive value for MC. Patient chart review and granular data comparison revealed an association between creatine kinase (CK) level trends and catatonia diagnosis. Data were uniformly transformed for percent change to establish overall trends and subsequently analyzed for correlative strength via nonlinear regression. When comparing the inter-sample percent change of CK level to time, a moderate correlation was found (R2 = 0.3784). Analysis of nonlinear regression modeling using least squares for appropriateness of fit using runs test suggested minimal deviation from the model (p = 0.1566). In conclusion, in patients presenting with features that cause a suspicion of catatonia, CK level measurements may be implemented and utilized to more promptly make the diagnosis and begin potentially life-saving treatment or avoid life-threatening treatment.