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catatonia

A syndrome of psychomotor disturbances, first described in 1874 by Ludwig Karl Kahlbaum [11]. Etiology: (associated disorders) 1) schizophrenia 2) mood disorders, including major depression 3) organic mental disorders, including dementia Genetics: -> missense mutation in WKL1 on chromosome 22q13.33, encoding a non-selective cation channel is associated with autosomal dominant form of catatonic schizophrenia [4] Clinical manifestations: 1) acute onset 2) natural course of catatonia [11] a) single episode with recovery b) chronic, deteriorating, dementia c) episodic d) death, infections, institutionalization e) episodic, to chronic, dementia 3) hypomobility a) waxy flexibility -> limbs maintain position imposed by examiner b) negativism, resistance to examiner's efforts to move the patient c) generally no true rigidity, except that of voluntary resistance 4) resembling, but generally different from stupor a) patients may appear awake, with eyes open, but make no voluntary or responsive movements b) they make blink spontaneously c) patients may have some memory of events during episodes of catatonic stupor 5) fever may accompany a lethal form of catatonia 6) also see -> motor features of catatonia, DSM IV & ICD-10 7) forms of catatonia (classification) a) excited catatonia: -> excited, impulsive, hyperactive, combative b) periodic catatonia: -> regularly recurring episodes of excited catatonia c) stuporous catatonia: -> subdued, mute, negativistic, staring, rigidity, cataplexy Complications: 1) pulmonary embolism 2) physical restraint 3) pneumonia 4) labeling as advanced dementia 5) inappropriate Do Not Resuscitate Orders 6) death Differential diagnosis: 1) akinetic mutism 2) abulia 3) neuroleptic malignant syndrome (febrile catatonia) 4) schizophrenia 5) advanced dementia -> paratonia 6) Parkinson's disease Management: 1) electroconvulsive therapy (ECT) a) improves immediate signs of catatonia b) improves underlying depression or psychosis c) may be no better than other treatments after onset of negative symptoms 2) pharmaceutical agents a) benzodiazepines 1] improves immediate signs of catatonia 2] may not relieve underlying psychosis 3] lorazepam 6-16 mg/day for 3-5 days b) clozapine, may be used in conjunction with ECT c) carbamazepine is suggested to be useful [5] d) valproic acid [6] 1] 4 g/day IV (initially) 2] taper & maintain on oral dose of 1 g/day e) risperidone, acute & maintenance therapy [7, 9] f) barbiturates (amobarbital) [11] 3) prognosis: -> response is favorable, unless associated with disorganized schizophrenia

Related

motor features of catatonia, DSM IV & ICD-10

General

sign/symptom syndrome

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 126
  2. Principles of Neurology, 4th edition, Adams RD & Victor M, McGraw-Hill, NY, 1989, pg 327
  3. Fink. J Neural Transm 108:637, 2001 (review)
  4. Meyer et al Mol Psychiatry 6:302, 2001
  5. Kritzinger & Jordaan Int J Neuropsychopharmacol 4:251, 2001
  6. Braunig P, J Neuropsychiatry Clin Neurosci 13:302, 2001
  7. Valevski et al, Clin Neuropharmacol 24:228, 2001
  8. Malur et al, J ECT 17:55, 2001
  9. Hesslinger et al, Pharmacopsychiatry 34:25, 2001
  10. Swartz & Galang, Am J Geriatr Psychiatry 9:78, 2001
  11. Carroll BT, Psych & Clin Neurosci 55: 431, 2001 (review)
  12. Peralta & Cuesta Schizophrenia Res 47:117, 2001