Catatonia: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{SI}} | {{SI}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{JH}} | ||
==Overview== | ==Overview== | ||
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===Subtypes=== | ===Subtypes=== | ||
'''Stupor''' is a motionless, | '''Stupor''' is a motionless, apathetic state in which one is oblivious or does not react to external [[stimulus (physiology)|stimuli]]. [[motor skill|Motor activity]] is nearly non-existent. Individuals in this state make little or no eye contact with others and may be [[speech disorder|mute]] and rigid. One might remain in one position for a long period of time, and then go directly to another position immediately after the first position. | ||
'''Catatonic excitement''' is state of constant purposeless [[agitation]] and excitation. Individuals in this state are extremely hyperactive although the activity seems to lack purpose. | '''Catatonic excitement''' is state of constant purposeless [[agitation]] and excitation. Individuals in this state are extremely hyperactive although the activity seems to lack purpose. | ||
==Catatonia Associated with Another Mental Disorder | ==Catatonia Associated with Another Mental Disorder== | ||
===Epidemiology and Demographics=== | ===Epidemiology and Demographics=== | ||
The prevalence of catatonia associated with another mental disorder is unknown of the overall population.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558}}</ref> | The prevalence of catatonia associated with another mental disorder is unknown of the overall population.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558}}</ref> | ||
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*Psychotic disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | *Psychotic disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
===DSM-V Diagnostic Criteria for Catatonic Disorder Due to Another | ===DSM-V Diagnostic Criteria for Catatonic Disorder Due to Another Medical Condition<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ||
{{cquote| | {{cquote| | ||
* A. The clinical picture is dominated by three (or more) of the following symptoms: | * A. The clinical picture is dominated by three (or more) of the following symptoms: | ||
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}} | }} | ||
==Catatonia Due to Another Medical Condition== | |||
===Differential Diagnosis=== | |||
*Brief psychotic disorder | |||
*Cerebrovascular disease | |||
*Diabetic ketoacidosis | |||
*[[Encephalitis]] | |||
*[[Neoplasms]] | |||
*[[Head trauma]] | |||
*[[Hepatic encephalopathy]] | |||
*[[Hypercalcemia]] | |||
*[[Homocystinuria]] | |||
*[[Schizoaffective disorder]] | |||
*[[Schizophrenia]] | |||
*[[Schizophreniform disorder]] | |||
*Substance/medication-induced psychotic disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | |||
===Epidemiology and Demographics=== | |||
The prevalence of catatonia associated with another medical disorder is unknown of the overall population.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558}}</ref> | |||
==Risk Factors== | |||
==Natural History, Complications and Prognosis== | |||
Poor prognostic factors are: | |||
*Neuroleptic malignant syndrome | |||
*Neuroleptic medication intake<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558}}</ref> | |||
==Diagnostic Criteria== | |||
===DSM-V Diagnostic Criteria for Paranoid Personality Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | |||
{{cquote| | |||
* A. The clinical picture is dominated by three (or more) of the following symptoms: | |||
# Stupor (i.e., no psychomotor activity; not actively relating to environment). | |||
# Catalepsy (i.e., passive induction of a posture held against gravity). | |||
# Waxy flexibility (i.e., slight, even resistance to positioning by examiner). | |||
# Mutism (i.e., no, or very little, verbal response [Note: not applicable if there is an established aphasia]). | |||
# Negativism (i.e., opposition or no response to instructions or external stimuli). | |||
# [[Posturing]] (i.e., spontaneous and active maintenance of a posture against gravity). | |||
# Mannerism (i.e., odd, circumstantial caricature of normal actions). | |||
# Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). | |||
# [[Agitation]], not influenced by external stimuli. | |||
# Grimacing. | |||
# [[Echolalia]] (i.e., mimicking another’s speech). | |||
# [[Echopraxia]] (i.e., mimicking another’s movements). | |||
'''''AND''''' | |||
* B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. | |||
'''''AND''''' | |||
* C. The disturbance is not better explained by another mental disorder(e.g.,amanicepisode). | |||
'''''AND''''' | |||
*D. The disturbance does not occur exclusively during the course of a delirium. | |||
'''''AND''''' | |||
*E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | |||
}} | |||
==Treatment== | ==Treatment== | ||
Revision as of 20:05, 11 November 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]
Overview
Catatonia is a syndrome of psychic and motoric disturbances. In the current Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (DSM-IV) it is not recognized as a separate disorder, but is associated with psychiatric conditions such as schizophrenia (catatonic type), bipolar disorder, post-traumatic stress disorder, depression and other mental disorders, as well as drug abuse and/or overdose. It may also be seen in many medical disorders including infections (such as encephalitis), autoimmune disorders, focal neurologic lesions (including strokes), metabolic disturbances and abrupt or overly rapid withdrawal from benzodiazepines.[1] It can be an adverse reaction to prescribed medication. It bears similarity to conditions such as encephalitis lethargica and neuroleptic malignant syndrome. There are a variety of treatments available, and depending on the case, one or more drugs may be used, including antipsychotics and benzodiazepines.
Clinical features
Patients with catatonia may experience an extreme loss of motor ability or constant hyperactive motor activity. Catatonic patients will sometimes hold rigid poses for hours and will ignore any external stimuli. Patients with catatonic excitement can die of exhaustion if not treated. Patients may also show stereotyped, repetitive movements. They may show specific types of movement known as "waxy flexibility" in which they maintain positions after being placed in them by someone else, or gegenhalten (lit. "counterhold"), in which they resist movement in proportion to the force applied by the examiner. They may repeat meaningless phrases or speak only to repeat what the examiner says.
Subtypes
Stupor is a motionless, apathetic state in which one is oblivious or does not react to external stimuli. Motor activity is nearly non-existent. Individuals in this state make little or no eye contact with others and may be mute and rigid. One might remain in one position for a long period of time, and then go directly to another position immediately after the first position.
Catatonic excitement is state of constant purposeless agitation and excitation. Individuals in this state are extremely hyperactive although the activity seems to lack purpose.
Catatonia Associated with Another Mental Disorder
Epidemiology and Demographics
The prevalence of catatonia associated with another mental disorder is unknown of the overall population.[2]
Risk Factors
- Bipolar disorders
- Depressive disorders
- Schizophrenia[2]
Natural History, Complications and Prognosis
Poor prognostic factors include:
- Bipolar disorder
- Depressive disorder
- Mental disorder
- Metabolic conditions
- Infectious conditions
- Psychotic disorder[2]
DSM-V Diagnostic Criteria for Catatonic Disorder Due to Another Medical Condition[2]
| “ |
|
” |
Catatonia Due to Another Medical Condition
Differential Diagnosis
- Brief psychotic disorder
- Cerebrovascular disease
- Diabetic ketoacidosis
- Encephalitis
- Neoplasms
- Head trauma
- Hepatic encephalopathy
- Hypercalcemia
- Homocystinuria
- Schizoaffective disorder
- Schizophrenia
- Schizophreniform disorder
- Substance/medication-induced psychotic disorder[2]
Epidemiology and Demographics
The prevalence of catatonia associated with another medical disorder is unknown of the overall population.[2]
Risk Factors
Natural History, Complications and Prognosis
Poor prognostic factors are:
- Neuroleptic malignant syndrome
- Neuroleptic medication intake[2]
Diagnostic Criteria
DSM-V Diagnostic Criteria for Paranoid Personality Disorder[2]
| “ |
AND
AND
AND
AND
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” |
Treatment
Initial treatment is aimed at providing relief from the catatonic state. Benzodiazepines are the first line of treatment, and high doses are often required. A test dose of 1-2 mg intramuscular lorazepam will often result in marked improvement within half an hour. In France, zolpidem has also been used in diagnosis and response may occur within the same time period. Ultimately the underlying cause needs to be treated.
Electroconvulsive therapy is an effective treatment for catatonia as well as for most of the underlying causes (e.g. psychosis, mania, depression). Antipsychotics should be used with care as they can worsen catatonia and are the cause of neuroleptic malignant syndrome, a dangerous condition that can mimic catatonia and requires the immediate discontinuation of the antipsychotic.
References
- ↑ Rosebush PI (1996). "Catatonia after benzodiazepine withdrawal". Journal of clinical psychopharmacology. 16 (4): 315–9. PMID 883570. Unknown parameter
|coauthors=ignored (help); Unknown parameter|month=ignored (help) - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.