Catatonia
Template:DiseaseDisorder infobox
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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-V), catatonia became recognized as a separate disorder. Catatonia is also 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
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]
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Catatonia associated with another mental disorder (catatonia specifier) may be used when criteria are met for catatonia during the course of a neurodevelopmental, psychotic, bipolar, depressive, or other mental disorder.
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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[2]
Epidemiology and Demographics
The prevalence of catatonia associated with another medical disorder is unknown of the overall population.[2]
Risk Factors
- History of neuroleptic medatt[2]
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]
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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.