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Catatonia; Presentation, Assessment, Diagnosis and Management

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Catatonia; Presentation, Assessment, Diagnosis and Management

INTRODUCTION

Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioural, emotional, and autonomic abnormalities Karl Ludwig Kahlbaum in 1874 first described catatonia; he was a German psychiatrist. It is an important condition in psychiatry though it can also have medical causes.

Causes

General medical, neurological, and psychiatric disorders medications and drugs of abuse.

Onset

Catatonia presents acutely, and we often see it in emergency departments and hospitalised patients. Sometimes it may have a sub-acute onset and a chronic course.

Cardinal Signs

Studies have identified forty signs of catatonia but are mutism, catalepsy/posturing, stupor, rigidity, waxy flexibility, stereotypies/mannerisms, and echophenomena are its cardinal ones

Cardinal Signs of Catatonia

Mutism

Catalepsy

Posturing

Stupor

Rigidity

Waxy flexibility

Stereotypies

Mannerisms

echophenomena

Clinical Variants

Authors consistently describe two clinical variants of catatonia.

Hypokinetic Variant

Patients have reduced movements, mutism, and withdrawal
Most often found in depressive disorders and general medical conditions.

Hyperkinetic variant

  • Presents with aimless motor activity confusion, and frequent autonomic dysfunction.
  • Mostly seen during manic episodes and in a special form of catatonia called delirious mania.
  • Both forms of catatonia can co-exist in the same patient, occurring in quick succession.

Factor analysis studies of catatonic signs suggest four dimensions

Catatonic signs

Associated condition

Catatonic excitement

Pure mania and mixed mania

Abnormal involuntary movements

Schizophrenia, Tourette’s disorder, obsessive-compulsive disorder

Volitional disturbance/catalepsy

Schizophrenia and mixed mania

Catatonic inhibition

depression and medical catatonia

With stereotypies, echophenomena, posturing/catalepsy, negativism, mannerisms, Mitgehen, and Mitmachen


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