Adult Psychiatric Unit: Catatonia

Catatonia is a complex neuropsychiatric syndrome characterised by a broad range of motor, speech and behavioural abnormalities. 'Waxy flexibility', 'posturing' and 'catalepsy' are among the well-recognised motor abnormalities seen in catatonia. However, there are many other motor abnormalities associated with catatonia. Recognition of the full spectrum of the phenomenology is critical for an accurate diagnosis. Although controlled trials are lacking benzodiazepines are considered first-line therapy and N-Methyl-d-aspartate receptor antagonists also appears to be effective...

OBJECTIVES: Catatonia is a unique clinical phenomenon characterized by concurrent motor, emotional, vegetative and behavioral signs. Benzodiazepines (BZD) and electroconvulsive therapy (ECT) can rapidly relieve catatonic signs. The lorazepam-diazepam protocol presented here has been proven to relieve catatonia in schizophrenia within a day. METHODS: From July 2002 to August 2011, schizophrenic patients requiring psychiatric intervention for catatonia in Kaohsiung Chang Gung Memorial Hospital were studied by medical chart review...

Although catatonia has historically been associated with schizophrenia and is listed as a subtype of the disorder, it can occur in patients with a primary mood disorder and in association with neurological diseases and other general medical conditions. Consequently, catatonia secondary to a general medical condition was included as a new condition and catatonia was added as an episode specifier of major mood disorders in DSM-IV. Different sets of criteria are utilized to diagnose catatonia in schizophrenia and primary mood disorders versus neurological/medical conditions in DSM-IV, however, and catatonia is a codable subtype of schizophrenia but a specifier for major mood disorders without coding...

BACKGROUND: Despite a growing scientific and clinical interest in catatonia, its precise definition remains debated. AIM: The aim of this study was to offer a systematic review of the different rating scales that have been developed to assess catatonia in clinical practice. METHODS: A Medline-search was performed, up to December 2010. RESULTS: Seven catatonia rating scales were retrieved: the Modified Rogers Scale, the Rogers Catatonia Scale, the Bush-Francis Catatonia Rating Scale (BFCRS), and its revision, the Northoff Catatonia Rating Scale (NCRS), the Braunig Catatonia Rating Scale (BCRS), and the Kanner Scale...

Acute catatonia in an adolescent or young adult can present complex clinical challenges. Prominent issues include those involving diagnosis, timely and effective treatment, and diminished capacity to provide consent. The authors describe a 19-year-old woman presenting initially with manic excitement followed by a lengthy period of mutism, immobility, and food and fluid refusal. Elevated temperature, an elevated creatine phosphokinase level, and autonomic dysfunction led to consideration of a malignant catatonic syndrome...

Psychiatric diagnoses are currently categorized on a syndromic basis. The syndrome of catatonia, however, remains in a diagnostic limbo, acknowledged predominantly as a subtype of schizophrenia. Yet, catatonia is present in about 10% of acutely ill psychiatry patients, only a minority of whom have schizophrenia. Among those with comorbid affective disorders, who comprise the largest subgroup of catatonic patients, the catatonic signs typically resolve dramatically and completely with benzodiazepine therapy...

BACKGROUND: A resurgence of interest has led to renewed attempts to clarify the concept and treatment of catatonia. METHOD: A large prospective study was conducted to estimate the incidence of catatonic syndrome in 138 consecutive psychiatric patients admitted to a general hospital in India, to demarcate the common symptom presentations and its response to intravenous benzodiazepines. Patients were screened using the Bush Francis Catatonia Screening Instrument. Patients with two or more signs on the Instrument were subsequently administered intravenous lorazepam and their response was rated on the Bush Francis Catatonia Rating Scale...

Catatonia is a disorder characterized by mutism, posturing, echophenomena, and negativism. The preferred treatment for non-malignant catatonia is benzodiazepines, which often produce a reduction in symptoms within 24 hours. Presented here is a case report of a 19-year-old woman appearing in a catatonic state that did not respond to lorazepam. On the basis of emerging evidence that atypical antipsychotics and weak N-Methyl-D-Aspartate (NMDA) receptor-antagonists may effectively treat catatonia, we treated our patient with olanzapine and amantadine, which resulted in a dramatic reduction in her catatonic symptoms...

OBJECTIVE: The authors reviewed the recent literature regarding the treatment of catatonia as a syndrome of multiple etiologies. Given the historical and clinical association of catatonia with schizophrenia, the authors' examined the assumption that the first-line treatment of catatonia is antipsychotic medication. METHODS: Articles published between January 1, 1985 and December 31, 1994 were located using the Paperchase medical literature search system. Additionally, references from those identified articles were examined for possible inclusion in this review...

The authors describe three patients who each had a catatonic syndrome associated with affective psychosis and who responded dramatically to low doses of lorazepam.

Six papers have reported the efficacy of lorazepam in alleviating catatonic symptoms that have psychogenic causes. The authors report five new cases of catatonia; three patients responded favorably and two failed to respond to lorazepam. Investigation of the nonresponders revealed the presence of pernicious anemia in one and postpartum psychosis in the other. These findings demonstrate that lorazepam has an important role in the treatment of catatonic symptoms. Its effects appear to be specific for psychogenic catatonic states and for conditions in which biogenic amines, specifically dopamine and gamma-aminobutyric acid, play a part...