Catatonia zim://A/Catatonia.

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Catatonia
Not to be confused with Katatonia, cataplexy, catalepsy, or Catalonia.

Catatonia is a state of neurogenic motor immobility and

Catatonia
behavioral abnormality manifested by stupor. It was first
described in 1874 by Karl Ludwig Kahlbaum, in Die Classification and external resources

Katatonie oder das Spannungsirresein[1] (Catatonia or Specialty Neurology, psychiatry

Tension Insanity). ICD-10 F06.1

In the Diagnostic and Statistical Manual of Mental Disorders ICD-9-CM 293.89

5th edition catatonia is not recognized as a separate disorder, MeSH D002389
but is associated with psychiatric conditions such as
schizophrenia (catatonic type), bipolar disorder, post-traumatic stress disorder, depression and other mental
disorders, narcolepsy, as well as drug abuse or overdose (or both). It may also be seen in many medical
disorders including infections (such as encephalitis), autoimmune disorders, focal neurologic lesions (including
strokes), metabolic disturbances, alcohol withdrawal[2] and abrupt or overly rapid benzodiazepine withdrawal.
[3][4][5]

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; benzodiazepines are
a first-line treatment strategy. Electro-convulsive therapy is also sometimes used. There is growing evidence for
the effectiveness of NMDA antagonists for benzodiazepine resistant catatonia.[6] Antipsychotics are sometimes
employed but require caution as they can worsen symptoms and have serious adverse effects.[7]

Features
Patients with catatonia may experience an extreme loss of motor skill or even constant hyperactive motor
activity. Catatonic patients will sometimes hold rigid poses for hours and will ignore any external stimuli.
Patients with catatonic excitement can suffer from exhaustion if not treated. Patients may also show
stereotyped, repetitive movements.

They may show specific types of movement such as waxy flexibility, in which they maintain positions after
being placed in them through someone else 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.

While catatonia is only identified as a symptom of schizophrenia in present psychiatric classifications, it is

increasingly recognized as a syndrome with many faces. It appears as the Kahlbaum syndrome (motionless
catatonia), malignant catatonia (neuroleptic malignant syndrome, toxic serotonin syndrome), and excited forms
(delirious mania, catatonic excitement, oneirophrenia).[7] It has also been recognized as grafted on to autism
spectrum disorders.[8]

Diagnostic criteria
According to the DSM-V, "Catatonia Associated with Another Mental Disorder (Catatonia Specifier)" is
diagnosed if the clinical picture is dominated by at least three of the following:[9]

stupor (i.e., no psychomotor activity; not actively relating to environment)

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catalepsy (i.e., passive induction of a posture held against gravity)

waxy flexibility (i.e., allow positioning by examiner and maintain position)
mutism (i.e., no, or very little, verbal response [exclude if known 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)

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 a state of constant purposeless agitation and excitation. Individuals in this state
are extremely hyperactive, although, as aforementioned, the activity seems to lack purpose. The
individual may also experience delusions or hallucinations.[10] It is commonly cited as one of the most
dangerous mental states in psychiatry.[11]

Malignant catatonia is an acute onset of excitement, fever, autonomic instability, delirium and may be
fatal.[12]

Rating scale

Fink and Taylor developed a catatonia rating scale to identify the syndrome.[7] A diagnosis is verified by a
benzodiazepine or barbiturate test. The diagnosis is validated by the quick response to either benzodiazepines or
electroconvulsive therapy (ECT). While proven useful in the past, barbiturates are no longer commonly used in
psychiatry; thus the option of either benzodiazepines or ECT.

Treatment
Initial treatment is aimed at providing symptomatic relief. Benzodiazepines are the first line of treatment, and
high doses are often required. A test dose of 1–2 mg of 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.[7]

Electroconvulsive therapy (ECT) is an effective treatment for catatonia. 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 immediate discontinuation of the antipsychotic.[7]

Excessive glutamate activity is believed to be involved in catatonia; when first-line treatment options fail,
NMDA antagonists such as amantadine or memantine are used. Amantadine may have an increased incidence

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of tolerance with prolonged use and can cause psychosis, due to its additional effects on the dopamine system.
Memantine has a more targeted pharmacological profile for the glutamate system, reduced incidence of
psychosis and may therefore be preferred for individuals who cannot tolerate amantadine. Topiramate, is
another treatment option for resistant catatonia; it produces its therapeutic effects by producing glutamate
antagonism via modulation of AMPA receptors.[13]

See also
Blank expression
Awakenings - 1990 film with Catatonia as a plot topic
Botulism
Disorganized schizophrenia
Karolina Olsson
Oneiroid syndrome
Paranoid schizophrenia
Persistent vegetative state
Tonic immobility

References
1. ↑ http://web.archive.org/web/20080209213229/http:
//www.entwicklung-der-psychiatrie.de/seiten
/24.1_kahlbaum_die_katatonie.htm, Archived copy
(Internet Archive)
2. ↑ Geoffroy PA, Rolland B, Cottencin O. (May–June
2012). "Catatonia and alcohol withdrawal: a complex
and underestimated syndrome.". Alcohol Alcohol. 47
(3): 288–90. doi:10.1093/alcalc/agr170.
PMID 22278315.
3. ↑ Rosebush PI; Mazurek MF. (August 1996).
"Catatonia after benzodiazepine withdrawal". Journal
of clinical psychopharmacology. 16 (4): 315–9.
doi:10.1097/00004714-199608000-00007.
PMID 8835707.
4. ↑ Deuschle M, Lederbogen F (January 2001).
"Benzodiazepine withdrawal-induced catatonia".
Pharmacopsychiatry 34 (1): 41–2. doi:10.1055/s-
2001-15188. PMID 11229621.
5. ↑ Kanemoto K, Miyamoto T, Abe R (September
1999). "Ictal catatonia as a manifestation of de novo
absence status epilepticus following benzodiazepine
withdrawal". Seizure 8 (6): 364–6.
doi:10.1053/seiz.1999.0309. PMID 10512781.
6. ↑ Daniels, J. (2009). "Catatonia: clinical aspects and
neurobiological correlates.". J Neuropsychiatry Clin
Neurosci 21 (4): 371–80.
doi:10.1176/appi.neuropsych.21.4.371.
PMID 19996245.
7. 1 2 3 4 5 Fink M, Taylor MA: CATATONIA: A
Clinician's Guide to Diagnosis and Treatment,
Cambridge U Press, 2003"
8. ↑ Dhossche D et al.: Catatonia in Autism Spectrum
Disorders, Elsevier, Amsterdam, 2006
9. ↑ American Psychiatric Association (2013).
Diagnostic and Statistical Manual of Mental
Disorders (Fifth ed.). Arlington, VA: American
Psychiatric Publishing. p. 119.
ISBN 978-0-89042-555-8.
10. ↑ Nolen-Hoeksema. Abnormal psychology. (6th ed.,
p. 224)
11. ↑ Maric, J. (2000). Clinical Psychiatry. Nolit,
Belgrade.
12. ↑ Semple,David."oxford hand book of psychiatry"
Oxford press. 2005.
13. ↑ Carroll, BT.; Goforth, HW.; Thomas, C.; Ahuja, N.;
McDaniel, WW.; Kraus, MF.; Spiegel, DR.; Franco,
KN. et al. (2007). "Review of adjunctive glutamate
antagonist therapy in the treatment of catatonic
syndromes". J Neuropsychiatry Clin Neurosci 19 (4):
406–12. doi:10.1176/appi.neuropsych.19.4.406.
PMID 18070843.

External links

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Encyclopedia of Mental Disorders - Catatonic Disorders

Mental and behavioral disorders (F 290–319)

Neurological/symptomatic
Mild cognitive impairment · Alzheimer's disease · Vascular dementia · Pick's disease ·
Dementia Creutzfeldt–Jakob disease · Huntington's disease · Parkinson's disease ·
AIDS dementia complex · Frontotemporal dementia · Sundowning · Wandering
Autism · Asperger syndrome · Savant syndrome · PDD-NOS ·
Autism spectrum
High-functioning autism

Other Delirium · Post-concussion syndrome · Organic brain syndrome

Psychoactive substances, substance abuse, drug abuse and substance-

related disorders
Intoxication/Drug overdose · Physical dependence · Substance dependence · Rebound effect ·
Double rebound · Withdrawal

Schizophrenia, schizotypal and delusional

Psychosis Schizoaffective disorder · Schizophreniform disorder · Brief reactive psychosis

Schizophrenia Disorganized schizophrenia · Delusional disorder · Folie à deux

Mood (affective)
Mania · Bipolar disorder · (Bipolar I · Bipolar II · Cyclothymia · Bipolar NOS) · Depression ·
(Major depressive disorder · Dysthymia · Seasonal affective disorder · Atypical depression ·
Melancholic depression)

Neurotic, stress-related and somatoform

Agoraphobia · Social anxiety · Social phobia · (Anthropophobia) ·
Phobia
Specific phobia · (Claustrophobia) · Specific social phobia
Anxiety disorder
Panic disorder · Panic attack · Generalized anxiety disorder · OCD ·
Other
stress · (Acute stress reaction · PTSD)

Adjustment disorder Adjustment disorder with depressed mood

Somatization disorder · Body dysmorphic disorder · Hypochondriasis ·

Somatoform disorder Nosophobia · Da Costa's syndrome · Psychalgia · Conversion disorder ·
(Ganser syndrome · Globus pharyngis) · Neurasthenia · Mass psychogenic illness
Dissociative identity disorder · Psychogenic amnesia · Fugue state ·
Dissociative disorder
Depersonalization disorder

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Physiological/physical behavioral
Eating disorder Anorexia nervosa · Bulimia nervosa · Rumination syndrome · NOS

Nonorganic (Nonorganic hypersomnia · Nonorganic insomnia) · Parasomnia · (REM behavior

sleep disorders disorder · Night terror · Nightmare)

sexual desire · (Hypoactive sexual desire disorder · Hypersexuality)

Sexual sexual arousal · (Female sexual arousal disorder) · Erectile dysfunction
dysfunction orgasm · (Anorgasmia · Delayed ejaculation · Premature ejaculation · Sexual anhedonia)
pain · (Vaginismus · Dyspareunia)

Postnatal Postpartum depression · Postnatal psychosis

Adult personality and behavior

Sexual and Sexual maturation disorder · Ego-dystonic sexual orientation · Sexual relationship
gender identity disorder · Paraphilia · (Voyeurism · Fetishism)

Personality disorder · Impulse control disorder · (Kleptomania · Trichotillomania ·

Other Pyromania · Dermatillomania) · Body-focused repetitive behavior · Factitious disorder ·
(Münchausen syndrome)

Mental disorders diagnosed in childhood

Intellectual disability X-linked intellectual disability · (Lujan-Fryns syndrome)

Psychological development
Specific · Pervasive
(developmental disorder)

ADHD · Conduct disorder · (ODD) · emotional disorder ·

(Separation anxiety disorder) · social functioning · (Selective mutism · RAD
Emotional and behavioral
· DAD) · Tic disorder · (Tourette syndrome) · Speech · (Stuttering ·
Cluttering) · Movement disorder · (Stereotypic)

Symptoms and uncategorized

Catatonia · False pregnancy · Intermittent explosive disorder · Psychomotor agitation · Sexual addiction ·
Stereotypy · Psychogenic non-epileptic seizures · Klüver-Bucy syndrome

Index of psychology and psychiatry

Description Mental processes

Mental and behavioral ( ADHD · OCD · Tourette's) · Mood · Developmental ( pervasive ·

Disorders dyslexia and specific) · Substance-related ( alcohol) · Emotional and behavioral ·
Symptoms and signs · Evaluation and testing

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Psychotherapy ( CBT) · Drugs ( depression · antipsychotics · anxiety · dementia · hypnotics

Treatment
and sedatives)

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