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“My Patient is Hysterical”
Published in Paul Ian Steinberg, Psychoanalysis in Medicine, 2020
Catatonic symptoms provide the clinician with a diagnostic challenge because of the multiplicity of psychiatric, neurological, and medical presentations. Catatonic symptoms may occur in psychiatric conditions, including bipolar disorder, major depression, conversion disorder, and dissociative disorder. Catatonia has been observed in many neurological disorders, including lesions in the basal ganglia, limbic system, temporal lobes, third ventricle, thalamus, and frontal lobe, and in diffuse encephalomalacia, closed head injury, petit mal status, postictal phase of epilepsy, Wernicke’s encephalopathy, tuberous sclerosis, general paresis, narcolepsy, encephalitis lethargica, and cerebral-macular degeneration.
The Evolution of Electroconvulsive Therapy
Published in Barry M. Maletzky, C. Conrad Carter, James L. Fling, Multiple-Monitored Electroconvulsive Therapy, 2019
In summary, ECT still has not gained the respectability and consistency attributed to antischizophrenic medications in the treatment of this syndrome. Its use today is restricted to those schizophrenic patients not showing adequate reponse to medications or to those with particularly affective signs and symptoms. Of note in this regard is the response of patients with catatonia. This syndrome of nonresponse to most stimuli, muscular rigidity, acute onset, and poor therapeutic response to medications, often responds dramatically to ECT,100,165 perhaps a sign that it is not a result of schizophrenia, as was originally almost automatically assumed, but a variant presentation of an affective disorder.19
Clinical indications for ECT: adults
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
The treatment of choice for catatonia is benzodi-azepines; antipsychotic medication demonstrates poor efficacy (Hawkins, Archer, Strakowski and Keck, 1995). Treatment should be based upon the underlying cause when it is identifiable. ECT should be considered when rapid resolution is necessary in malignant catatonia or when an initial trial of lorazepam has been ineffective (Hawkins et al., 1995). Those with schizophrenia respond less reliably, suggesting that the underlying processes causing the catatonia may be different in this group. Failure to treat the catatonia may increase the risk of drugs-induced neuroleptic malignant syndrome (Rosebush and Mazurek, 2010).
Malignant catatonia: Severity, treatment and outcome – a systematic case series analysis
Published in The World Journal of Biological Psychiatry, 2022
Maximilian Cronemeyer, Carlos Schönfeldt-Lecuona, Maximilian Gahr, Ferdinand Keller, Alexander Sartorius
The most frequently described catatonic symptoms were mutism (n = 65, 55.6%), stupor (n = 47, 40.2%) and agitation (n = 46, 39.3%). Fever was reported in 98 patients (83.8%), mean body temperature was 39.0 ± 1.3 °C. Autonomic abnormalities appeared as tachycardia in 76 cases (65.0%), autonomic instability (n = 64, 54.7%), abnormal blood pressure (n = 60, 51.3%) and tachypnoea (n = 23, 19.7%). On average, heart rate was 127 ± 26 bpm, systolic blood pressure 167 ± 27 mmHg and diastolic blood pressure 96 ± 16 mmHg, mean respiratory rate was 30 ± 10/min. Other common symptoms were rigidity (n = 60, 51.3%), diaphoresis (n = 43, 36.8%), refusal of food/fluids (n = 29, 24.8%) and impaired consciousness (n = 26, 22.4%).
Catatonia Related to Cannabis and Synthetic Cannabinoids: A Review
Published in Journal of Dual Diagnosis, 2021
Raul Felipe Palma-Álvarez, Albert Soriano-Dia, Elena Ros-Cucurull, Constanza Daigre, Pedro Serrano-Pérez, Germán Ortega-Hernández, Marta Perea-Ortueta, David Gurrea Salas, Josep-Antoni Ramos-Quiroga, Lara Grau-López
There was a broad spectrum of catatonia-like symptoms reported in the cases analyzed in this review. This is congruent with literature that describes more than 40 signs and symptoms of catatonia (Solmi et al., 2018; Walther et al., 2019; Tandon et al., 2013; Rasmussen et al., 2016). Remarkably, almost all cases in the current review presented mutism. This is in line with a previous report that has linked acute use of cannabis to mutism (with no other catatonic symptoms) and contrasts with the traditional view of loquaciousness related to cannabis consumption (Marcotte, 1972). Similarly, other reports have stated that cannabis use also decreases speech quantity (Higgins & Stitzer, 1986), and may modify functions in the auditory cortex which has been connected to induced-psychotic symptoms (Winton-Brown et al., 2011). In the investigations in the present review, the duration of the catatonia-like symptoms varied, lasting hours (Cohen et al., 2012; Ilambaridhi B et al., 2020) weeks and even months (Haro et al., 2014; Manning et al., 2020; Roberto et al., 2016; Smith & Roberts, 2014). Thus, these symptoms may be present during acute intoxication and may persist for periods longer than expected when compared to the biological half-life of cannabis or SC.
Catatonia revived: a unique syndrome updated
Published in International Review of Psychiatry, 2020
Charles Mormando, Andrew Francis
Catatonia is being increasingly recognized in children and adolescents with autism spectrum disorders (ASD) and neurodevelopmental disorders. Several studies show that 12–20% of adolescents with autism have comorbid catatonia (Billstedt, Gillberg, & Gillberg, 2005; Breen & Hare, 2017; Wing & Shah, 2000), and this still may be an underestimate of the true prevalence (Breen & Hare, 2017). Catatonia may be undiagnosed in this population as repetitive speech and behaviour, purposeless agitation and stereotyped self-injury are misinterpreted as signs of ASD (Cohen, 2006; Cohen, Flament, Dubos, & Basquin, 1999; Dhossche, Wing, Ohta, & Jurge-Neumarker, 2006). Although there are no prospective studies, case series and other reports indicate that catatonia in these groups can be effectively treated with benzodiazepines and/or ECT (Miles, Takahashi, Muckerman, Nowell, & Ithman, 2019; Wachtel, 2019; Withane & Dhossche, 2019). Maintenance ECT may be required for sustained remission (Wachtel, 2019; Withane & Dhossche, 2019). A recent research and clinical focus has been the recognition of some forms of intractable self-injurious behaviour as a sign of catatonia that is responsive to ECT (Wachtel, Shorter, & Fink, 2018).