Major Mood Disorders
Dr. Ather Muneer in Mood Disorders, 2018
Catatonia can be defined as a neurobehavioral syndrome that has motor, psychic and autonomic manifestations and can occur in a wide range of medical, neurological and psychiatric conditions. The etiology of this distinctive syndrome is not fully understood, but emerging evidence indicates that biological stress facilitated by inflammatory mediators and reactive oxygen species leads to imbalance of neurotransmitters in the brain and precipitates the catatonic state.35 Catatonic symptoms can be present in any severe phase of major mood disorders, when the specifier “with catatonic features” is applied to describe the particular episode. There is a wide range of catatonic symptoms; behavioral manifestations can vary from negativism, withdrawal, staring, immobility/stupor, mutism, posturing, grimacing, stereotypies, and mannerisms to non-purposeful excitement, undirected combativeness, unexplained impulsive behavior, echopraxia and echolalia. Motor abnormalities can include rigidity, waxy flexibility (when moved passively the limbs maintain their position), catalepsy (the person sustains a certain posture irrespective of environmental changes), mitgehen (anglepoise lamp sign) and gegenhalten (involuntary variable resistance during passive movement). According to DSM-5, if two of the abovementioned signs are present then the specifier “with catatonic features” can be used. Evidence from the extant literature suggests patients with mood disorders are regularly afflicted with catatonia and this state can emerge in both MDD and BD.36
The Evolution of Electroconvulsive Therapy
Barry M. Maletzky, C. Conrad Carter, James L. Fling in 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
“My Patient is Hysterical”
Paul Ian Steinberg in 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.
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.
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%).
Can acute stress be fatal? A systematic cross-disciplinary review
Published in Stress, 2019
Solveig Baltzer Nielsen, Sharleny Stanislaus, Kari Saunamäki, Carsten Grøndahl, Jytte Banner, Martin Balslev Jørgensen
There are several theories of what causes catatonia. But relevant in this context is the theory that catatonia is an extreme fear response (Dhossche, 2014; Moskowitz, 2004). That benzodiazepines can successfully treat catatonia and that many patients describe their experiencing of malignant catatonia as states of intense anxiety supports this theory (Moskowitz, 2004). In “‘Scared stiff’: Catatonia as an evolutionary-based fear response” Moskowitz (2004) argues that malignant catatonia is a deadly form of anxiety, and in that view, one can be scared to death. Moskowitz argues that the immobile state of catatonia is an unadjusted primitive reaction, which in a modern context becomes pathological and is a reaction to fearful situations where the immobility makes no sense (Moskowitz, 2004).
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