Catatonia

Catatonia

Catatonia is a clinical syndrome, first described by Kahlbaum (1874), characterized by a state of unresponsiveness but with maintained, immobile, body posture (sitting, standing; cf. stupor), mutism, and refusal to eat or drink, with or without staring, grimacing, limb rigidity, maintained abnormal postures (waxy flexibility or flexibilitascerea), negativism, echophenomena (imitation behavior), stereotypy, and urinary incontinence or retention. After recovery patients are often able to recall events which occurred during the catatonic state (cf. stupor). "Lethal catatonia", in which accompanying fever and collapse lead to death, was described in the 1930’s, and seems to resemble neuroleptic malignant syndrome; the name "malignant catatonia" has been proposed for this syndrome. Catatonia may be confused clinically with abulia.

Kraeplin classified catatonia as a subtype of schizophrenia but most catatonic patients in fact suffer a mood or affective disorder. Furthermore, although initially thought to be exclusively a feature of psychiatric disease, catatonia is now recognized as a feature of structural or metabolic brain disease. The original account contains descriptions suggestive of extrapyramidal disease.

Catatonia of psychiatric origin often responds to lorazepam; there are also advocates of ECT.

 

References

Fink M, Taylor MA. Catatonia: a clinician’s guide to diagnosis and treatment. Cambridge: CUP, 2003
Kahlbaum K. Catatonia. Levij Y, Pridan T (trans.). Baltimore: Johns Hopkins University Press, 1973
Muqit MMK, Rakshi JS, Shakir RA, Larner AJ. Catatonia or abulia? A difficult differential diagnosis. Movement Disorders 2001; 16: 360-362

 

Cross References

Abulia; Akinetic mutism; Imitation behavior; Mutism; Negativism; Rigidity; Stereotypy; Stupor