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Catatonia Dr. Rajdeep Routh ST5 Old Age Psychiatry Leverndale Hospital, Glasgow Sept., 2012

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Overview Introduction History Classification Clinical Features Differential Diagnosis Treatment Future Bibliography

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Introduction Neuropsychiatric syndrome of disturbed motor functions amid disturbances in mood and thought process Prevalence: rare has been suggested that catatonia is under-recognised and under-diagnosed 9%15% of patients admitted to a typical acute care psychiatric service meet diagnostic criteria for catatonia (Rosebush P.I. 2010) More common in mood disorders (28%-31% of catatonic patients had mixed mania or mania) Only 10%-15% - underlying diagnosis of schizophrenia

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History Before 1874: Stupor/ stupidite delineation of catatonia as a disease comparable to general paralysis of the insane (GPI) Two schools emerged one view supported the proposal of catatonia as a disease of its own. The opposing view was that it was a complication of different pathophysiologies and not a distinctive disease

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Contd. The Kraepelin Position First agreed with Kahlbaum By the time of the sixth edition of his textbook in 1899 catatonia had become a category of dementia praecox along with hebephrenia and paranoid dementia. Bleuler had a milder view of schizophrenia brought Kraepelins view that catatonia equaled schizophrenia to North America

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Contd. Karl Jaspers, portrayed catatonia as an illness with special characteristics like opposing pairs of symptoms (negativism vs automatic obedience). Kurt Schneiders psychology of catatonia, which he found unknowable: Sometimes it seems as though the patient is like a dead camera: He sees everything, hears everything, understands everything and yet is capable of no reaction, of no affective display, and of no action. Even though fully conscious he is mentally paralyzed. He considered Catatoinia a complication of many illnesses and rejected Kraepelins formulations

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Contd. highly influential figure in British psychiatry. In 1954, he became the lead authorin collaboration with Eliot Slater and Martin Rothof that eras principal English language psychiatry textbook, Clinical Psychiatry Mayer-Grosss position on catatonia was resolutely Kraepelinian that catatonia was a type of schizophrenia.

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Is it really a part of Schizophrenia? George Kirby (1913) pictured catatonia as typically occurring among patients with manic-depressive illness August Hoch(1921) described 25 psychiatric patients in stupor. Thirteen with manic-depressive illness had a favorable prognosis and 12 with general medical illnesses or schizophrenia had a poor prognosis Lange (1922) reported an experience with 200 patients found catatonia to be more common among the manic-depressive patients than among those with dementia praecox. The neurologic connection was established from studies of epidemic encephalitis by Von Economo (1931) who described catatonia in many patients in the acute and chronic phases of the illness

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The Debate Continues Stauder (1934) reported Malignant Catatonia in 27 patients with an acute onset and a lethal outcome A periodic form of catatonia with hormonal connections was described by Gjessing. Taylor and Abrams: 4 publications between 1973 and 1979, reported catatonia to be more common among manic and depressed patients Morrison found catatonia in more than 10% of 500 patients, most commonly among those with mood disorders. Gelenberg described catatonia among patients with neurologic and general medical illnesses 1980: identification of the NMS with accompanied by fever, tachycardia, hypertension, and tachypnea

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Classification: DSM 1952: Schizophrenic reaction: catatonic type 3 rd. Edition 1980: ignored new reports and again catalogued catatonia as a type of schizophrenia 4 th. Edition 1994: diagnosis of schizophrenia, catatonic type (code 295.20) If a physical cause is identified the diagnosis is catatonic disorder due to a medical condition (code 293.89) no separate diagnostic category for catatonia due to either depression or mania, but catatonia can be added as a specifier in mood disorders

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World Health Associations International Classification of Diseases (ICD) 6 th. Ed. 1948: catatonic type among the schizophrenic disorders. 10 th. Edition 1992: unchanged; For reasons that are poorly understood, catatonic schizophrenia is now rarely seen in industrial countries, though it remains common else where. Catatonic schizophrenia (category F20.2) Pt. With severe depression is in a stupor- a diagnosis of severe depressive episode with psychotic symptoms (F32.3) manic stupor will be diagnosed as having mania with psychotic symptoms (F30.2) Catatonia due to physical causes is diagnosed as organic catatonic disorder (F06.1).

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Clinical Features Stupor Posturing Waxy flexibility (cerea flexibilitas) Negativism (Gegenhalten) Automatic obedience Ambitendency Psychological pillow Forced grasping Obstruction

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Contd. Echopraxia Aversion Mannerisms Stereotypies Excitement Speech abnormalities Echolalia, logorrhoea and verbigeration

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Rating scales for catatonia General agreement among researchers that the syndrome is poorly recognised BushFrancis Catatonia Rating Scale (BFCRS) most widely used 23 items shorter, 14-item screening version Modified Rogers Scale (MRS)

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