Two-thirds of medical catatonia involved CNS-specific disease including encephalitis, neural injury, developmental disorders, structural brain pathology, or seizures.Ĭatatonia presents with a range of clinical signs that are relatively non-specific. At least 80% of older adults seen by consult psychiatry and critically ill patients had a medical cause.In acute medical and surgical settings, medical catatonia comprised more than half of the cases.Hospital-wide, 20% of catatonia was medical.It is important to rule out organic causes:Ī systematic review showed that: Bush- Francis Catatonia Rating Scale (BCFRS).Excited catatonia: less common presentation in which patients develop prolonged periods of psychomotor agitation Retarded catatonia: characterised by immobility, mutism, staring, rigidity,Ģ. The alternative clinical classification includes:ġ. One key difference highlighted between NMS and catatonia is that malignant catatonia starts with psychotic excitement while NMS starts with severe extrapyramidal muscular rigidity. Due to the similarity with the presentation of neuroleptic malignant syndrome, Fink suggested that malignant catatonia and NMS should be considered the same disorder. Malignant catatonia: acute onset, fever, autonomic instability, leucocytosis, increased CK.Delirious catatonia: defined by the presence of excitement, altered states of consciousness and delirium requiring higher doses of BZDs, worsens with antipsychotics (APs) and often requires adjunctive ECT.Non-malignant (Kahlbaum syndrome): the most frequent form of catatonia which has a positive response to treatment with benzodiazepines (lorazepam 6-20 mg IV).Taylor and Fink proposed that catatonia should be classified as an independent entity with three subtypes: For further reading, please refer to Luchini F et al., 2015 There are several proposed classifications of catatonia, which is outside the scope of this article. Īlthough the catatonic subtype of schizophrenia has been deleted from the DSM, catatonia is still included as a specifier for schizophrenia and major mood disorders (bipolar disorder, major depressive disorder, and other mental, and neurodevelopmental disorders).Ĭatatonia is also a specifier for brief psychotic disorder, schizoaffective disorder, schizophreniform disorder and substance-induced psychotic disorder.Ī new residual diagnostic category of catatonia not otherwise specified (NOS) is added in patients with psychiatric conditions other than schizophrenia or mood disorders or when the general medical condition is not immediately recognised. Another classic symptom is posturing, whereby the patient positions themselves in an uncomfortable position against gravity with complete akinesia.Ĭatatonia is an identifiable syndrome that is well characterised and defined in the DSM-V as a separate clinical diagnosis to schizophrenia. The classical clinical feature of catatonia is stupor, which is characterised by immobility and mutism. The ‘death feint’ is an instinctive response to predators that detect movement but in humans of today is now inappropriately triggered by modern-day threats. Catatonia may also be an evolutionary fear response to imminent danger that is similar to the animal defence strategy of tonic immobility.Evidence of sudden and massive dopamine blockade in the striatal dopaminergic system does, however, explain why antipsychotics such as haloperidol can exacerbate the syndrome (i.e. Dysfunctional dopamine metabolism was originally hypothesised to be linked to catatonia during the 1970’s however the data is inconsistent.Therapeutic recovery with the NMDA-antagonist, amantadine, is gradual and therefore NMDA receptors are likely to be a secondary mechanism (unlike GABA-A receptors)
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