Diagnosis Of Catatonia Research Articles

Catatonia in the elderly

Catatonia in geriatric patients has been insufficiently investigated. We reviewed 71 case descriptions from 45 studies to clarify the phenomenology, diagnosis, etiology, and treatment of catatonia in the elderly. In elderly patients, catatonia is frequently observed in association with general medical conditions. In patients with a history of depression or schizophrenia, physicians occasionally overlook the medical conditions because they believe the previous psychosis to be the cause of the catatonic features. Despite historical discussions of a relation between the disorders, the number of patients with catatonia and a prior diagnosis of schizophrenia or another psychotic disorder is not large. A diagnosis of catatonia should be considered in cases of atypical “collapse” in elderly patients with a previous psychiatric history of mood disorder. Catatonia due to anxiety/adjustment disorder is quite rare, whereas catatonia in association with neuroleptic malignant syndrome is fairly common. For early commencement of treatment, early detection of catatonia in the elderly is important. In studies of psychotropic drug treatment, many authors observed a beneficial response to lorazepam in catatonic patients. For medication-refractory patients, electroconvulsive therapy should be considered. It is important to prevent the development of venous thrombosis as a serious complication in stuporous catatonic patients.

Travail en réseau : exemple du réseau des consultations de pathologie professionnelle

Catatonia is a neuropsychiatric disorder that can occur in the setting of many illnesses, but the frequency of catatonia diagnosis among hospitalized patients is poorly characterized. This study reports the occurrence of catatonia diagnosis among acute care hospital discharges in the United States and the cooccurring diagnoses of these patients.The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients older than 18 discharged with a diagnosis of catatonia in 2019.13,630 encounters among the 30,080,038 adult hospitalizations in the NIS during the study year included a diagnosis of catatonia. Total hospital charges for these admissions were $1.15 billion, with 215,165 cumulative hospital days. In this sample, approximately 60% of admissions had a primary psychiatric discharge diagnosis, while 40% had a primary neurologic or medical discharge diagnosis. Procedures were performed in 36.7% of hospitalizations involving catatonia, of which electroconvulsive therapy was most common.Catatonia is a rare but costly discharge diagnosis among patients in acute care hospitals. It occurs across the age spectrum and is associated with a range of medical and psychiatric comorbidities. Further research is needed to better characterize the occurrence of catatonia and its optimal treatment.

Catatonic schizophrenia in Croatia.

A representative sample of schizophrenic subjects was collected for epidemiological and clinical follow-up in 1972 from the pool of 8069 patients registered in the Croatian Psychotics Case Register (CPCR). This sample comprised 402 patients (207 males and 195 females), who were followed up until 1990/91. The diagnosis of schizophrenia, catatonic type according to ICD-8 (V/295.2), was made in 59 cases (14.7%; 28 males, 31 females) at least once in the course of the follow-up. This study presents data concerning the diagnostic instability of the catatonic subtype during the long-term follow-up. As subtype diagnoses were frequently changed over the course of illness, at the end of the follow-up, the diagnosis of catatonic schizophrenia was only confirmed in 11 (18.6%) cases. Positive family history of psychosis was found in 44.1% of catatonic patients, a percent significantly greater than the corresponding figure for all non-catatonic schizophrenic subtypes combined (20.1%). This study provides preliminary evidence that the catatonic subtype of schizophrenia is a separate diagnostic entity with a high familial loading.

Notes on the Psychiatric Diagnosis of Anton Boisen

Describes the different opinions regarding the psychiatric diagnosis of Anton Boisen with special attention to their historical contexts. Outlines Boisen's relationship with psychiatrist Harry Stack Sullivan. Discusses the diagnosis of catatonia as a product of nineteenth century psychiatry and relates it to Boisen's description of his experience of illness. Reviews a contemporary understanding of catatonia helpful in clarifying this debate.

The catatonia rating scale I—Development, reliability, and use

The study objective is to present reliability data on the Catatonia Rating Scale (CRS). The CRS is a 21-item clinician-administered rating scale. Items are individually defined and are scored from 0 (absent) to 4 (severe). A definition for each degree of severity is provided for each item. The diagnostic threshold for catatonia is 4 symptoms rated at least 2 (moderate). The CRS requires, at most, 45 minutes to administer. Reliability data were evaluated in a sample of 120 inpatients, 71 of whom were catatonic. Ratings were performed by 4 pairs of raters. Interrater reliability was high (Pearson correlation coefficient = .91 to .99, intraclass correlation coefficient = .94 to .99). Internal consistency was very good (Cronbach's alpha = .8890). Analysis of individual items showed that all were frequently endorsed and occurred across a wide range of severity. The CRS is a reliable rating scale for the diagnosis of catatonia. Advantages of the scale, areas of use, and clinical implications are discussed.

Test for Catatonia with zolpidem

Catatonia is associated with severe motor and behavioural signs and has psychiatric and other general medical aetiologies. The effectiveness of benzodiazepines for catatonia has been shown. Mastain et al described a case of reproducible relief of a catatonic syndrome with zolpidem, a selective -aminobutyric acid A (GABA-A) agonist with a hypnoselective profile. GABA-A agonists enhance GABA activity that may reverse abnormal basal ganglia dopaminergic activity which has been postulated to explain the motor abnormalities of catatonia. We report clinical changes in relation to zolpidem plasma concentrations that confirm the improvements of catatonia syndrome with zolpidem. A 21-year-old woman with a first episode of schizoaffective disorder was treated with haloperidol 4 weeks after onset of the episode. Since her condition deteriorated haloperidol was discontinued. She met the criteria for diagnosis of catatonia according to DSM-IV. She displayed severe oppositional behaviour, mutism, staring, posturing, and food and drink refusal. 1 month after haloperidol withdrawal she was given zolpidem 10 mg orally with informed consent from her father. Zolpidem plasma concentrations were monitored every 15 min with concomitant rating assessments of the catatonic symptoms with the scale proposed by Rosebush et al. All her motor and behavioural signs resolved. The improvement occurred 15 min after administration of zolpidem as the plasma concentration reached 90 ng/mL and lasted 4 h. Relapse occurred when plasma concentrations fell below 90 ng/mL (see figure). The trial was replicated 24 h later with an identical threshold effect. She was then placed on alprazolam 2 mg three times daily and the catatonia resolved. Response to zolpidem is consistent with the effectiveness of GABA-A agonists in catatonia. Zolpidem may be an effective and prompt pharmacological test for catatonia.

Catatonia in depression: prevalence, clinical correlates, and validation of a scale.

To examine the clinical correlates of catatonia in depression, to validate a scale for catatonia, and to assess the validity of the DSM-IV criteria of the catatonic features specifier for mood disorders. A series of 79 consecutive patients with depression and 41 patients with Parkinson's disease without depression were examined using the modified Rogers scale (MRS), the unified Parkinson's disease rating scale (UPDRS), and the structured clinical interview for DSM-III-R (SCID). Sixteen of the 79 depressed patients (20%) had catatonia. Depressed patients with catatonia had significantly higher scores on the MRS than non-catatonic depressed patients matched for severity of depression, or non-depressed patients with Parkinson's disease matched for severity of motor impairment. Depressed patients with catatonia were older, had a significantly higher frequency of major depression, more severe cognitive impairments, and more severe deficits in activities of daily living than depressed non-catatonic patients. The DSM-IV criteria of catatonia separated depressed catatonic patients from patients with Parkinson's disease matched for motor impairment, with a specificity of 100%. Catatonic signs did not improve after apomorphine. catatonia is most prevalent among elderly patients with severe depression. The study showed the validity of the MRS for the diagnosis of catatonia in depressed patients, as well as the specificity of the DSM-IV criteria of the catatonic features specifier.

Street drugs yield primate Parkinson's model

The tragic mistake of several young drug abusers has led scientists at the National Institute of Mental Health (NIMH) to develop a unique animal model of Parkinson's disease. The animals are rhesus monkeys, and their parkinsonism is produced with 1-methyl4-phenyl-1,2,5,6-tetrahydropyridine (MPTP), a byproduct of the synthesis of a meperidine (Demerol) analogue, MPPP. The story began in November 1976, when a 23-year-old chemistry graduate student became severely rigid, mute, weak, and tremorous. He had injected himself during the course of several days with doses of a sloppy homemade batch of MPPP. He was admitted to the psychiatric ward of a general hospital with an initial diagnosis of catatonic schizophrenia but later was successfully treated with anti-parkinson medications and referred to NIMH for further evaluation. While receiving treatment for his parkinsonian symptoms, the student persisted in abusing drugs and finally died of an overdose in September 1978. Autopsy revealed severe loss of

A reassessment of catatonia

We consider catatonia as a disease entity having a cyclic, alternating course with periods of depression and mania. The prodromal symptoms observed often have a strong affective component. Diagnosis of catatonic schizophrenia should not be made on the basis of catatonic features or symptoms alone. It should only be made after schizophrenia has first been diagnosed by recognized diagnostic criteria. Research is needed to validate these observations. Epidemiologic studies, family genetic studies, and laboratory methods (such as the dexamethesone suppression test and other procedures) may offer avenues for pursuing catatonia as described by Kahlbaum as mainly an affective disorder. The presence of catatonic features demands a careful differential diagnosis. To merely label a patient with catatonic features as schizophrenic without further examination and investigation may deprive such a patient of proper treatment, which in cases such as malignant neuroleptic syndrome may mean the difference between life and death.

Criteria for the Diagnosis of Catatonia

Back to table of contents Previous article Next article ArticleNo AccessCriteria for the Diagnosis of CatatoniaALAN J. GELENBERGALAN J. GELENBERGSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.134.4.462-bAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Criteria for the Diagnosis of Catatonia." American Journal of Psychiatry, 134(4), pp. 462-b–463 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byProgress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. 33, No. 1Progress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. 29, No. 1Psychiatry Research, Vol. 134, No. 2Schizophrenia Research, Vol. 44, No. 3Movement Disorders, Vol. 14, No. 3Schizophrenia Research, Vol. 37, No. 2Cognitive Neuropsychiatry, Vol. 3, No. 3Biological Psychiatry, Vol. 39, No. 6Psychological Medicine, Vol. 26, No. 3Movement Disorders, Vol. 10, No. 5Psychopharmacology, Vol. 122, No. 2 Volume 134Issue 4 April 1977Pages 462-b-463 Metrics PDF download History Published online 1 April 2006 Published in print 1 April 1977

Criteria for the diagnosis of catatonia

Criteria for the diagnosis of catatonia

Catatonia. Retarded and excited types.

Of 250 patients carrying a chart diagnosis of catatonia, 110 were predominantly retarded and 67 predominantly excited. A comparison of these two groups showed that whereas no symptom was limited to one type, retarded patients were significantly more often negativistic, mute, rigid, cataleptic, and staring, whereas excited patients were more frequently impulsive, combative, and denudative. Excited patients were also characterized by an abrupt, rapid onset, were more likely to be greatly improved at discharge, and at follow-up were more often recovered. These differences suggest two separate prognostic entities, supported by the fact that excited patients were more often diagnosable as having affective disorder. Retarded and excited subtypes of catatonia should be reported separately in treatment and follow-up studies, and cannot be assumed to represent a single illness.