Catatonia Research Articles

Non-convulsive epiletic seizure after electroconvulsive therapy session

IntroductionElectroconvulsive therapy (ECT) is a procedure performed under general anaesthesia involving triggering an intentional brief seizure through small electrical currents through the brain. The anaesthetic depth should be adequate prior to shock and measured with BIS, a processed electroencephalogram (EEG) monitor. Adjusting the hypnotic dose allows to decrease the ictal threshold and thus improve the response to treatment and decrease side effects.ObjectivesOur goal is detecting elements such as spontaneous epileptiform activity after ECT without tonic-clonic activity with the spectral density matrix (SDM).MethodsOur patient: an 87-year-old woman, diagnosed with F20.2 catatonic schizophrenia and under antipsychotic treatment since her youth. She has required multiple hospital admissions due to psychopathological decompensations until starting monthly maintenance ECT sessions in 2014. Since then she no new hospital admissions have been required.ResultsImages 1D and 1E shows the SDM, a spectrogram of the EEG. The X axis show time (minutes), the Y axis shows the frequency (Hz) and the Z axis shows the energy or intensity of that electrical activity in the frequency bands replaced by colors: warm colors (red) reflecting high intensity electroencephalographic activity and cool colors (yellow, blue and green), low activity. Images 2 and 3’s EDM shows spontaneous epileptiform activity after electroconvulsive therapy without tonic-clonic activity. We observed an initial EDM of an awake patient, with warm colours in practically all frequency bands, including the beta band (13-30 Hz), characteristic of waking states. Around 9:50 anaesthetic induction occurs, activity increases in slow frequencies (red colours in alpha, theta and delta), plus an increase of cold colours in beta, reflecting the disappearance of brain activity in that frequency. The asterisk reflects the EEG response to the electrical discharge, followed by a postcritical state with brain activity exclusively in slow waves and high amplitude (delta and some theta) and absence of activity in other frequencies (blue colour in the beta and alpha bands) around 9:57. At about 10:00 there is an abrupt appearance of high intensity brain activity (warm colours) in beta and alpha and delta, mainly, reflecting spontaneous epileptiform activity after treatment and clinically reflected as a patient absent and disconnected from the environment, but without tonic-clonic activity. New postcritical state in which blue colour predominates, reflecting little brain activity, and warmer colours reappear in all frequency bands, including beta, reflecting the progressive recovery of wakefulness.Image:Image 2:Image 3:ConclusionsPsychiatric pathology can be reflected in the SDM, which allows to observe changes in the EEG, correcting the electrical stimulus of the shock and the dose of anesthetic appropriate to the patient to trigger an intentional brief seizure under general anesthesia.Disclosure of InterestNone Declared

Role of transgenerational transmission of trauma in development of schizophrenia: A case report of a patient whose parents survived genocide in Srebrenica

IntroductionDevelopmental predisposition to schizophrenia can be a consequence of early experienced traumas. Transgenerational trauma is process in which traumatic experience of one generation is passed on to the next generation.ObjectivesTo show connection between transgenerational transmission of trauma and development of schizophrenia.MethodsPsychiatric interview, psychological testing.ResultsPatient G.E. age 29, admitted to Psychiatry Clinic due to altered behavior, aggressiveness and presence of delusions and hallucinations. First mental problems in form of a catatonic stupor appeared 6 years ago. Patient has history of earlier abuse of psychoactive substances. A drug test performed at admission was negative. Patient was born in Srebrenica in 1993, he escaped to Tuzla with his mother in July 1995, while father survived escaping on foot. Patient is a first child from his father’s second marriage. The father’s first wife and two minor children were shot by Bosnian Serbs in early 1992. Patient was born a year and a half after death of his siblings and was named after his half-sister. Patient’s father consumed alcohol after the war and was aggressive towards children. In the last two years, patient had frequent hallucinations, he told his parents that voices were telling him to kill his mother and told his father that his children were still alive. Diagnostic processing was performed and diagnosis of schizophrenia was stated. During hospitalization, patient was treated with olanzapine and low doses of haloperidol, along with haloperidol decanoate, which resulted in significant reduction of productive psychotic symptoms. A partial remission is achieved, negative schizophrenic symptoms and cognitive impairments verified by psychological instruments remain.ConclusionsCase report emphasize transgenerational transmission of trauma: father‘s untreated trauma, alcohol dependency and abuse of the patient in childhood. These findings are important for treatment and therapeutic considerations. Mentalizing is a possible mediator between childhood abuse and negative symptoms. Parental bonding was explored within high expressed emotions theory as a risk factor for relapse to psychosis, especially the “affectionless control” in the parental (mainly father‘s) bonding style. Studies also stated that psychotic patients often show insecure attachment representations. Possible pathway for further analysis could be discussed: a cold parental bonding style leading to experienced emotional neglect and attachment avoidance might be reflected in lower capacity to mentalize. To improve the mentalization capacity, it would be essential to establish a sustainable therapeutic treatment frame.Disclosure of InterestNone Declared

Amantadine augmentation in electroconvulsive therapy-resistant catatonia: a case report.

IntroductionCatatonia is a syndrome characterized by physical symptoms ranging from immobility to excessive motor activity. Besides being historically associated mainly with schizophrenia, it is widely known that it can be the expression of different psychiatric, neurological or medical conditions. The treatment of choice is benzodiazepines, indicating electroconvulsive therapy in refractory cases. Amantadine is considered a second-line therapy in setting when electroconvulsive therapy is not available.ObjectivesTo describe the case of a patient with treatment-resistant catatonic schizophrenia. Not having responded to benzodiazepines or electroconvulsive therapy, potentiation with amantadine was subsequently started.MethodsOur patient presented at a psychopathological level; psychomotor inhibition, a perplexing attitude, and mute speech. At the motor level; ambitendency, indecision, automatic obedience, motor stereotypes, and facial grimaces. He did not present other alterations at the neurological level. Regarding complementary explorations, we performed neuroimaging and blood tests, which resulted all anodyne. With an alternative diagnosis, we considered that sequelae of a neuroleptic malignant syndrome could have produced the symptoms that he had suffered. Due to the persistence of the symptoms and their typical characteristics, catatonia was our first diagnostical impression. As treatment with benzodiazepines was ineffective, electroconvulsive therapy was started. No clinical improvement was observed. Given the refractoriness of the case, a review of the existing literature was carried out. We found reports of a good response to amantadine in similar cases. Amantadine was introduced up to a dose of 200mg.ResultsAfter four weeks of treatment with amantadine at a dose of 200mg, the patient showed meager improvement at both psychopathological and motor level.ConclusionsWe find the case of a patient with long-term schizophrenia who is nowadays dependent on all daily living activities and requires sustained care.Disclosure of InterestNone Declared

Intranasal Esketamine administration in catatonia: a case report.

IntroductionCatatonia is a complex psychomotor syndrome that often goes unrecognized and, consequently, untreated. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. Benzodiazepines and electroconvulsive therapy (ECT) are the most widely studied treatment methods. However, no uniform treatment method has yet been brought forward and no previous attempts to treat catatonia on a patient suffering concomitant major depressive disorder (MDD) with NMDA receptor antagonists have been documented so far.ObjectivesTo describe the unknown and novel management of catatonia and MDD with intranasal esketamine, a NMDA receptor antagonist.MethodsA 55-year-old woman with a diagnosis of long-standing recurrent major depressive disorder who was admitted to the psychiatric inpatient unit of UniversityHospital Marqués de Valdecilla (Santander, Spain) suffering a complex catatonic, mutative state framed on a severe MDD. Different ineffective therapeutic interventions were deployed during the course of her illness. After failing to improve under conventional pharmacological treatment and ECT, and given the complexity of peripheral venous access on this patient (which disabled the option for iv ketamine use), we decided to initiate compassionate treatment with intranasal esketamine.ResultsIntranasal esketamine was effective in the resolution of patient’s complex catatonic state. Clinical response from catatonia was observed after 6 intranasal esketamine administrations (2-week follow-up), reaching full catatonia and MDD remission after 12 sessions in absence of significant adverse eventsConclusionsEsketamine showed promising effectiveness for the treatment of catatonia in the context of MDD, although further research on this topic is needed.Disclosure of InterestNone Declared

Slow Panic? The Regulation of Salvia Divinorum in Canada, 1991-2019

ABSTRACT Smoking a potent concentration of salvia divinorum (hereafter salvia) has the capacity to dissolve one’s ego and sense of self. Due to the catatonic state a strong dose of salvia produces, the substance has been considered alarming by claims-makers including politicians, media officials, police, and citizen groups. This paper examines news media accounts of salvia use in Canada and salvia’s regulation by the Canadian federal government. Providing a qualitative content analysis of newspaper articles spanning 1991–2019 regarding claims made about salvia, we draw from literature on moral panics and drugs to conceptualize the police and political response to salvia in Canada. We trace the shifting claims made by an array of claims-makers, showing how the focus changed from curiosity to claims about risk. The banning of salvia in Canada displays the hallmarks of a moral panic, though in this case the claims-making about the harm and risk of salvia went on for years before the substance was made illegal. We apply the notions of slow panic and panic policy to salvia regulation in Canada and reflect on the implications for literatures regarding drug panics and the new psychedelic renaissance.

Two Cases of Schizophrenia Treated with Individualized Homoeopathy

Background: Schizophrenia is a chronic, debilitating psychiatric disorder which is one of the leading causes of disability worldwide and has a large impact on individuals, families and society. There is paucity of literature on usefulness of Homoeopathy in Schizophrenia.
 Cases summary: Two cases of Schizophrenia are assessed symptomatically using Positive and Negative Syndrome Scale (PANSS) and treated in Psychiatry Department of (blinded for review)
 Case no.1 (Paranoid Schizophrenia) presented with sleeplessness, irritable mood, referential and persecutory delusions, auditory and olfactory hallucinations and thought broadcasting. The case was analyzed according to Kent’s method and Lycopodium 30c was prescribed. PANSS score of 135 at baseline turned to 30(Normal) within 4 months and maintained for the next 24 months of observation period.
 Case no.2 (Catatonic Schizophrenia) presented with sleeplessness, laughing and crying alternately, not responding to questions, silly smiling, slow activities, need for compulsion to do her daily activities, standing like a statue for hours assuming strange postures, poor sociability and delusion that her body is split vertically into two. The case was managed acutely with Ignatia 200C followed by a dose of Phosphorus 200C as a constitutional remedy. PANSS score of 157 at baseline turned to 30 (Normal) within 3 months and maintained for 24 months.
 There is reduction of positive, negative and general symptoms along with good psycho-social adaptation. Causal attribution of changes in condition to the homoeopathic treatment was depicted by the Modified Naranjo Criteria score.
 Conclusion: Homoeopathic medicines selected on the basis of individualization are useful in the management of Schizophrenia.

Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types

BackgroundA comprehensive assessment of catatonic symptoms is decisive for diagnosis, neuronal correlates, and evaluation of treatment response and prognosis of catatonia. Studies conducted so far used different cut-off criteria and clinical rating scales to assess catatonia. Therefore, the main aim of this study was to examine the frequency and distribution of diagnostic criteria and clinical rating scales for assessing catatonia that were used in scientific studies so far. MethodsWe conducted a systematic review using PubMed searching for articles using catatonia rating scales/criteria published from January 1st 1952 (introduction of catatonic schizophrenia to first edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM]) up to December 5th, 2022. Results1928 articles were considered for analysis. 1762 (91,39 %) studies used one and 166 (8,61 %) used ≥2 definitions of catatonia. However, 979 (50,7 %) articles did not report any systematic assessment of catatonia. As for clinical criteria, DSM criteria were used by the majority of studies (n = 290; 14.0 %), followed by International Classification of Diseases (ICD) criteria (n = 61; 2.9 %). The Bush-Francis Catatonia Rating Scale (BFCRS) was found to be by far the most frequently utilized scale (n = 464; 22.4 % in the respective years), followed by Northoff Catatonia Rating Scale (NCRS) (n = 31; 1.5 % in the respective years). ConclusionDSM and ICD criteria as well as BFCRS and NCRS were most frequently utilized and can therefore be recommended as valid instruments for the assessment of catatonia symptomatology.

Transient Fever Response After ECT in a Patient with Catatonic Schizophrenia: A Case Report.

Electroconvulsive therapy (ECT) is an effective and safe treatment method for many psychiatric disorders. In general medical practice, ECT may cause side effects as most other treatment methods do. Headache, myalgia, nausea, vomiting, confusion, anterograde amnesia are common side effects of electroconvulsive therapy. Fever; in addition to general medical conditions such as infection, malignancy, connective tissue diseases, drug treatments, malignant hyperthermia, convulsions, it can also occur due to conditions such as neuroleptic malignant syndrome (NMS), serotonin syndrome, catatonia, malignant catatonia, which are frequently encountered in psychiatry clinics. In the literature, transient fever response due to electroconvulsive therapy application have been described, albeit rarely. Although there are many proposed mechanisms for the emergence of a fever response, regardless of its cause, it is still not understood why some fever responses occur. In this article, we present the differential diagnosis of the fever response, possible causes, and the mechanisms that may reveal the secondary fever response to electroconvulsive therapy in a case with a diagnosis of catatonic schizophrenia, who developed a fever response during electroconvulsive therapy sessions and no fever response was observed at times other than electroconvulsive therapy sessions. In this case, postictal benign fever response associated with electroconvulsive therapy was considered after excluding other medical conditions that may cause a fever response after electroconvulsive therapy. Keywords: ECT, Fever, Catatonia, NMS.

A Case Series of Noncatatonic Mutism with Poor Response to Conventional Treatment Approach

Abstract Mutism is the absence or marked paucity of verbal output due to functional or organic causes. Selective mutism is commonly seen in children with anxiety disorder. In psychiatric literature, long-standing mutism is most commonly associated with catatonic syndrome in adults. Although less commonly reported, long-standing mutism has also been associated with noncatatonic schizophrenia and posits a treatment challenge. Here, we describe two cases of long-standing noncatatonic mutism secondary to Schneiderian first rank symptoms, which were poorly responsive to conventional antipsychotic treatment and had good response to the combination of antipsychotics and electroconvulsive therapy (ECT). ECT is an underutilized treatment modality in patients with schizophrenia and is usually limited to catatonic states. The case series, thus, highlights the need for the development of an evidence base for the use of ECT in patients with noncatatonic mutism.

ОСОБЕННОСТИ АУТОАГРЕССИВНОГО ПОВЕДЕНИЯ ПРИ РАССТРОЙСТВАХ АУТИСТИЧЕСКОГО И ШИЗОФРЕНИЧЕСКОГО СПЕКТРОВ В ДЕТСКОМ ВОЗРАСТЕ

Relevance. Auto-aggressive harming behavior (ASB) among children and adolescents who suffer from mental disorders of various nosologies is an urgent problem and requires a special approach from the diagnosis and rehabilitation of such patients. Purpose: To identify clinical, pathopsychological and neurophysiological characteristics of ASP in children and adolescents with different etiopathogenesis depending on the manifestation within the framework of ASD and nosologies of the schizophrenic range with affective disorders. Materials and methods. The study included patients being treated in the Department of Child Psychiatry Study of the Federal State Budgetary Institution National Center for Mental Health. Two samples of patients were formed: the first sample included 30 patients (23 boys and 7 girls), the average age was 6.9 ± 2.5 years, with diagnoses according to ICD-10 ‘Childhood autism’ (DA, F84.02), ‘Atypical autism with mental retardation’ (AA with mental retardation, F84.11), ‘Atypical autism without mental retardation’ (AA without mental retardation, F84.12) with the presence of psychotic symptoms during an attack. The second sample consisted of patients with signs of nonsuicidal ASP (with traces of bodily self-harm) with moderate and severe severity within the nosologies of the schizophrenic circle. 25 female children and adolescents were examined, the average age was 14.15±0.95 years, with diagnoses according to ICD-10 of ‘Schizoaffective disorder, depressive type’ (F25.18), ‘Pseudopsychopathic schizophrenia’ (F21.4), ‘Undifferentiated schizophrenia, observation period less than a yea’ (F20.3). Research methods included clinical-psychopathological, pathopsychological, and neurophysiological studies (EEG with spectral analysis and topographic mapping), survey data with psychometric scales. Results. In patients of the 1st sample with ASD, the leading syndrome in the structure of psychosis was catatonic. Self-harm varied in clinical presentation and severity. In 16 (53%) people, self-harm was represented by palm strikes to the head and face, 11 (37%) – hitting the head against various surfaces, 6 (20%) – hitting parts of the body with the palms, and 6 (20%) – biting fingers and hands. The severity of clinical manifestations of ASP in children with ASD corresponded to the data of a psychometric examination: the severity of autism on the CARS scale was 54.3 ± 3.1, according to the general catatonia scale (BFCRS, Bush-Francis Catatonia Rating Scale, 1996) was 32.7 ± 2.5, which corresponds to a ‘severe’ degree of catatonic disorders. A pathopsychological examination of children with ASP within the framework of ASD revealed a delay in psycho-speech development with signs of the formation of a cognitive defect against the background of distorted dysontogenesis with dissociation of cognitive activity, autism, stereotypic behavior, heteroaggression and ASP, emotional flatness and pronounce dnegativism. These children howed diffuse changes in the form of an increase in the level of slow-wave θ activity, which can be considered as an EEG correlate of immaturity, acuity, and regression of mentalfunctions. Behavioral disorders in the second group of patients with nonsuicidal ASP manifest themselves within the nosologies of the schizophrenic circle (F25.18, F21.4, F20.3), occurring with hallucinatory-delusional, psychopathic-like, and negative symptoms of varying severity, against the background of moderate or severe episode with antivital manifestations, without suicidal actions. Often (in 64% of the patients), the course of the underlying disease was accompanied by cognitive deficits with impaired thinking and memory. The total score on the PANSS scale was 102.5 points, on the CGI scale 6-7 points, which corresponds to a pronounced and severe degree of psychopathological symptoms. Pathopsychological analysis in these patients revealed a dissociated type of mental development, a diversity of thinking, disturbances in the form of slips, associations with secondary symptoms, deficits of will and emotions, and disturbances in social functioning. The decrease and disorganization of the α-rhythm and the increased β-rhythm revealed on the EEG were considered assigns of suppression of the activity of the functions of the cerebral cortex and the severity of psychopathological disorders; the dominance of slow θ- and δ-rhythm sindicates the dysontogenesis of mental development with dissociation of cognitive activity and the formation of cognitive deficit.

Het maligne neurolepticasyndroom kan zich presenteren zonder koorts

Neuroleptic malignant syndrome can present without fever Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic adverse reaction to antipsychotic drugs. A fast recognition of NMS is vital to prevent a fatal outcome. In this article, the case of a 15-year-old boy with psychosis presenting with motor symptoms like tremor and akathisia while on olanzapine is discussed. Due to persistent psychotic symptoms and motoric side effects under olanzapine, the therapy was switched to aripiprazole. This switch resulted in a dramatic worsening of the symptoms and a sudden decrease in global functioning. Psychosis with catatonia was diagnosed and lorazepam was started, with a moderate effect. After several days, lower back pain, chest pain, excessive sweating and rigidity emerged. A blood sample showed extremely high serum creatine kinases. The catatonic state had evolved to NMS during the switch to antipsychotics. The absence of hyperthermia delayed the diagnosis because of the misleading idea that NMS is always associated with an increased body temperature.

The Girl in the Castle by James Patterson

Reviewed by: The Girl in the Castle by James Patterson April Spisak Patterson, James The Girl in the Castle; by James Patterson and Emily Raymond. Jimmy Patterson, 2022 [368p] Trade ed. ISBN 9780316411721 $18.99 E-book ed. ISBN 9780316411929 $9.99 Reviewed from digital galleys Ad Gr. 9-12 Seventeen-year-old Hannah Doe has spent years in and out of Belman Psychiatric Hospital in modern day New York City, but she insists that she actually belongs in an entirely different life as Hannah Dory, a downtrodden peasant from 1347 England. Enter Jordan Hussan, an earnest nineteen-year-old psychology student who takes a personal interest in Hannah when interning at the hospital. He decides to track down her history, assuming that making her confront whatever demons she is avoiding will "fix" her. There is undeniable, if highly awkward (and rather icky), chemistry between Hannah Doe and Jordan whenever she is not in a catatonic state, and her feelings toward him help ground Hannah in the modern world. They also further complicate her recovery when that budding relationship goes astray before it even really begins. The glimpses of life in the psychiatric hospital are some of the most effective passages in this novel—the well-intentioned but often ineffective staff, the ways in which patients cope, or don't, with their illnesses, and the numbing routine of therapy, prescription, and structured activities that make up their days are all insightful and poignant. Unfortunately, the book never quite acknowledges how problematic and awful the men are, from Jordan who essentially stalks and violates Hannah Doe's privacy with the illusion of healing her, to an onerous baron who has Hannah Dory's fiancé hanged but still manages to gain her affection through grooming her with luxuries at his castle. Fortunately, those flaws are mitigated by Hannah, a memorable heroine whose ways of coping may be extreme but still feel plausible and even relatable. Copyright © 2022 The Board of Trustees of the University of Illinois

Therapy of Catatonia in Schizophrenia and Schizophrenia Spectrum Disorders

Background: the study of catatonia’s treatment methods is one of the most important researchers’ tasks, nevertheless the common therapeutic strategies of cupping the catatonic phenomena haven’t been created yet. The aim: review to therapeutic interventions for catatonic disorders in schizophrenia.Materials and methods: according to the keywords “catatonia treatment”, “catatonia therapy”, publications found in the Scopus, PubMed, Cochrane Library, eLibrary databases were selected and analyzed.Results: historical background, illustrating the development of catatonia treatment methods, is given; the results of the last decades scientific studies of catatonia’s treatment and preliminary results of own study, devoted to the effectiveness of diazepam and cariprazine in relieving catatonia manifestations are presented. Based on the studies’ results, presented in the review, it can be concluded that the most common modern method of treating catatonic disorders is the use of benzodiazepines, however, in some cases, the use of antipsychotics is also advisable. Electroconvulsive therapy (ECT) remains an important treatment for catatonic phenomena. There are also isolated clinical cases of successful testing of both: other pharmacological groups (antidepressants, dopaminergic and anticholinergic drugs, normothymic drugs, etc.) and non-drug interventions (transcranial magnetic stimulation — TMS) presented in modern research data.Conclusion: the effectiveness of benzodiazepines in catatonia, associated with schizophrenia and schizophrenia spectrum disorders (SSD), remains controversial according to modern authors’ opinion. In turn, among antipsychotics, antipsychotics of the second and third generation seem to be safe for the treatment of psychomotor symptoms. In accordance with the results of our own study, catatonia in the structure of schizophrenia and SSD is heterogeneous and, depending on the psychopathological structure of catatonic disorders, a different reaction of psychomotor symptoms to therapeutic intervention was observed.

Paratonia, Gegenhalten and psychomotor hypertonia Back to the roots

In the first half of the 20th century, well before the antipsychotic era, paratonia, Gegenhalten and psychomotor hypertonia were described as new forms of hypertonia intrinsic to particular psychoses and catatonic disorders. A series of astute clinical observations and experiments supported their independence from rigidity seen in Parkinson's disease. After World War II, motor disorders went out of fashion in psychiatry, with drug-induced parkinsonism becoming the prevailing explanation for all involuntary resistance to passive motion. With the ‘forgetting’ of paratonia and Gegenhalten, parkinsonism became the prevailing reading grid, such that the rediscovery of hypertonia in antipsychotic-naive patients at the turn of the 21st century is currently referred to as “spontaneous parkinsonism”, implicitly suggesting intrinsic and drug-induced forms to be the same.Classical descriptive psychopathology gives a more nuanced view in suggesting two non-parkinsonian hypertonias: (i) locomotor hypertonia corresponds to Ernest Dupré's paratonia and Karl Kleist's reactive Gegenhalten; it is a dys-relaxation phenomenon that often needs to be activated. (ii) Psychomotor hypertonia is experienced as an admixture of assistance and resistance that partially overlaps with Kleist's spontaneous Gegenhalten, but was convincingly isolated by Henri Claude and Henri Baruk thanks to electromyogram recordings; psychomotor hypertonia is underpinned by “anticipatory contractions” of cortical origin, occurrence of which in phase or antiphase with the movement accounted for facilitation or opposition to passive motions.This century-old knowledge is not only of historical interest. Some results have recently been replicated in dementia and as now known to involve specific premotor systems.

Network analysis of psychiatric symptoms in schizophrenia: Findings from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP).

Schizophrenia is a major mental disorder with a wide range of psychiatric symptoms. This study explored the structure of psychiatric symptoms of schizophrenia using network analysis in a large representative Asian sample based on a survey of clinical features and treatment used in schizophrenia patients across 15 countries/territories in Asia. Data on the demographic characteristics and psychiatric symptoms in schizophrenia patients were extracted from the dataset of the fourth Research on Asia Psychotropic Prescription for Antipsychotics (REAP-AP) project. The presence of the following psychiatric symptoms including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, social/occupational dysfunction, verbal aggression, physical aggression, and affective symptoms were analyzed. A total of 3681 patients were included. The network analysis revealed that verbal aggression, hallucinations, and social/occupational dysfunction were the most central symptoms, while the connections between social/occupational dysfunction and verbal aggression, and between hallucinations and disorganized speech were the two strongest edges. There were significant gender differences in the network structure based on the network structure invariance test (M=0.74, P=0.03) and invariant edge strength test. The positive correlation between verbal aggression and hallucinations was significantly stronger in the female network than that in the male network (P=0.03), while a negative correlation between affective symptoms and negative symptoms was found in the female, but not the male network (P<0.01). Central symptoms including verbal aggression, hallucinations, and socio-occupational dysfunction should be addressed in developing targeted treatment strategy for schizophrenia patients.

The psychological and subjective experience of catatonia: a qualitative study

BackgroundCatatonia is a severe psychomotor disorder that presents as abnormality of movement which may also be excessive or severely slowed. It often inhibits communication when protracted or severe. In this study we investigated the emotive and cognitive experience of patients with catatonia during a prevalence study in an acute mental health unit from August 2020 to September 2021. The value of this study is the addition of the inner and often unexplored cognitive and emotive experience of patients in the description of the catatonic state, which lends an additional dimension to complement the medical and psychopathological descriptors that have been the focus of most studies on catatonia.MethodsEthical approval was received from the Nelson Mandela University Human Research Committee and convenience sampling was undertaken to recruit participants admitted into an acute mental health unit with catatonia, four to eight weeks after discharge, following admission. The BFCSI and BFCRS and a pre-designed data collection sheet were used to assess n = 241 participants, and collect data on descriptions of thoughts, feelings, and behaviours they experienced during the catatonic episode.ResultsForty-four (18.3%) of the total 241 participants who were assessed had catatonia. Thirty (68.2%) of the 44 participants with catatonia provided data on their experience of catatonia. Twenty-three were males (76.7% of 30) and seven were females (23.3% of 30). All were within the age range of 17 to 65 years. The dominant themes of thoughts, feelings, and behaviors described centered around yearning for or missing loved ones, heightened fear, intense anxiety, negative affect, aggression, obedience, and withdrawal.ConclusionsThe common themes that emerged from this study were overwhelming anxiety, fear, and depression. These were found to occur frequently in patients with catatonia when describing their psychological experience. These experiences may possibly relate to the flight, fight, freeze and fawn response, as described in prior studies on the subjective experience of catatonia.Trial registration: Not applicable.

Evolution of the Affective Catatonia Concept in XIX–XXI Centuries

Background: the connection of catatonic disorders with affective pathology is noted in publications related to the prenosological stage of research in psychiatry. Numerous publications of the last and the current centuries are devoted to clinical studies of the relationship between affective and catatonic symptoms. At the present stage of scientic development, catatonia is considered as a transnological formation, manifesting in the framework of various nosological units, including affective diseases. Aim: analysis of the affective catatonia construct’s development in the period of the XIX–XXI centuries and development of affective-catatonic states, forming in the clinical space of schizophrenia and schizophrenic spectrum disorder, conceptual model. Conclusion: affective-catatonic disorders represent a continuum of psychopathologically differentiated phase-owing state. At one of the continuum pole there are catatonic disorders manifesting in the structure of affective pathology, which is realized at the level of recurrent depressions; at the other pole — affective-catatonic states of more severe psychopathological register, acting in the clinical space of bipolar affective disorder and schizoaffective psychoses. The role of movement disorders in affective-catatonic attacks and phases, as well as the modus of interaction of catatonic disorders with affective ones, also varies widely. In some cases, motor symptoms replace the affective symptoms, on the basis of which they were formed, and completely determine the clinical picture of the state; in others — they only modify the manifestations of affective disorders without altering their syndromic structure.

Case report on Catatonic schizophrenia with encephalitis in a 14 years old child

Introduction : Catatonic schizophrenia (Cata: disturbed, tonic: tone) is distinguished by a substantial disturbance of motor behaviour. Excited catatonia, stuporous catatonia, and catatonia oscillating between excitement and stupor are the three clinical types. The inflammation of brain tissue is known as encephalitis. It might happen along the peripheral nerves or across the olfactory mucosa. Encephalitis can also be caused by an immune reaction. Case Presentation : A 14 years old child brought in AVBRH with the chief complaint of fever, cough, and cold since 8 days. Decreased oral intake since 2 days, irrelevant talk since 2 day. As narrated by the mother, patient was apparently well till 2 days, then patient had fever which was gradually onset, high grade, also chills and rigors, intermittent, vomiting, headache- throbbing in nature, abdominal pain, patient went to local practitioner for the some complaint where medication for fever and medication was given. Complete blood count (CBC) Initially lab test shows, Urine analysis, MRI Brain (plain and contrast) revels: no significant abnormally is seen. Electroencephalogram (EEG)-Abnormal EEG record. Antibiotics, corticosteroids, antacids, anti-convulsant, anti-psychotics, and multivitamins were given to the patient. Monitor all vital signs, checked and recorded intake and output, administered medication as prescribed. Conclusion : The patient was admitted in AVBRH with chief complaint of with the chief complaint of fever, cough, and cold, decreased oral intake, high grad fever vomiting, headache- throbbing in nature, abdominal pain, decreased oral intake and irrelevant talk. Members of the health team began therapy very away, and the patient’s condition is presently satisfactory.

The Creation of Clinical and Biological Concept of Schizophrenia: Participation of Chronic Inflammation and Genetic Predisposition in the Formation of Psychopathological Disorders

The aim of the study was to investigate chronic inammation and genetic predisposition processes, involved in the formation of psychopathological dimensions of schizophrenia and schizophrenia spectrum disorders on the catatonia model. Method: the analysis of PubMed/MEDLINE, RSCI and other sources databases on genetics and immunology of catatonia in comparison with the results of our own clinical and biological studies of catatonic disorders as a model of clinical heterogeneity of positive disorders, as well as various mechanisms of their formation. Results: the results obtained demonstrate the involvement of inammatory mechanisms and genetic factors, not associated with the process of inammation, in the formation of psychopathological disorders in schizophrenia. In accordance with the developed clinical and biological model of schizophrenia, non-specic pathophysiological inammatory mechanisms determine the development of both positive and negative disorders by different, albeit related, molecular mechanisms. Identication of various psychopathological types of positive disorders (by the example of catatonic disorders) and their comparison with the activity of inammation allows us to differentiate these disorders. Such a comparison makes it possible to identify disorders, that are mainly determined by genetic factors, at the stages of the disease, associated with a low level of inammation (basic disorders). Positive disorders, mainly determined by inammatory mechanisms, can probably be considered as less specic, i.e. “secondary” ones. Conclusion: within the framework of the developed concept a different ratio of inammatory and genetic mechanisms, that are not associated with the process of inammation, determines the formation of psychopathological disorders and their clinical heterogeneity at various stages of the disease. These disorders represent a broad continuum, at one pole of which are disorders determined predominantly by inammatory mechanisms, and at the other pole by predominantly genetic ones. The activation of inammation and its attenuation may be one of the variants of a repeatedly recurring cycle of the disease, in which the ratio of inammatory and genetic mechanisms changes.

Postpartum Depression, Catatonia and Covid-19 Infection: One Case, Different Clinical Presentations

IntroductionPost-partum depression may occur in the first year after childbirth in approximately 25% of women, at times presenting with psychotic symptoms and catatonic states. Catatonia is a psychomotor syndrome that occurs in association with various neuropsychiatric disorders and can be described according to the characteristics of its manifestation in types such as retarded or agitated.ObjectivesWe report the case of a patient with postpartum depression and catatonic syndrome who, after a session of electroconvulsive therapy, was infected with Sars-COV-2, suspended treatment, and had her condition aggravated with distinct clinical manifestations.MethodsClinical case report and non-systematic review of articles consulted in the PubMed platform.ResultsA 24-year-old patient develops depressive symptoms and obsessive behaviour 6 months after delivery and deteriorates with mutism, stupor and motor immobility. She was hospitalised and medicated with lorazepam, with no improvement. One session of electroconvulsive therapy was carried out with improvement of the symptoms. Due to an inpatient Covid-19 outbreak, in which the patient was infected, treatment was suspended. During isolation, deterioration of the patient’s condition was observed with psychomotor agitation, bizarre behaviour, and perseverative speech. The patient resumed treatment with ECT, with total remission of the catatonic syndrome and improvement of the affective symptoms.ConclusionsCatatonic syndromes are relatively rare, but its association with post-partum depression is not so uncommon. The occurrence of different presentations of catatonia, although described as possible in the same episode in the literature, were not found in any clinical studies reviewed, which leads us to conclude that it is an uncommon situation.DisclosureNo significant relationships.