Catatonia Research Articles

Homage to Catatonia.

Perspectives in Psychiatric CareVolume 52, Issue 4 p. 234-238 Column Homage to Catatonia Sandra L. Mallisham DNP, APRN, PMHNP-BC, Sandra L. Mallisham DNP, APRN, PMHNP-BC Psychiatric Nurse Practitioner at San Antonio Military Medical Center, Department of Behavioral Medicine, Fort Sam Houston, Texas, USASearch for more papers by this authorJonathan S. Dowben MD, Jonathan S. Dowben MD Staff Psychiatrist, Pediatric and Behavioral Health Service, San Antonio Military Medical Center, Fort Sam Houston, Texas, USASearch for more papers by this authorPeter C. Kowalski MD, Peter C. Kowalski MD Child Psychiatrist at Behavioral Health Center, Eastern Idaho Regional Medical Center, Idaho Falls, Idaho, USASearch for more papers by this authorNorman L. Keltner EdD, CRNP, Corresponding Author Norman L. Keltner EdD, CRNP normankeltner@gmail.com Professor (retired), School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USAAuthor contact: normankeltner@gmail.com, with a copy to the Editor: gpearson@uchc.eduSearch for more papers by this author Sandra L. Mallisham DNP, APRN, PMHNP-BC, Sandra L. Mallisham DNP, APRN, PMHNP-BC Psychiatric Nurse Practitioner at San Antonio Military Medical Center, Department of Behavioral Medicine, Fort Sam Houston, Texas, USASearch for more papers by this authorJonathan S. Dowben MD, Jonathan S. Dowben MD Staff Psychiatrist, Pediatric and Behavioral Health Service, San Antonio Military Medical Center, Fort Sam Houston, Texas, USASearch for more papers by this authorPeter C. Kowalski MD, Peter C. Kowalski MD Child Psychiatrist at Behavioral Health Center, Eastern Idaho Regional Medical Center, Idaho Falls, Idaho, USASearch for more papers by this authorNorman L. Keltner EdD, CRNP, Corresponding Author Norman L. Keltner EdD, CRNP normankeltner@gmail.com Professor (retired), School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USAAuthor contact: normankeltner@gmail.com, with a copy to the Editor: gpearson@uchc.eduSearch for more papers by this author First published: 16 June 2016 https://doi.org/10.1111/ppc.12155Citations: 1 Conflict of Interest Statement: :The view(s) expressed here in are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army or the Department of Defense or the U.S. Government. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume52, Issue4October 2016Pages 234-238 RelatedInformation

Catatonia in acute psychiatric patients

Introduction Over the past years, catatonia received increasing attention. The concept of catatonia has been decoupled from schizophrenia and broadened. Aim The aim of our prospective study was to determine the prevalence of catatonia in patients admitted to an acute psychiatric ward. Material and methods We examined all patients acutely admitted to the Centre for Psychiatry and Addiction Medicine (CPAM) of Szent Istvan and Szent Laszlo Hospitals, from 01/04/2015 to 31/07/2015. We used Bush Francis Catatonia Screening Instrument (BFCSI) for the assessment of catatonic signs. In case of presence of 2 or more symptoms on BFCSI, the severity of catatonia was rated with Bush Francis Catatonia Rating Scale (BFCRS). After detailed clinical examination, we used Structured Clinical Interview for DSM-IV, Mini Mental State Examination and Clock Drawing Test in setting up a diagnose. Results In the study period, altogether 338 patients were admitted to CPAM. Catatonia could be diagnosed in 8.55% of them, according to BFCRS and in case of 5.02% the diagnosis of catatonia could be set up according to DSM-5 diagnostic criteria. Female patients were present in 58.62%. The mean age was 57.62 years. Schizophrenia spectrum disorder was diagnose in 41.3%, dementia in 27.5%, affective disorder in 6.89%, alcohol, drug withdrawal syndrome, Down syndrome and mental retardation in 3.44% each, other organic disease in 10.34% of all catatonia cases. Conclusion Catatonia can be present in a variety of psychiatric conditions. Its specific therapy gives a special importance to the recognition of this syndrome.

Catatonic schizophrenia vs anti-NMDA receptor encephalitis – A video case report

IntroductionAnti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune disease of the CNS with prominent neuropsychiatric features that primarily affects young adults and children.ObjectiveTo present the diagnosis course of a case of anti-NMDAR encephalitis in a patient with previous diagnosis of Schizophrenia.MethodsAnalysis of the patient's clinical records and of a PubMed database review, using “anti-NMDAR encephalitis” as keywords.ResultsWe report a single case of a 33-year-old man diagnosed with Paranoid Schizophrenia in 2009 that after 1 year of treatment abandoned follow-up. Six years later, the patient presented to the psychiatric emergency department with persistent headaches, abnormal behavior and loss of motor skill. He was admitted to the psychiatric ward with a presumptive diagnosis of “Catatonic Schizophrenia” and began to manifest fluctuating catatonic symptoms (captured in video). Neuroleptics and benzodiazepines were tried without success. There was a clinical deterioration with autonomic dysfunction, breathing instability and seizures. Complementary exams revealed: EEG with slow base activity; brain MRI with right temporal pole and right frontobasal lesions compatible with head trauma; CSF with pleocytosis; and positive anti-NMDAR antibodies. Occult neoplasm was excluded. Treatment with high-dose steroids, intravenous immunoglobulins, followed by cyclophosphamide resulted in relevant clinical improvement.ConclusionsAs early detection of antibodies may allow for earlier treatment of anti-NMDAR encephalitis, which is associated with better outcomes, we believe the present case underscores the importance of clinicians maintaining vigilance for neuropsychiatric symptoms that have not adequately responded to therapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The syndrome of irreversible lithium-effectuated neurotoxicity: Clinical case and review

IntroductionLithium is a mood stabilizer used in the treatment of bipolar disorder. Lithium has recently been associated to permanent neurological damage namely persistent cerebelar dysfunction as well as peripheral and central neuropathies.ObjectivesTo present a clinical case of a probable Syndrome of Irreversible Lithium-effectuated Neurotoxicity (SILENT) and a review of the literature concerning this rare syndrome.AimsIncrease awareness and knowledge of SILENT.MethodsPsychiatric and psychological evaluation of a probable clinical case of SILENT and review of the literature using the key words “lithium neurotoxicity” and “Syndrome of Irreversible Lithium-effectuated Neurotoxicity”.ResultsA 54-year-old female patient was admitted in our hospital due to involuntary lithium intoxication, with acute renal and cardiovascular failure, neurological, metabolic and electrolytic dysfunction in an acute confusional state and in need of dialysis. The patient clinical picture rapidly improved although, when she achieved normal lithium seric levels, it was observed a worsening of the preexisting confusional state followed by two consecutive generalized tonic-clonic convulsions and a partial convulsion. A short time after, it was recognized the development of a persistent catatonic state. It was detected urinary incontinence and repetitive, monosyllabic, incoherent, short phrased speech featuring echolalia, together with emotional lability and incongruous affect. The patient slightly improved with the introduction of anti-Parkinson's pharmacotherapy.ConclusionsThis clinical case raises several differential diagnoses due to its psychiatric and neurologic characteristics. We conclude that the most probable diagnosis is SILENT.Disclosure of interestThe authors have not supplied their declaration of competing interest.

La catatonie dans tous ses états

Catatonia is a frequent but unrecognized syndrome. Described in the late nineteenth century by the German psychiatrist Karl Kahlbaum, catatonia has experienced some nosological twists including the attachment to schizophrenia by Emil Kraepelin and Eugen Bleuler. It was not until the mid-nineteenth century that clinicians recognize catatonia related to other etiologies including somatic ones. This paradigm shift has helped to rediscover this syndrome, to find a treatment algorithm and try to understand its pathophysiology. From a diagnostic point of view, we will see that a few cardinal signs may be retained: inhibition and rigidity, stereotypies, aimless agitation, negativity and ambivalence. The treatment of catatonia must be twofold: to relieve the catatonic state, and to treat the cause. Among symptomatic treatments, some benzodiazepines (such as lorazepam) and zolpidem are generally very effective and provide a diagnostic test. If that fails, electroconvulsive therapy is the main second line treatment. Regarding the cause of catatonia, one should distinguish psychiatric disorders: mood disorders, schizophrenia, autism and periodic catatonia; and numerous organic causes among which we will highlight anti-NMDAR (N-Methyl-D-aspartate glutamate receptor) encephalitis. Treating the cause should be undertaken as quickly as possible in parallel with the treatment of the catatonic state, except for neuroleptics which may worsen catatonia if administered early. Catatonia corresponds to a dysfunction of the circuits involved in voluntary movement in response to fear, most often in the form of stupor but sometimes in a furious form. The lateral orbitofrontal cortex, in default in catatonia, and carrier of GABA-A receptors, would be heavily involved in this primitive reaction which it should inhibit by interaction with the median orbitofrontal cortex and the amygdala.

Psychosis, Catatonia and Post-psychosis PTSD

Psychosis, Catatonia and Post-psychosis PTSD

Brain biopsy in the diagnosis of Creutzfeldt-Jakob disease with a history of prodromal psychiatric symptoms and catatonic behavior

Creutzfeldt-Jakob disease (CJD) is a neurodegenerative disorder belonging to the group of transmissible spongiform encephalopathies. Transition of physiological, soluble, neuroprotective prion protein PrPc into its insoluble, misfolded isoform PrPSc remains the central pathogenic event in this disorder. Their progressive accumulation within the brain tissue results in spongiform degeneration and plethora of clinical symptoms. Typically, CJD manifests as progressive dementia with myoclonus, visual or cerebellar dysfunction, pyramidal/extrapyramidal signs or akinetic mutism. However, growing number of studies indicate that CJD may present with prodromal psychiatric manifestations including anhedonia, anxiety, irritability, depression, insomnia, psychosis and catatonic behaviour. We present case of biopsy proven CJD with a history of prodromal psychiatric symptoms and catatonic behaviour.

Síndrome neuroléptico maligno

Neuroleptic malignant syndrome is a disease that, in addition to being rare, is potentially life-threatening. Its early diagnosis by differentiation from other diseases, also rare, and thus unknown by much of the medical personnel, such as lethal catatonia and malignant hyperthermia, where the pathophysiological mechanism is totally different but just as devastating and potentially life-threatening.In this review, special relevance will be made to its epidemiology, pathophysiology, differential diagnosis, and therapeutic approach.Emphasis will be placed on the importance of maintaining a high suspicion of this clinical picture, taking into account that there is a current actual increase in the formulation of neuroleptic drugs and emergence of psychiatric illness in our population. Maintaining a high suspicion of this clinical picture will allow early diagnosis and initiate timely and appropriate treatment, and thus reducing the associated mortality and morbidity.

Fecaloma mimicking acute abdomen: a diagnostic challenge

Fecaloma can occur as a result of several causes and may present as a challenging diagnostic and therapeutic problem. In this case report, we would like to present the case of a 37-year-old male who presented with abdominal distention and pain. His previous medical history was significant for catatonic disorder due to psychiatric conditions. Physical examination showed a distended abdomen with focal tenderness in the lower quadrant regions. Bowel sounds were decreased and fecal materials were palpable on digital rectal examination. Upon further clinical interrogation, the patient admitted to constipation for the past three months. Except for leukocytosis (28,000/mm3 (normal range 4.5-10.5/mm3) and elevated C reactive protein (304mg/L) levels, all other laboratory findings were normal. Abdominal plain x-ray demonstrated a predominantly feces-filled colon. This was confirmed on abdominal computed tomography (CT) scan as a giant sigmoid colon, measuring 25 cm in diameter and lateralized bladder. The patient was initially treated with oral laxatives and rectal enema, which were ineffective. He was then treated with evacuation of the feces under general anesthesia. After then, patient’s symptoms were relieved. Post-operative CT imaging confirmed a decrease in the size of the sigmoid colon to an acceptable measure. No mass or polypoid lesions were seen on colonoscopy. This report attracts the attention how sigmoid colon can be a long-term reservoir for fecal contents without serious symptoms but only abdominal distention. Evacuation of fecal contents under general anesthesia may help to relieve fecaloma without surgery.

Oliver Wolf Sacks, BMBCh, FRCP, CBE (1933–2015)

Oliver Wolf Sacks, BMBCh, FRCP, CBE. Figure credit: James Estin/The New York Times/Redux Oliver Sacks died on August 30, 2015, at the age of 82 years, from metastatic ocular melanoma. He was a physician and a Professor of Neurology, but is of course best known as an author who used case histories to illustrate the personal aspects of neurologic conditions for the layman and professional alike. Dr. Sacks had great empathy and deep respect for individuals with chronic neurologic diseases and their capacity to adapt, but did not gloss over the harsh realities of their conditions and the suffering they had to endure. He wrote about dementia and visual agnosia ( The Man Who Mistook His Wife For a Hat , 1985),1 deafness ( Seeing Voices , 1989),2 autism and Tourette syndrome ( An Anthropologist on Mars , 1995),3 achromatopsia and Guam neurodegeneration ( The Island of The Color Blind , 1997),4 migraine headaches ( Migraine , 1970),5 hallucinations ( Hallucinations , 2012),6 and the relationship between music and a variety of brain disorders ( Musicophilia: Tales of Music and the Brain , 2007).7 He even used himself as a subject, writing about losing awareness of one of his legs after an accident ( A Leg To Stand On , 1984),8 in which he explored the “Arctics and Tropics of neurologic disorders.” He is best known for writing Awakenings (1973),9 in which he described patients with encephalitis lethargica who had been in a longstanding catatonic state until they were treated with the newly discovered levodopa. The story was immortalized in a movie starring Robin Williams and Robert De Niro ( Awakenings , 1990), which brought the horrors of a …

Microarray Analysis of Human Blood During Electroconvulsive Therapy.

IntroductionElectroconvulsive therapy (ECT) is currently regarded as a significant treatment option for intractable psychiatric disorders, such as catatonic schizophrenia or treatment-resistant depression; however, the underlying molecular mechanism for its therapeutic effect remains obscure.MethodsEmploying microarray analysis (Human Genome U133 Plus 2.0 Array; Affymetrix, United States) of cDNA derived from the peripheral blood of patients with catatonic schizophrenia (n = 5), we detected a significant change in 145 genes (0.68%) before and after modified ECT (mECT). Moreover, we performed quantitative polymerase chain reaction validation of genes that had previously been suggested to be functionally related to schizophrenia.ResultsOf 4 genes examined (AKT3, TCF7, PPP3R1, and GADD45B), only TCF7 was increased during the mECT procedure (P = 0.0025).DiscussionThis study describes the first attempt to uncover the molecular mechanism of mECT using a microarray assay of mRNA derived from peripheral blood, and our results suggest that the TCF family may play a role in the functional mechanism of mECT.

Seeing the king's frenzy as catatonia.

Seeing the king's frenzy as catatonia.

Hidden in Plain Sight: Recognizing Catatonia Amidst its Medical Complications

ABSTRACT:Although catatonia is a common syndrome, diagnosis is often delayed or missed altogether. The medical sequelae of catatonia can cloud the diagnostic picture, making it difficult to know what is the primary problem. In this case, a patient presented several times about 1 month apart with recurrent urinary retention, inability to walk, and delirium. This resulted in admissions to Internal Medicine and consultations to Urology with the underlying primary problem being missed until catatonia was later recognized and diagnosed. The elderly are more prone to complications from catatonia and, as a result, it is even more important that catatonia be recognized and treated in a timely manner in this population. In addition to exploring the case, this article reviews the diagnosis, etiology, prognosis, and treatment of catatonia, particularly as these pertain to the elderly.RÉSUMÉ:La catatonie est un syndrome commun, mais son diagnostic est parfois difficile à faire. Les symptômes associés à ce syndrome peuvent rendre le problème médical primaire difficile à déceler. Par exemple, l’association récurrente de symptômes de rétention urinaire, des difficultés à marcher et des signes de syndrome confusionnel qui se présentent chaque mois sont souvent associés à d’autres maladies. Ces manifestations symptomatiques mènent à des admissions en médecine interne et des consultations en urologie. Les cliniciens peuvent perdre de vue le problème primaire, celui de la catatonie. Le diagnostic est alors manqué ou découvert plus tard. Les personnes âgées sont plus susceptibles à des complications liées à la catatonie. Ainsi, il s’avère important que ce désordre soit reconnu et traité dans un délai raisonnable chez cette population. Cet article évalue le diagnostic, l’étiologie, le pronostic et le traitement de la catatonie, particulièrement dans le cadre des personnes âgées.

Effect of Sigma agonist 1, 3 di-o-tolyl-guanidine (DTG) on Squizophrenia and Immobility responses

Recently in our laboratory we found that DTG (sigma receptor agonist 1,3-di-o-tolyl-guanidine) sub-chronic administration reduced the hyperlocomotor activity and reversed the neuronal hypotrophy in the prefrontal cortex, amygdala and nucleus accumbens, generated in rats with neonatal ventral hippocampus lesion (nVHL). We also observed that DTG reversed some of the behavioral and neuromorphological effects of nVHL rats, which supports the possibility that DTG has beneficial effects in the management of symptoms of schizophrenia. We also found that DTG had effects on immobility responses, in the unlesioned rats increased the duration of the dorsal immobility but it did not have effect on the duration of immobility elicited by clamping. However, the nVHL increased the duration of immobility elicited by clamping, but did not have effect on the duration of the dorsal immobility. It should be noted that DTG counteracted the increase in the duration of the immobility by clamping produced by nVHL. The increase in the duration of the dorsal immobility produced by DTG was counteracted by nVHL. We suggested that the differential effect on these two immobility responses, is due to they are different varieties of immobility mediated by different mechanisms. Therefore, we believe that this evidence could help us to connect, schizophrenia with immobility reaction, which may be associated or somehow present in catatonic schizophrenia Key words; immobility response, schizophrenia, neonatal ventral hippocampus lesion, sigma agonist.

Catatonia is a systemic medical syndrome.

Catatonia is a systemic medical syndrome.

Atypical course in severe catatonic schizophrenia in a cannabis-dependent male adolescent: a case report.

IntroductionAdolescents with psychoses usually have full recovery from their first psychotic episode, but the first relapse often arises within 2 years of the first episode. Cannabis-related psychoses are difficult to distinguish from schizophrenic psychoses. Here, we describe a particularly severe clinical case, with a first psychotic episode occurring after heavy cannabis smoking, an atypically long symptom-free duration, and a subsequent non-substance-related episode.Case presentationA 17-year-old male adolescent of Middle-East origin presented with delusions and hallucinations after extensive cannabis smoking. His first psychotic episode, with paranoid delusions and hallucinations, progressed into severe catatonic symptoms. His symptoms were treated with electroconvulsive therapy and risperidone and he was transferred to a residential substance abuse treatment center. He remained drug-free and non-psychotic for 3.5 years. Given the temporal association with extensive cannabis use, and his full remission of symptoms lasting several years, a cannabis-induced psychosis—though atypically extended—could be suspected. However, after 3.5 years without psychiatric care, and in a drug-free state, our patient again presented with positive psychotic symptoms, possibly induced by a period of severe psychosocial stress.ConclusionWe here discuss whether a primary schizophrenic episode possibly induced by cannabis can increase the risk of subsequent non-drug-related schizophrenic episodes.

Recurrent Idiopathic Catatonia: Implications beyond the Diagnostic and Statistical Manual of Mental Disorders 5th Edition.

We describe a case of recurrent, life-threatening, catatonic stupor, without evidence of any associated medical, toxic or mental disorder. This case provides support for the inclusion of a separate category of “unspecified catatonia” in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) to be used to classify idiopathic cases, which appears to be consistent with Kahlbaum’s concept of catatonia as a distinct disease state. But beyond the limited, cross-sectional, syndromal approach adopted in DSM-5, this case more importantly illustrates the prognostic and therapeutic significance of the longitudinal course of illness in differentiating cases of catatonia, which is better defined in the Wernicke-Kleist-Leonhard classification system. The importance of differentiating cases of catatonia is further supported by the efficacy of antipsychotics in treatment of this case, contrary to conventional guidelines.

Relationship of clinical presentation and psychopathological mechanisms at the commitment of grave socially dangerous acts by schizophrenic patients

Aim. To study the relationship of clinical presentation and psychopathological mechanisms at the commitment of grave socially dangerous acts by schizophrenic patients. Methods. The sample consisted of 201 schizophrenic patients who have committed grave socially dangerous acts targeted at the life and health of people. The investigation that included social-demographic, anamnestic and clinical data was performed. The sample was divided into three subgroups according to psychopathological mechanisms of grave socially dangerous acts commitment, determined by authors: unconditional-psychotic mechanism (n=46), conditional-psychotic mechanism (n=76) and negative-personality mechanism (n=79). Results. In patients with the unconditional-psychotic mechanism, the acute psychopathological symptoms such as catatonic, affective and delusional syndromes, acute delusional conditions were prevalent by the time of commitment of socially dangerous acts. In patients with this mechanism of catatonic schizophrenia, remittent course or intermittent-progressive course with the increased production of negative symptoms in remission were significantly more common. In patients with the conditional-psychotic mechanism, paranoid schizophrenia was prevalent, which was characterized by a continuous course without remissions, delusions without hallucinations, or chronic paranoid states. In patients with the negative-personality mechanism, the major psychopathological syndromes were defect and final states; residual schizophrenia and paranoid form of schizophrenia were common, intermittent-progressive course with stable but not increasing negative symptoms had dominated. The highest average duration of the disease at the time of committing a socially dangerous action was associated with the negative-personality mechanism. It was 13.56±9.00 years, which is considerably higher than at unconditional-psychotic mechanism (7.02±7.40 years) and at conditional-psychotic mechanism (7.38±8.35 years). Conclusion. When developing treatment and prevention measures, it is necessary to take into account the psychopathological mechanisms of commitment of grave socially dangerous acts combined with data of clinical presentation.

Lyme neuroborreliosis presenting chiefly with neuropsychiatric symptoms displaying difficulties in diagnosis: Report of two cases

Lyme disease is an infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. Its clinical hallmark, erythema migrans, is present only in about two thirds of infected patients. After erythema migrans, Bannwarth's syndrome (meningitis, polyradiculoneuritis, cranial nerve palsies) represents the second most common clinical manifestation of acute Borrelia infection, especially in Europe. We describe here two cases of Lyme neuroborreliosis presenting chiefly with neuropsychiatric symptoms displaying difficulties in diagnosis because the patients had no history of tick bite or erythema migrans. In one of the cases, psychiatric complaints were predominant and she had a preliminary diagnosis of catatonic and psychotic disorder due to a general medical condition. The other patient had a clinical picture of meningitis with a protracted course. They were successfully treated with oral doxycycline. Apropos of these two cases, the relevant literature has been reviewed.

Successful Treatment of Treatment-Resistant Schizophrenia in a 10-Year-Catatonic Patient by Augmentation of Selective Serotonin Reuptake Inhibitors

Although catatonia is a well defined syndrome, the treatment of chronic catatonia remains an unresolved issue. Here, we report a successful treatment of a 30-year-old patient with treatment-resistant catatonic schizophrenia in 10 years by augmentation of selective serotonin reuptake inhibitors (SSRIs).We present a 30-year-old man with treatment-resistant catatonic schizophrenia who failed to respond to the treatment of benzodiazepines and antipsychotics for 10 years. He markedly improved after taking SSRIs. Now, he does not hold odd postures and begins to talk and show more facial expressions.We postulate that the therapeutic effect is related to the enhancement of 5-HT neurotransmission. SSRIs can be a considerable choice to treat chronic catatonia.