Catatonic disorders Health Article

Diagnosis

Catatonic symptoms are quite noticeable. Important diagnostic distinctions, however, must be made to determine their cause. Catatonic schizophrenia is diagnosed when the patient's other symptoms include thought disorder, inappropriate affect, and a history of peculiar behavior and dysfunctional relationships. Catatonic symptoms associated with a mood disorder are diagnosed when there is a prior history of mood disorder, or after careful psychiatric evaluation. Medical tests are necessary to determine the cause of catatonic symptoms caused by infectious diseases, metabolic abnormalities, or neurological conditions. The patient should be asked about recent use of both prescribed and illicit drugs in order to determine whether the symptoms are drug-related.

Treatment

Treatment for catatonic symptoms depends on the underlying cause. Catatonic schizophrenia is treated by a variety of pharmacological and psychotherapeutic methods. Hospitalization may be necessary to protect the patient's safety. Supportive psychotherapy and family educationcan help persons with schizophrenia and their families adjust to problems created by the illness. Such other supportive services as sheltered workshops and special education may also be necessary.

Treatment of catatonic symptoms due to mood disorder involves therapy directed at the underlying mood disorder. Manic episodes are treated with such mood stabilizers as lithium and valproic acid(Depakote). Depressive episodes are treated with antidepressant medications or, if necessary, electroconvulsive treatment (ECT).

Catatonic symptoms caused by a medical disorder require correct diagnosisof the underlying medical condition, followed by appropriate treatment. Levodopa and amantadine(Symmetrel) have shown some effectiveness in reducing catatonic symptoms due to post-encephalitic Parkinson'sdisease. Hospitalization and careful supervision of persons with catatonic symptoms may be necessary to insure that they do not hurt themselves or others.

Prognosis

Catatonic schizophrenia is usually a debilitating lifelong illness. Symptoms typically emerge in adolescence. Social and environmental stressors, such as leaving home for college or military service, use of an illicit drug, or the death of a close friend or relative may trigger the initial symptoms of schizophrenia. The classic pattern is one of worsened symptoms alternating with remissions rather than cure, although about 20% of patients eventually resume their previous level of functioning. Following the initial episode, most patients suffer a relapse within five years of the diagnosis. The course of the disorder varies, with women having a somewhat better prognosis, but persons with schizophrenia remain vulnerable to stressfor their lifetime.

Catatonia associated with mood disorders is somewhat more treatable, although it may also recur from time to time throughout the patients life.

Catatonic symptoms caused by medical conditions can be treated and sometimes cured. Infections are the most completely curable. Metabolic and neurological conditions may be treatable, but various degrees of impairment may remain throughout the patient's life.

Prevention

There are no specific preventive measures for most causes of catatonia. Infectious disease can sometimes be prevented. Catatonic symptoms caused by medications or drugs of abuse can be reversed by suspending use of the drug.

See also Affect; Bipolar disorders; Major depressive disorder; Manic episode; Schizophrenia

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Kaplan, Harold I., MD and Benjamin J. Sadock, MD. Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry.8th edition. Baltimore, MD: Lippincott Williams and Wilkins, 1998.

Sacks, Oliver. Awakenings.New York: HarperPerennial, 1990.

PERIODICALS

Carroll, B. T. "Kahlbaum's catatonia revisited." Psychiatry and Clinical Neuroscience55, no. 5 (October 2001):431-6.

Pfuhlmann, B., and G. Stober. "The different conceptions of catatonia: historical overview and critical discussion." European Archives of Psychiatry and Clinical Neruoscience251 Supplement 1 (2001):14-7.

Sarkstein, S. E., J. C. Golar, A. Hodgkiss. "Karl Ludwig Kahlbaum's concept of catatonia." History of Psychiatry6, no. 22, part 2 (June 1995): 201-7.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington, DC 20002. (202) 336-5500.

Mental Illness Foundation. 420 Lexington Avenue, Suite 2104, New York, NY 10170. (212) 682-4699.

National Alliance for the Mentally Ill (NAMI). 2101 Wilson Blvd., Suite 302, Arlington, VA 22201.

National Mental Health Association. 1021 Prince Street, Alexandria, VA, 22314. (703) 684-7722.

Barbara Sternberg, Ph.D.