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PubMed1994

Benzodiazepines and the psychopathology of catatonia.

This paper focuses attention on the importance of psychopathological analysis in the evaluation of benzodiazepine treatment response in catatonia. The authors report the successful reversal of the catatonic syndrome with small doses of benzodiazepine in two patients who demonstrated stupor and excitement respectively. Viewing the catatonic syndrome from a nosological vantage point, they attempt to demonstrate that its response to benzodiazepines is partly determined by the underlying psychiatric disorder. Discussing the psychopathological and clinical concept of catatonia, the authors argue that revision of the legacy of Jaspers and the Wernicke-Kleist-Leonhard school may help to disentangle the current terminological and conceptual ambiguity and confusion.

Adolescent↗
PubMed2003

Case study: effectiveness of plasma exchange in an adolescent with systemic lupus erythematosus and catatonia.

Catatonia is a rare but severe condition in adolescents that can be associated with both psychiatric and organic causes. The present report notes that systemic lupus erythematosus should be considered among possible causes of catatonia and shows that plasma exchange could be an efficient treatment option for such neuropsychiatric manifestations of systemic lupus erythematosus, to avoid the use of electroconvulsive therapy in young patients.

Adolescent↗
PubMedDate not supplied

Clozapine withdrawal catatonia associated with cholinergic and serotonergic rebound hyperactivity: a case report.

Catatonia as a clozapine withdrawal syndrome has not been well documented. There is only 1 case of excited catatonia described with the diagnosis made according to strict criteria. The authors report a patient who developed a catatonic stuporous state following abrupt discontinuation of clozapine, associated with features of cholinergic and serotonergic hyperactivity. The catatonic state resolved within 1 week with reinstatement of clozapine. It is suggested that serotonergic hyperactivity was involved, contributed by cholinergic rebound, in the pathogenesis of this patient's clozapine withdrawal catatonic syndrome.

Antipsychotic Agents↗
PubMed1986

Ictal catatonia as a manifestation of nonconvulsive status epilepticus.

Three patients with EEG documented ictal catatonia, a nonconvulsive status epilepticus, who responded dramatically to intravenous phenytoin are described. The EEG showed continuous bilateral pseudoperiodic sharp waves and spike discharges in one patient, spike and wave complexes were seen prominently in the right fronto-central region in another, and the EEG of the third patient showed periodic lateralising epileptiform discharges during the catatonic state. We postulate that such catatonia was due to involvement of the limbic system by seizure activity.

Aged↗
PubMed1985

Cerebral systemic lupus erythematosus presenting with catatonia.

A 13 year old girl with catatonia resulting from cerebral lupus is described. She had concurrent minor epileptic status, but abolition of her seizure activity failed to influence her catatonic state. She recovered after treatment with corticosteroids and immunosuppressive agents. Cerebral lupus should be considered in the differential diagnosis in patients presenting with catatonia.

Adolescent↗
PubMed1993

Structural brain abnormalities in catatonia.

In this study, the ventricle to brain ratios of catatonic subjects were compared and evaluated with respect to the underlying diagnoses. Catatonic individuals with the diagnosis of schizophrenia were more likely to have greater ventricle to brain ratios than other catatonic subjects. The association of large ventricles with chronic, deteriorating psychosis is maintained and the heterogeneity of the syndrome of catatonia is apparent. It is possible that the presence of large ventricles may be useful to predict the chronicity of disability for some cases of catatonia.

Adult↗
PubMed1995

Catatonia as an unusual presentation of posttraumatic stress disorder.

A patient with posttraumatic stress disorder (PTSD) had several episodes of catatonia in the past 44 years. These episodes were characterized by a sudden onset of intense excitement, mild pyrexia, often moderate elevation of serum creatinine phosphokinase and the development of a full catatonic state. We could not relate the symptomatology exhibited to any one of the accepted etiologies of catatonia. We assume, following careful evaluation of the clinical picture, and thorough biochemical and imaging work-up, that in this case the catatonic states represented an overwhelming psychic response to associated traumatic recollections, bringing to extreme the avoidance, numbness and motor responses usually encountered in PTSD.

Aged↗
PubMed1987

Lorazepam for psychogenic catatonia.

Catatonia poses special diagnostic and management problems for the psychiatrist. The authors report three patients with psychogenic catatonia who received intramuscular lorazepam and experienced rapid resolution of their conditions.

Adult↗
PubMed2006

Topiramate effect in catatonia: a case series.

The authors describe four cases of catatonia in which topiramate treatment was used. Commonly effective therapies, including benzodiazepines and divalproex, were proven refractory. In all four cases, subjects experienced complete remission of catatonic symptoms and tolerated treatment well. In one case, all psychotropic medications were discontinued because the patient became delirious. The delirium resolved after discovery and treatment of a urinary tract infection. Catatonic agitation relapsed when topiramate was withdrawn but remitted again when topiramate and lorazepam therapy was restored. In two cases, continued topiramate therapy was accompanied by sustained remission. These case reports present a novel approach to the treatment of catatonia.

Adult↗
PubMed2001

Lethal catatonia responding to high-dose olanzapine therapy.

We present the case of a 31-year-old woman with recent refractory bipolar disorder who developed a malignant syndrome preceded by catatonic motor features. This resistant case of lethal catatonia responded selectively to high-dose olanzapine treatment. The case illustrates the need to consider lethal catatonia in apparent cases of neuroleptic malignant syndrome that do not respond to conventional treatment with dantrolene and bromocriptine.

Adult↗
PubMed1991

Psychogenic catatonia with elevated creatine kinase and autonomic hyperactivity.

A case is presented in which a young man with no psychiatric history and no previous exposure to psychotropic medication rapidly developed severe catatonia and autonomic hyperactivity, and an elevated creatine kinase level. He was treated with electroconvulsive therapy and recovered completely. This case suggests that a subgroup of patients who presented with symptoms resembling those of neuroleptic malignant syndrome and who have been treated with neuroleptics may suffer from severe psychogenic catatonia.

Adult↗
PubMedDate not supplied

Is the immobility of advanced dementia a form of lorazepam-responsive catatonia?

Patients with end-stage dementia typically are very immobilized. Could this state actually be a form of lorazepam-responsive catatonia? Catatonia has been documented following cerebrovascular accidents, head injury, HIV encephalitis, brain tumors, and multiple sclerosis. Identified anatomical substrates include frontal lobes, parietal lobes, limbic system, diencephalon, and basal ganglia. Given that Alzheimer's disease, vascular dementia, Lewy body dementia, corticobasal degeneration, frontotemporal dementia, and Parkinsonian dementia often have degeneration in some of the same areas, dramatic awakenings might be possible by giving lorazepam challenges to locked-in dementia patients. If even a small percentage were lorazepam responders, the impact worldwide would be tremendous. Serious consideration should be given to undertaking large-scale clinical trials.

Aged↗
PubMed1988

Use of ECT in hysterical catatonia. A case report and discussion.

Catatonia is now accepted as a non-specific syndrome. Hysteria can very rarely be a cause. A case of hysterical catatonia developing twice in a year, and on both occasions responding to ECT, is presented. Initial diagnostic difficulties, and use of the sodium pentothal interview as a diagnostic test, are also described.

Adult↗
PubMed2000

Catatonia in autistic spectrum disorders.

BACKGROUND: The clinical pictures of autistic spectrum disorders include features described in catatonia. AIMS: To examine the severe exacerbation of the catatonic features of autistic disorders in adolescence or early adult life, which occurs in some individuals. METHOD: A semi-structured interview schedule was used to collect information from parents or other care-givers concerning 506 referrals to a specialist clinic for autistic spectrum disorders. Individuals with severe exacerbation of catatonic features were compared with a same-age group of referrals without this type of deterioration in skills and behaviour. RESULTS: Seventeen per cent of referrals aged 15 or over had severe exacerbation of catatonic features. They were significantly more likely than the comparison group to have had, before the onset of the change in behaviour, impaired language and passivity in social interaction. CONCLUSIONS: Catatonia is a later complication of autistic spectrum disorders, which adds considerably to the burden of caring. More research is needed to identify causes, neuropathology, and early signs of vulnerability.

Activities of Daily Living↗
PubMed2002

Neuroleptic malignant syndrome with prolonged catatonia in a dopa-responsive dystonia patient.

The authors describe a patient with dopa-responsive dystonia who developed neuroleptic malignant syndrome with prolonged catatonia following treatment with neuroleptic agents. Use of these agents probably expanded the patient's neuronal dysfunction beyond the nigrostriatal system to involve multiple dopaminergic systems. Electroconvulsive treatment alleviated the prolonged catatonia.

Adult↗
PubMed2005

Zotepine-induced catatonia as a precursor in the progression to neuroleptic malignant syndrome.

A 39-year-old man with schizophrenia developed severe catatonia, hyperthermia, muscle rigidity, tachycardia, leukocytosis, and elevated muscle enzyme levels while receiving zotepine therapy. Neuroleptic malignant syndrome (NMS) was diagnosed. After withdrawal of zotepine therapy, transfer to a neurologic intensive care unit, provision of supportive care, and administration of adjunctive bromocriptine therapy, the patient's fever and catatonia subsided. Biochemical irregularities spontaneously returned to normal with no complications. Antipsychotic therapy was restarted with risperidone 12 days after the patient's NMS resolved. After more than 1 year of follow-up, he experienced no adverse events. A recent decrease in mortality from NMS is related to increased awareness of this disorder, but not to treatment with specific agents. Clinicians need to recognize NMS early; although rare, it is a potentially fatal complication of antipsychotic treatment.

Antipsychotic Agents↗
PubMed1994

Catatonia on the consultation-liaison service: a replication study.

OBJECTIVE: The aim of this study is to identify the frequency, presentation, identification, treatment recommendations and outcome of patients with catatonia in the general hospital setting. METHOD: All patients seen on a consultation-liaison (C-L) service over a six-month period were screened prospectively for catatonic disorders. Research and DSM-IV criteria for catatonic disorder were applied. Treatment and outcome were naturalistic. RESULTS: Five (1.6%) of 297 patients met restrictive criteria for catatonic disorder. Data were extracted from medical charts. Case reports are presented to reflect the diagnosis and treatment. Extensive medical treatment was required in most cases and most had an unfavorable outcome. CONCLUSION: Catatonia is infrequent but underrecognized in medical-surgical settings. The C-L clinician should screen for catatonic signs in order to diagnose and treat patients with the catatonic disorders.

Adult↗