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Catatonia
- 1. CATATONIA DR MOSAM PHIRKE, RESIDENT, DEPT.OF PSYCHIATRY, SION HOSPITAL.
- 2. CATATONIA 1ST REPORTEDAND TERM COINED BY KARL LUDWIG KAHLBAUM (1874). KRAEPLIN AND BLEULER CONSIDERED CATATONIA AS A PART OF SCHIZOPHRENIA
- 3. CAUSES Northoff (2002)-a ‘top-down modulation’ of basal ganglia due to deficiency of cortical gamma-amino butyric acid (GABA). hyperactivity of GLUTAMATE, the primary excitatory neurotransmitter. Osman & Khurasani (1994)- sudden and massive blockade of dopamine. Yeh et al, 2004- Clozapine-withdrawal Catatonia. Moskowitz (2004)- an evolutionary fear response PET scan- Decreased density of GABA in sensorimotor cortex. NMS- Reduced GABA in CSF.
- 4. RISK FACTORS INCREASINGAGE AS RISK FACTOR FOR CATATONIA IN DEPRESSION (Starkstein et al, 1996). BRAIN INJURY AND PHYSICAL ILLNESS AT ONSET OF PSYCHOSIS (Wilcox & Nasrallah, 1986). SEVERE INFECTIOUS DISEASES IN CHILDHOOD (Wilcox, 1986). HYSTERIA THROMBOTIC THROMBOCYTOPENIC PURPURA (Yacoub et al, 2004). SUBSTANCE (COCAINE, OPIUM, ECSTASY) (Gingrich et al, 1998)
- 5. FEATURES Ambitendency Automaticobedience Aversion Catalepsy Echolalia Echopraxia Excitement Forced grasping Gegenhalten Grimacing Immobility Logorrhoea Mannerisms •Mitgehen •Mitmachen •Mutism •Negativism •Obstruction •Perseveration •Posturing •Psychological pillow •Rigidity •Staring •Stereotypies •Stupor •Verbigeration •Waxy flexibility •Withdrawal
- 6. DSM 5 THREE ORMORE OF STUPOR MUTISM NEGATIVISM CATALEPSY WAXY FLEXIBILITY POSTURING AGITATION ECHOLALIA ECHOPRAXIA GRIMACING MANNERISM STEREOTYPY
- 7. CATATONIA ASSOCIATED WITHANOTHER MENTAL DISORDER 293.89 MOOD DISORDER (MANIA>DEPRESSION)$ BRIEF PSYCHOTIC DISORDER, SCHIZOPHRENIFORM DISORDER, SCHIZOPHRENIA. NEURODEVELOPMENTAL DISORDER. $Abrams & Taylor (1976), Barnes et al (1986)
- 8. CATATONIA DUE TOANOTHER MEDICAL CONDITION 293.89 NEOPLASM, HEAD TRAUMA, CVA, HEAT STROKE. METABOLIC LIKE HYPERCALCEMIA, HYPONATREMIA, HEPATIC ENCEPHALOPATHY,HOMOCYSTINURIA, DIABETIC KETOACIDOSIS MEDICATION INDUCED CORTICOSTEROIDS, IMMUNOSUPPRESSANTS, OPIUM, COCAINE, ANTIPSYCHOTICS.
- 9. CATATONIA DUE TOANOTHER MEDICAL CONDITION 293.89 NEUROLOGICAL- 1. POSTENCEPHALITIC STATE 2. PARKINSONISM 3. NON CONVULSIVE STATUS EPILEPTICUS a.k.a. ICTAL CATATONIA (Lim et al, 1986). 4. B/L GLOBUS PALLIDUS DISEASE 5. LESION OF THALAMUS, PARITAL OR FRONTAL LOBE. 6. TEMPORAL LOBE EPILEPSY (Kirubakaran et al, 1987).
- 10. UNSPECIFIED CATATONIA 293.89 NATURE OF UNDERLYING DISORDER IS UNCLEAR FULL CRITERIA ARE NOT MET INSUFFICIENT DATA FOR MAKING DIAGNOSIS
- 11. ICD-10 CATATONIC SCHIZOPHRENIA F20.2 ONEOR MORE OF STUPOR OR MUTISM EXCITEMENT POSTURING NEGATIVISM RIGIDITY WAXY FLEXIBILITY COMMAND AUTOMATISM & PERSEVERATION ORGANIC CATATONIC DISORDER F06.1
- 12. DSM IV TR-> DSM 5 CRITERIA FOR CATATONIA ARE DISCRIBED UNIFORMLY ACROSS DSM 5. CATATONIA MAY BE DIAGNOSED WITH A SPECIFIER ( FOR DEPRESSION,BIPOLAR, PSYCHOTIC DISORDER ), IN THE CONTEXT OF A KNOWN MEDICAL CONDITION, OR AS AN OTHER SPECIFIC DIAGNOSIS.
- 13. CATATONIA SUBTYPES Taylor& Fink 2003 Van Den Eede & Sabbe 2004 Wernicke–Kleist–Leonhard school of psychiatry Hare & Malone, 2004 Catatonia asso with developmental disorder. Autistic catatonia Chro 15 •
- 14. DIFFERNTIAL DIAGNOSIS ELECTIVEMUTISM ( PD,STRESSORS,ETC. ) STROKE MUTISM ( LOCKED-IN SYNDROME ) STIFF PERSON SYNDROME MALIGNANT HYPERTHERMIA AKINETIC PARKINSONISM
- 15. MANAGEMENT ASSESMENT 1. HISTORYABOUT DRUGS EXPOSURE, STRESSOR AND MEDICAL CONDITIONS. 2. COMPLETE NEUROLOGICAL EXAMINATION 3. INVESTIGATION- TPR, CBC, LFT, RFT, BSL, TFT, CPK LEVELS, BRAIN IMAGING STUDIES (CT / MRI), EEG.
- 16. MANAGEMENT RATING SCALES 1. Bush–FrancisCatatonia Rating Scale (BFCRS) 2. Modified Rogers Scale (MRS)
- 17. TREATMENT BENZODIAZEPINES- LORAZEPAM4 MG 1 MG ORALLY REPEAT AFTER 3 HOURS AND IF NO RESPONSE GIVE BY IM ROUTE. INCREASE TILL 8 – 24 MG AFTER 2 DAYS IF NO RESPONSE. ECT DEFINATIVE TREATMENT FOR CATATONIA ALONE OR IN COMBINATION TREATMENT OF CAUSATIVE FACTOR.
- 18. TREATMENT OTHER TREATMENTS(RESERVED FOR RESISTANT TO BZD AND ECT’s) Mood stabilisers: especially CARBAMAZEPINE. Kritzinger & Jordaan (2001) Antipsychotics NMDA antagonists: amantadine and memantine (Northoff et al, 1999 Thomas et al, 2005) Dopamine agonists (e.g. bromocriptine) and skeletal muscle relaxants (e.g. dantrolene),especially if neuroleptic malignant syndrome is suspected.
- 19. TREATMENT Mann etal, 2001- NMS IS A ANTIPSYCHOTIC INDUCED LETHAL CATATONIA. Castillo et al (1989)-&, Lethal Catatonia begins with extreme psychotic excitement whereas the NMS characteristically starts with severe extrapyramidal muscular rigidity. ANTIPSYCHOTIC DRUGS White and Robbins described 5 patients with excited catatonia—characterized more by frenzied activity than immobility—who went on to develop NMS after being treated with antipsychotic drugs (APDs), and Lee confirmed this finding, proposing that low serum iron might be a marker for those at risk of developing NMS when exposed to APDs.
- 20. CHILD AND ADOLOSENT Catatonia has been increasingly recognized as a co- morbid syndrome of Autism, CDD, Kleine-Levin syndrome, Prader-Willi syndrome, tic disorder, and autoimmune encephalitis. Good response if diagnosed & treated with BZD &ECT’s. Padder willi syndrome genetic model of catatonia as linked to chro 15. Catatonia is Hidden in Plain Sight Among Different Pediatric Disorders: A Review ArticleDirk M. Dhossche, MD, PhD and Lee E. Wachtel, MD
- 21. COMPLICATIONS DEEP VAINTHROMBOSIS PULMONARY EMBOLISM DEATH CAN BE SUICIDAL OR HOMICIDAL IN EXCITED STAGE OF CATATONIA
- 22.