WorldWideScience

Sample records for catatonia

  1. Catatonia.

    Science.gov (United States)

    Walther, Sebastian; Strik, Werner

    2016-08-01

    One of the most exciting psychiatric conditions is the bizarre psychomotor syndrome called catatonia, which may present with a large number of different motor signs and even vegetative instability. Catatonia is potentially life threatening. The use of benzodiazepines and electroconvulsive therapy (ECT) has been efficient in the majority of patients. The rich clinical literature of the past has attempted to capture the nature of catatonia. But the lack of diagnostic clarity and operationalization has hampered research on catatonia for a long time. Within the last decades, it became clear that catatonia had to be separated from schizophrenia, which was finally accomplished in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). In DSM-5, catatonia syndrome may be diagnosed as a specifier to major mood disorders, psychotic disorders, general medical conditions, and as catatonia not otherwise specified. This allows diagnosing the syndrome in a large variety of psychiatric disorders. Currently, the pathobiology remains widely unknown. Suspected neurotransmitter systems include gamma-aminobutyric acid (GABA) and glutamate. Neuroimaging reports pointed to reduced resting state activity and reduced task activation in motor areas of the frontal and parietal cortex. The new classification of catatonia will foster more clinical research and neuroscientific approaches by testing catatonia in various populations and applying stringent criteria. The scarce number of prospective trials will hopefully increase, as more trials will be encouraged within a more precise concept of catatonia. PMID:27255726

  2. [Catatonia].

    Science.gov (United States)

    Pot, A-L; Lejoyeux, M

    2015-06-01

    In the new classification of the DSM-V, catatonia is individualized as a disease of its own. It is defined by presence of at least two out of five criteria: motor immobility, negativism, echolalia or echopraxia, sterile motor activity, atypical movements. The priority is to look first for organic causes: the main ones are neurologic disorders. Intoxication may also be found (illegal drugs or medication), and the role of neuroleptic malignant syndrome in catatonia remains unclear. Among the psychiatric causes, first come bipolar disorders, especially mania; then schizophrenia. Idiopathic forms can also be observed. Epidemiological work on catatonia show highly variable results, highlighting a possible underestimation of the diagnosis. Among the differential diagnoses, which are rare motor syndromes, neuroleptic malignant syndrome and serotonin syndrome are also discussed. The diagnosis of catatonia is clinical and can be obtained using standardized diagnostic scales. The use of zolpidem provides both a diagnostic and therapeutic guidance for the degree of response to drug treatment. The physiopathological hypotheses describe an intracerebral GABAergic, dopaminergic and glutamatergic dysfunction in catatonic patients. The complete mechanisms are still partly unknown. Benzodiazepines are the first treatment of choice. Electroconvulsive therapy is used secondarily or in severe cases. First-generation antipsychotics are prohibited, at the risk of worsening the catatonia in becoming malignant and lethal. The renewed interest in the catatonic syndrome during the past recent years has expanded research on the mechanisms of this syndrome and opened the way to new therapeutic options. The latest works tend to modulate the strict prohibition of antipsychotic in a catatonic patient.

  3. Malignant Catatonia

    Directory of Open Access Journals (Sweden)

    Ayca Ozkul

    2010-12-01

    Full Text Available Catatonia is a syndrome characterized by mutism, immobility, negativism, stereotypy, mannerisms, echophenomena, perseveration and passive obedience. The underlying causes can be psychiatric or may be associated with general medical status or neurological diseases. Additionally catatonia has two subtypes as malignant and nonmalignant catatonia. Main symptoms of malignant catatonia are hyperthermia and autonomic symptoms such as tachycardia, tachypnea and hyperhidrosis. It is important to make the diagnosis as early as possible for an appropriate medical treatment. Clinicians should be aware of the fatal outcome of the disease.

  4. Catatonia induced by disulfiram

    Directory of Open Access Journals (Sweden)

    HK Goswami

    2015-07-01

    Full Text Available Catatonia is a clinical syndrome with varieties of psychomotor abnormalities of retardation and excitement. It can occur both in psychiatric and medical conditions. The aetiology of catatonia has not been fully described. Many researchers suggest that catatonia can occur due to deficiency of cortical gamma-aminobutyric acid (GABA which is an inhibitory neurotransmitter. Disulfiram is an agent that is being used in the treatment of alcohol dependence by its aversive effect. It has been seen that disulfiram is one of the causes of catatonia. This paper aimed to report a case of catatonia induced by disulfiram with no past history of any psychiatric or medical illness.

  5. [Catatonia in the elderly].

    Science.gov (United States)

    Chiba, Yuhei; Odawara, Toshinari

    2013-10-01

    Catatonia is a syndrome characterized by mutism, stupor, immobility, negativism, posturing, stereotypy, and echophenomena. Not only patients with schizophrenia, but also patients with general medical disease, mood disorder, and substance-related disorder exhibit catatonia. In the patients with catatonia, it is recommended to examine whether they have a general medical disease. We present two catatonic elder patients. Case 1 exhibited catatonia with vascular dementia, and was revealed to have anti-phospholipid antibody syndrome. Case 2 exhibited catatonia with dementia with Lewy bodies, and was revealed to have Hashimoto's encephalopathy. The first recommended treatment for catatonia is benzodiazepines. In case of benzodiazepine resistance or malignant catatonia, it should be considered electroconvulsive therapy, but it needs to be carefully implemented for elder patients.

  6. Catatonia in DSM-5.

    Science.gov (United States)

    Tandon, Rajiv; Heckers, Stephan; Bustillo, Juan; Barch, Deanna M; Gaebel, Wolfgang; Gur, Raquel E; Malaspina, Dolores; Owen, Michael J; Schultz, Susan; Tsuang, Ming; van Os, Jim; Carpenter, William

    2013-10-01

    Although catatonia has historically been associated with schizophrenia and is listed as a subtype of the disorder, it can occur in patients with a primary mood disorder and in association with neurological diseases and other general medical conditions. Consequently, catatonia secondary to a general medical condition was included as a new condition and catatonia was added as an episode specifier of major mood disorders in DSM-IV. Different sets of criteria are utilized to diagnose catatonia in schizophrenia and primary mood disorders versus neurological/medical conditions in DSM-IV, however, and catatonia is a codable subtype of schizophrenia but a specifier for major mood disorders without coding. In part because of this discrepant treatment across the DSM-IV manual, catatonia is frequently not recognized by clinicians. Additionally, catatonia is known to occur in several conditions other than schizophrenia, major mood disorders, or secondary to a general medical condition. Four changes are therefore made in the treatment of catatonia in DSM-5. A single set of criteria will be utilized to diagnose catatonia across the diagnostic manual and catatonia will be a specifier for both schizophrenia and major mood disorders. Additionally, catatonia will also be a specifier for other psychotic disorders, including schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, and substance-induced psychotic disorder. A new residual category of catatonia not otherwise specified will be added to allow for the rapid diagnosis and specific treatment of catatonia in severely ill patients for whom the underlying diagnosis is not immediately available. These changes should improve the consistent recognition of catatonia across the range of psychiatric disorders and facilitate its specific treatment.

  7. Movement disorders in catatonia.

    Science.gov (United States)

    Wijemanne, Subhashie; Jankovic, Joseph

    2015-08-01

    Catatonia is a complex neuropsychiatric syndrome characterised by a broad range of motor, speech and behavioural abnormalities. 'Waxy flexibility', 'posturing' and 'catalepsy' are among the well-recognised motor abnormalities seen in catatonia. However, there are many other motor abnormalities associated with catatonia. Recognition of the full spectrum of the phenomenology is critical for an accurate diagnosis. Although controlled trials are lacking benzodiazepines are considered first-line therapy and N-Methyl-d-aspartate receptor antagonists also appears to be effective. Electroconvulsive therapy is used in those patients who are resistant to medical therapy. An underlying cause of the catatonia should be identified and treated to ensure early and complete resolution of symptoms.

  8. CATATONIA IN OBSESSIVE COMPULSIVE DISORDER

    OpenAIRE

    Jagadheesan, K.; Nizamie, Haque S.; Thakur, Anupam

    2002-01-01

    Catatonia occurs in a wide range of neuropsychiatric conditions. Among the psychiatric disorders, occurrence of catatonia has rarely been documented in obsessive-complsive disorder. Given the paucity of reports, we report two cases of obsessive compulsive disorder that presented as catatonia.

  9. The Syndrome of Catatonia

    Directory of Open Access Journals (Sweden)

    James Allen Wilcox

    2015-12-01

    Full Text Available Catatonia is a psychomotor syndrome which has historically been associated with schizophrenia. Many clinicians have thought that the prevalence of this condition has been decreasing over the past few decades. This review reminds clinicians that catatonia is not exclusively associated with schizophrenia, and is still common in clinical practice. Many cases are related to affective disorders or are of an idiopathic nature. The illusion of reduced prevalence has been due to evolving diagnostic systems that failed to capture catatonic syndromes. This systemic error has remained unchallenged, and potentiated by the failure to perform adequate neurological evaluations and catatonia screening exams on psychiatric patients. We find that current data supports catatonic syndromes are still common, often severe and of modern clinical importance. Effective treatment is relatively easy and can greatly reduce organ failure associated with prolonged psychomotor symptoms. Prompt identification and treatment can produce a robust improvement in most cases. The ongoing prevalence of this syndrome requires that psychiatrists recognize catatonia and its presentations, the range of associated etiologies, and the import of timely treatment.

  10. Malignant Catatonia Mimicking Pheochromocytoma

    Directory of Open Access Journals (Sweden)

    Sophia Wong

    2013-01-01

    Full Text Available Malignant catatonia is an unusual and highly fatal neuropsychiatric condition which can present with clinical and biochemical manifestations similar to those of pheochromocytoma. Differentiating between the two diseases is essential as management options greatly diverge. We describe a case of malignant catatonia in a 20-year-old male who presented with concurrent psychotic symptoms and autonomic instability, with markedly increased 24-hour urinary levels of norepinephrine at 1752 nmol/day (normal, 89–470 nmol/day, epinephrine at 1045 nmol/day (normal, <160 nmol/day, and dopamine at 7.9 μmol/day (normal, 0.4–3.3 μmol/day. The patient was treated with multiple sessions of electroconvulsive therapy, which led to complete clinical resolution. Repeat urine collections within weeks of this presenting event revealed normalization or near normalization of his catecholamine and metanephrine levels. Malignant catatonia should be considered in the differential diagnosis of the hypercatecholamine state, particularly in a patient who also exhibits concurrent catatonic features.

  11. Catatonia and Autistic Spectrum Disorders

    Science.gov (United States)

    Hare, Dougal Julian; Malone, Caroline

    2004-01-01

    The phenomenon of catatonic-like states in people with autistic spectrum disorders is discussed in the context of current knowledge about catatonia as it occurs in severe mental illness and, less frequently documented, in conjunction with developmental disorders. The existing literature on catatonic-like states in people with autistic spectrum…

  12. Catatonia Associated with Initiating Paliperidone Treatment

    Directory of Open Access Journals (Sweden)

    Nathanael J. McKeown

    2010-05-01

    Full Text Available We present a case of catatonia, which occurred shortly after starting a new antipsychotic,paliperidone, an active metabolite of risperidone. Catatonia may be caused by a variety of conditions,including metabolic, neurologic, psychiatric and toxic processes. Interestingly, risperidone, whichhas been thought to cause several cases of catatonia, has also been recommended as a potentialtreatment. We discuss potential mechanisms for causes of drug-induced catatonia as well as potentialtreatment options. [West J Emerg Med. 2010; 11(2:186-188.

  13. Catatonia in Autism: A Distinct Subtype?

    Science.gov (United States)

    Ghaziuddin, M.; Quinlan, P.; Ghaziuddin, N.

    2005-01-01

    Catatonia is a life-threatening disorder characterized by motor abnormalities, mutism, and disturbances of behaviour, which is increasingly being diagnosed in persons with autism. In this report, we describe the presentation and course of catatonia in an adolescent with autism who responded to electroconvulsive therapy (ECT). The illness started…

  14. Cannabis Induced Periodic Catatonia: A Case Report

    Science.gov (United States)

    Bajaj, Vikrant; Pathak, Prashant; Mehrotra, Saurabh; Singh, Vijender; Govil, Sandeep; Khanna, Aman

    2011-01-01

    Catatonia is a syndrome of specific motor abnormalities closely associated with disorders in mood, affect, thought and cognition. The principal signs of the disorder are mutism, immobility, negativism, posturing, stereotypy and echo phenomena. Catatonia is commonly seen in various psychiatric disorders, neurological disorders and certain medical…

  15. Recurrent opisthotonus in catatonia: An atypical presentation

    Directory of Open Access Journals (Sweden)

    Manjunatha Narayana

    2009-11-01

    Full Text Available Opisthotonus is known to occur in tetanus, rabies, cerebral malaria, neurosyphilis, acute cerebral injury and other medical conditions. Opisthotonus, so far, has not been reported in any major psychiatric disorder. Authors report a case of recurrent opisthotonus presenting concurrently with other catatonic signs which showed dramatic response to combination of lorazepam and electroconvulsive therapy (ECT. Clinicians should consider the possibility of catatonia in the differential diagnosis of opisthotonus since catatonia can be treated easily with benzodiazepines and ECT.

  16. Catatonia in children following systemic illness

    Directory of Open Access Journals (Sweden)

    Sadanandavalli Retnaswami Chandra

    2015-01-01

    Full Text Available Background: The term catatonia was first introduced in 1874 and several etiologies, both organic and psychiatric have been attributed to the clinical phenotype of catatonia. The interesting feature is their response to lorazepam irrespective of their etiology. Patients and Methods: Four patients admitted with verbal and motor unresponsiveness following febrile illness were evaluated for infective and metabolic causes. Those who qualified for catatonia as per Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition criteria and Bush-Francis Catatonia Screening Instrument screening tool and rating scale were evaluated in detail and reported. Observations: Catatonia occurs in clusters, females are more affected than males. Electroencephalogram can be abnormal based on the precipitating symptom. Minor changes in serum total iron and transferrin saturation and nonspecific elevation of viral antibody titers are seen in some patients. Lorazepam challenge always gives the diagnosis. Result: All patients where females and had preceeding systemic or CNS infection. Three out of the Four patients where independent at the end of one month. Conclusion: Catatonia should be considered as a differential diagnosis in all children with verbal and motor unresponsiveness, which have no other explanation. Early initiation of treatment is very rewarding at least during short term follow-up.

  17. Catatonia due to systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Francisco de Assis Pinto Cabral Júnior Rabello

    2014-07-01

    Full Text Available Objectives Discuss neuropsychiatric aspects and differential diagnosis of catatonic syndrome secondary to systemic lupus erythematosus (SLE in a pediatric patient. Methods Single case report. Result A 13-year-old male, after two months diagnosed with SLE, started to present psychotic symptoms (behavioral changes, hallucinations and delusions that evolved into intense catatonia. During hospitalization, neuroimaging, biochemical and serological tests for differential diagnosis with metabolic encephalopathy, neurological tumors and neuroinfections, among other tests, were performed. The possibility of neuroleptic malignant syndrome, steroid-induced psychosis and catatonia was also evaluated. A complete reversal of catatonia was achieved after using benzodiazepines in high doses, associated with immunosuppressive therapy for lupus, which speaks in favor of catatonia secondary to autoimmune encephalitis due to lupus. Conclusion Although catatonia rarely is the initial clinical presentation of SLE, the delay in recognizing the syndrome can be risky, having a negative impact on prognosis. Benzodiazepines have an important role in the catatonia resolution, especially when associated with parallel specific organic base cause treatment. The use of neuroleptics should be avoided for the duration of the catatonic syndrome as it may cause clinical deterioration.

  18. Hysteria and catatonia as motor disorders in historical context

    OpenAIRE

    Shorter, Edward

    2006-01-01

    Abstract It is difficult to imagine motor symptoms in psychiatry as different as hysteria and catatonia. The mechanism of hysteria is presumed to be psychogenic, while catatonia has always been considered to be among the most organic syndromes in psychiatry. Yet hysteria and catatonia have historically been regarded as allied conditions, an observation borne out by recent developments in neuroscience as wel...

  19. Catatonia as presenting clinical feature of subacute sclerosing panencephalitis

    Directory of Open Access Journals (Sweden)

    Prabhoo Dayal

    2014-01-01

    Full Text Available Catatonia is not a usual clinical presentation of subacute sclerosing panencephalitis (SSPE, especially in the initial stages of illness. However, there is only one reported case of SSPE presenting as catatonia among children. In this report, however, there were SSPE-specific changes on EEG and the catatonia failed to respond to lorazepam. We describe a case of SSPE in a child presenting as catatonia that presented with clinical features of catatonia and did not have typical EEG findings when assessed at first contact. He responded to lorazepam and EEG changes emerged during the course of follow-up.

  20. Brief Report: Catatonia in Autistic Disorders.

    Science.gov (United States)

    Dhossche, Dirk

    1998-01-01

    A case study of an adolescent with catatonia superimposed on autism is presented. The symptoms of the patient are highlighted and include abnormal social interactions, deficits in symbolic play and in communicative language, and occurrence of hallucinations and delusions. Treatment of the patient with clozapine and lorasepam is described. (CR)

  1. Catatonia in mixed alcohol and benzodiazepine withdrawal

    Directory of Open Access Journals (Sweden)

    Aniruddha Basu

    2014-01-01

    Full Text Available Catatonia is mostly caused by different neuropsychiatric conditions. We report a case of a 30 year old man suffering from both alcohol and benzodiazepine dependence who exhibited catatonic features soon after stopping the intake of substances. This case will help clinicians to recognize catatonic features within the varied symptomatology of substance withdrawal and thereby helping in its early diagnosis and management.

  2. The catatonia conundrum: controversies and contradictions.

    Science.gov (United States)

    Padhy, Susanta Kumar; Parakh, Preeti; Sridhar, M

    2014-02-01

    Although catatonia is known to psychiatrists for more than a century, it is still poorly understood, often under recognized, have inspired debate and criticism about nosological status of the catatonic syndrome in recent times without reaching its conclusion. It can present with a number of psychiatric and medical illnesses and is easily treatable, though treatment response varies depending upon the underlying condition and can lead on to a multitude of complications, if not treated. Some issues are more than forty catatonic signs are available to scientific audience for diagnosis; threshold number for labelling varies according to the nosological system followed and the underlying condition; and mood stabilizers like carbamazepine and lithium are helpful in some cases of idiopathic periodic catatonia. Researchers have been asking for a separate diagnostic category for catatonia since long and the debate has gained pace over the last few years, with new editions of both DSM and ICD coming up. Therefore, this paper looks at the controversies associated with the diagnosis and classification of catatonia, the arguments and counter-arguments and future directions, in crisp.

  3. Cotard syndrome with catatonia: Unique combination

    Directory of Open Access Journals (Sweden)

    Aniruddha Basu

    2013-01-01

    Full Text Available Cotard syndrome is a rare psychiatric condition characterized by extreme nihilistic delusions. Catatonia though common, its combination with the Cotard syndrome is exceeding rare and more so the response with the pharmacotherapy as in our case. Since, both are found in organic conditions the importance of studying such a case is to understand the underlying neurobiologic determinants.

  4. Catatonia versus neuroleptic malignant syndrome: the diagnostic dilemma and treatment

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Sahoo

    2014-01-01

    Full Text Available Catatonia is a syndrome, comprised of symptoms such as motor immobility, excessive motor activity, extreme negativism, and stereotyped movements. Neuroleptic is able to induce catatonia like symptoms, that is, the neuroleptic malignant syndrome (NMS. In NMS, patients typically show symptoms such as an altered mental state, muscle rigidity, tremor, tachycardia, hyperpyrexia, leukocytosis, and elevated serum creatine phosphorous kinase. Several researchers have reported studies on catatonia and the association between catatonia and NMS, but none were from this part of the eastern India. In our case, we observed overlapping symptoms of catatonia and NMS; we wish to present a case of this diagnostic dilemma in a patient with catatonia, where a detailed history, investigation, and symptom management added as a great contribution to the patient′s rapid improvement.

  5. Deep Vein Thrombosis with First Episode Catatonia: A Case Report

    Directory of Open Access Journals (Sweden)

    Sunilkumar

    2015-04-01

    Full Text Available Catatonia is a medical emergency condition with varied causative factors. Subsequent medical complications of catatonia put the patient to high risk of morbidity and mortality. Earlier studies show mortality rates up to 50% without proper and timely intervention. Deep vein thrombosis is one such life threatening complication which can be prevented with proper management and care. A case of acute onset catatonia with a left leg DVT in a 21 yr old young single male is discussed here.

  6. Clozapine responsive catatonia: A series of five cases

    Directory of Open Access Journals (Sweden)

    Somsubhra Chattopadhyay

    2012-01-01

    Full Text Available The main objective of presenting the case series is that despite dramatic symptomatic response by intra venous lorazepam or electro convulsive therapy irrespective of primary diagnosis in catatonia cases some cases remain difficult to treat by conventional treatment. Here, we present five catatonia cases who did not respond to conventional treatment even when treated for primary psychiatric diagnosis along with treatment for catatonia. They ultimately responded partially or completely to clozapine only, which explains the multi-factorial causation of catatonia syndrome as postulated by different scientific research.

  7. Adolescent Catatonia Successfully Treated with Lorazepam and Aripiprazole

    Directory of Open Access Journals (Sweden)

    Aaron J. Roberto

    2014-01-01

    Full Text Available Catatonia is especially concerning in children and adolescents. It leads to significant impairment, including emotional distress, difficulty communicating, and other debilitating symptoms. In this case report, we discuss a patient with no previous history of neuroleptic medication or psychotic symptoms, presenting with first-episode catatonia in the presence of disorganized, psychotic thoughts. We then review the catatonia syndrome, citing examples in the literature supporting its underdiagnosis in children and adolescents, and discuss successful treatment modalities. It is important to diagnose and treat catatonia as efficiently as possible, to limit functional and emotional distress to the patient.

  8. Special medical conditions associated with catatonia in the internal medicine setting: hyponatremia-inducing psychosis and subsequent catatonia.

    Science.gov (United States)

    Novac, Andrei A; Bota, Daniela; Witkowski, Joanne; Lipiz, Jorge; Bota, Robert G

    2014-01-01

    Diagnosis and treatment of catatonia in the psychiatry consultation service is not infrequent. Usually, the patient either presents to the Emergency Department or develops catatonia on the medical floor. This condition manifests with significant behavioral changes (from mildly decreased speech output to complete mutism) that interfere with the ability to communicate. After structural brain disorders are excluded, one of the diagnoses that always should be considered is catatonia. However, the causes of catatonia are numerous, ranging from psychiatric causes to a plethora of medical illnesses. Therefore, it is not surprising that there are many proposed underlying mechanisms of catatonia and that controversy persists about the etiology of specific cases.There are only 6 reports of hyponatremia-induced catatonia and psychosis in the literature. Here, we present the case of a 30-year-old woman with catatonia and psychosis induced by hyponatremia, and we use this report to exemplify the multitude of biologic causes of catatonia and to propose a new way to look at the neuroanatomical basis of processing, particularly the vertical processing systems we believe are involved in catatonia.

  9. Three patients with mood disorders showing catatonia and frontotemporal lobes atrophy.

    Science.gov (United States)

    Utumi, Yushi; Iseki, Eizo; Arai, Heii

    2013-12-01

    Here we report the cases of three patients with mood disorders showing catatonia and frontotemporal lobe atrophy. Catatonia is a syndrome linked to frontal dysfunction that most frequently occurs in patients with mood disorders. The diagnostic criteria of catatonia and frontotemporal dementia partly overlap. In the present patients, catatonia might be closely related to frontal dysfunction caused by frontotemporal lobe atrophy. With regard to therapeutics for catatonia, we found that administering a low dose of lorazepam alone or after electroconvulsive therapy may be useful for treating and preventing catatonia. We also found that administering glutaminate antagonists such as memantine may be useful for treating lorazepam-resistant catatonia.

  10. Severe Relapsing Clozapine-Withdrawal Catatonia

    Science.gov (United States)

    Shahrour, Tarek; Siddiq, Muez; Ghalib, Saad

    2015-01-01

    Catatonia as a clozapine-withdrawal syndrome has only been documented in the medical literature as case reports. We are reporting a case in which a 32-year-old man develops a catatonic state upon withdrawal of clozapine. The state was quite severe and needed ICU admission. The course was chronic and intermittent which we think was caused by the poor adherence to antipsychotics. The importance of identifying such cases early is underlined. PMID:26788394

  11. Severe Relapsing Clozapine-Withdrawal Catatonia

    Directory of Open Access Journals (Sweden)

    Tarek Shahrour

    2015-01-01

    Full Text Available Catatonia as a clozapine-withdrawal syndrome has only been documented in the medical literature as case reports. We are reporting a case in which a 32-year-old man develops a catatonic state upon withdrawal of clozapine. The state was quite severe and needed ICU admission. The course was chronic and intermittent which we think was caused by the poor adherence to antipsychotics. The importance of identifying such cases early is underlined.

  12. "Scared Stiff": Catatonia as an Evolutionary-Based Fear Response

    Science.gov (United States)

    Moskowitz, Andrew K.

    2004-01-01

    Catatonia, long viewed as a motor disorder, may be better understood as a fear response, akin to the animal defense strategy tonic immobility (after G. G. Gallup & J. D. Maser, 1977). This proposal, consistent with K. L. Kahlbaum's (1874/1973) original conception, is based on similarities between catatonia and tonic immobility ("death feint") as…

  13. A clinical review of the treatment of catatonia

    Directory of Open Access Journals (Sweden)

    Pascal eSienaert

    2014-12-01

    Full Text Available Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.

  14. Electroconvulsive therapy for catatonia in juvenile neuropsychiatric lupus.

    Science.gov (United States)

    Leon, T; Aguirre, A; Pesce, C; Sanhueza, P; Toro, P

    2014-09-01

    Neuropsychiatric manifestations are serious and frequent complications of systemic lupus erythematous (SLE). Catatonia is a neuropsychiatric disorder characterized by motor disturbance (including waxy flexibility and catalepsy), stupor, excitement, negativism, mutism, echopraxia and echolalia. Catatonia associated with SLE has been only rarely reported, especially in children. Here we present a case of a 14-year-old patient encountered in consultation-liaison psychiatry who presented catatonia associated with SLE. Her catatonia was refractory to treatment with pulse methylprednisolone, intravenous cyclophosphamide and rituximab. The patient responded to a combined therapy of electroconvulsive therapy and benzodiazepines. The present case suggests that although rarely reported, catatonia seen in the background of SLE should be promptly identified and treated to reduce the morbidity.

  15. "Burn catatonia": a case report and literature review.

    Science.gov (United States)

    Quinn, Davin Kenneth

    2014-01-01

    Thermal injuries have been recognized to cause significant neuropsychiatric symptoms and disability in their sufferers since the middle of the 20th century, when Drs. Stanley Cobb and Erich Lindemann of the Massachusetts General Hospital (Boston, MA) studied survivors of the Cocoanut Grove nightclub fire in Boston. Although "burn encephalopathy" or burn-induced delirium is a common occurrence in the acute phase, catatonia in burn patients is not often reported. This report describes a case of malignant catatonia occurring in a 51-year-old male patient acutely suffering from burns acquired in a chemical explosion, effectively treated with reinstitution of a selective serotonin reuptake inhibitor. The literature on burn encephalopathy and catatonia in burns is reviewed. Few examples of burn catatonia exist. Burn encephalopathy is common, and may occur in patients with low TBSA burns such as described in the case above. Descriptions of burn encephalopathy are numerous, but have not included catatonia as a possible etiology. Catatonia in burn patients as an etiology of burn encephalopathy is likely underrecognized. Clinicians should be aware of the possibility of catatonia when a patient's confusional state after a burn does not respond to usual care.

  16. Use of electroconvulsive therapy in an adolescent patient with catatonia

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2014-01-01

    Full Text Available There is lot of skepticism about the use of electroconvulsive therapy (ECT in children and adolescents. However, available literature suggests that use of ECT can be at times life-saving in adolescents, especially those presenting with severe catatonia. We treated a 16-year-old female who presented to us with catatonia with a course of nine ECTs, with which she showed marked improvement. Review of the literature suggests that ECT should be considered as the second line treatment in the management of catatonia in adolescents.

  17. Renal Failure in Dementia with Lewy Bodies Presenting as Catatonia

    Directory of Open Access Journals (Sweden)

    Robert Fekete

    2013-01-01

    Full Text Available Catatonia, originally described by Karl Kahlbaum in 1874, may be regarded as a set of clinical features found in a subtype of schizophrenia, but the syndrome may also stem from organic causes including vascular parkinsonism, brain masses, globus pallidus lesions, metabolic derangements, and pharmacologic agents, especially first generation antipsychotics. Catatonia may include paratonia, waxy flexibility (cerea flexibilitas, stupor, mutism, echolalia, and catalepsy (abnormal posturing. A case of catatonia as a result of acute renal failure in a patient with dementia with Lewy bodies is described. This patient recovered after intravenous fluid administration and reinstitution of the atypical dopamine receptor blocking agent quetiapine, but benzodiazepines and amantadine are additional possible treatments. Recognition of organic causes of catatonia leads to timely treatment and resolution of the syndrome.

  18. Wax on, wax off: a rare case of catatonia.

    Science.gov (United States)

    Greenberg, Karen; D'Ambrosio, Michael; Liebman, Kenneth M; Veznedaroglu, Erol

    2014-10-01

    Catatonia was first described by a German psychiatrist, Karl Kahlbaum, in 1874. It is a behavioral syndrome marked by an inability to move normally, which can occur in the context of many underlying general medical and psychiatric disorders. A wide variety of neurologic, metabolic, drug-induced, and psychiatric causes of catatonia have been reported. We present a unique case of late onset catatonia in a 56-year-old man with no prior medical or psychiatric history initially presenting with stroke-like symptoms. The patient was awake and alert, with spontaneous eye opening, but completely nonverbal and not following any commands. Specifically, the patient demonstrated stupor, catalepsy, mutism, and negativism. After extensive emergency department testing, including negative computed tomography head, negative magnetic resonance imaging brain, negative electroencephalogram, and normal laboratory results, the patient was diagnosed with new-onset bipolar disorder with depressive features presenting as catatonia. Recognizing catatonia is important because it may be caused or exacerbated by treatment of the underlying disorder. Failure to institute treatment early in the course of catatonia is associated with a poor prognosis.

  19. A Case of Catatonia and Neuroleptic Malignant Syndrome Probably Associated with Antipsychotic in Korea

    OpenAIRE

    Choi, Ho-Dong; Kim, Kyoung-Keun; Koo, Bon-Hoon

    2011-01-01

    Several studies have reported on catatonia caused by the use of antipsychotic drugs and on the association between catatonia and neuroleptic malignant syndrome (NMS), but none has reported such a case in Korea. Here, we report the case of a 20-year-old woman whose catatonia and NMS appeared associated with the administration of an atypical antipsychotic drug. We discuss the association between NMS and catatonia due to neuroleptic use.

  20. Brief Report: Electroconvulsive Therapy for Malignant Catatonia in an Autistic Adolescent

    Science.gov (United States)

    Wachtel, Lee Elizabeth; Griffin, Margaret Merrie; Dhossche, Dirk Marcel; Reti, Irving Michael

    2010-01-01

    A 14-year-old male with autism and mild mental retardation developed malignant catatonia characterized by classic symptoms of catatonia, bradycardia and hypothermia. Bilateral electroconvulsive therapy and lorazepam were required for resolution. The case expands the occurrence of catatonia in autism into its malignant variant.

  1. Catatonia in inpatients with psychiatric disorders: A comparison of schizophrenia and mood disorders.

    Science.gov (United States)

    Grover, Sandeep; Chakrabarti, Subho; Ghormode, Deepak; Agarwal, Munish; Sharma, Akhilesh; Avasthi, Ajit

    2015-10-30

    This study aimed to evaluate the symptom threshold for making the diagnosis of catatonia. Further the objectives were to (1) to study the factor solution of Bush Francis Catatonia Rating Scale (BFCRS); (2) To compare the prevalence and symptom profile of catatonia in patients with psychotic and mood disorders among patients admitted to the psychiatry inpatient of a general hospital psychiatric unit. 201 patients were screened for presence of catatonia by using BFCRS. By using cluster analysis, discriminant analysis, ROC curve, sensitivity and specificity analysis, data suggested that a threshold of 3 symptoms was able to correctly categorize 89.4% of patients with catatonia and 100% of patients without catatonia. Prevalence of catatonia was 9.45%. There was no difference in the prevalence rate and symptom profile of catatonia between those with schizophrenia and mood disorders (i.e., unipolar depression and bipolar affective disorder). Factor analysis of the data yielded 2 factor solutions, i.e., retarded and excited catatonia. To conclude this study suggests that presence of 3 symptoms for making the diagnosis of catatonia can correctly distinguish patients with and without catatonia. This is compatible with the recommendations of DSM-5. Prevalence of catatonia is almost equal in patients with schizophrenia and mood disorders.

  2. The relationship between catatonia and dissociation: A preliminary investigation.

    Science.gov (United States)

    Ross, Colin A; Browning, Elena

    2016-01-01

    Unlike the relationship between dissociation and Schneiderian first-rank symptoms, the relationship between dissociation and catatonia has not been investigated empirically. In order to gather some initial data about catatonia, dissociation, and childhood adverse experiences, we administered the Bush-Francis Catatonia Scale (BFCS), the Dissociative Experiences Scale (DES), the Adverse Childhood Experiences Questionnaire, and the Dissociative Disorders Interview Schedule to 100 inpatients in a hospital trauma program. The average DES score was 44.1 (SD = 22.4), and 86 participants were in the DES-Taxon. The average score on the BFCS was 7.7 (SD = 10.3); 81 participants scored 2 or higher, and 67 scored 5 or higher. The results showed that, in this sample, catatonic symptoms are frequent and related to adverse childhood experiences but seem to be a separate symptom category from both dissociation and psychosis. PMID:26751346

  3. Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal

    Directory of Open Access Journals (Sweden)

    Teng J. Peng

    2016-01-01

    Full Text Available We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA signaling during benzodiazepine withdrawal.

  4. The Management of Catatonia in Bipolar Disorder with Stimulants

    Directory of Open Access Journals (Sweden)

    Waheed K. Bajwa

    2015-01-01

    Full Text Available Catatonia, while not a rare occurrence in bipolar disorder, has not been widely discussed in the literature. We present a case of a married Caucasian male with a history of bipolar disorder, exhibiting catatonia and experiencing difficulty in day-to-day functioning. He demonstrated impairment in cognition and an inability to organize simple activities of daily life. After exhausting a number of options for medical management, including benzodiazepines, atypical antipsychotics, and amantadine, he only displayed significant clinical improvement with the addition of a stimulant, methylphenidate. In time, the patient saw a complete return to normal functioning. The use of stimulants for catatonia in bipolar disorder may be an interesting and effective option for treatment. While this is not the first time this treatment has been suggested, there is very little data in support of it; our case confirms the discoveries of previous case reports.

  5. Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal

    Science.gov (United States)

    Peng, Teng J.

    2016-01-01

    We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA) signaling during benzodiazepine withdrawal. PMID:27547472

  6. Catatonia in patients with autism: prevalence and management.

    Science.gov (United States)

    Mazzone, Luigi; Postorino, Valentina; Valeri, Giovanni; Vicari, Stefano

    2014-03-01

    Although recent studies have shown that catatonia can occur in patients with autism spectrum disorders (ASDs), the overlap of the behavioral features between these disorders raises many diagnostic challenges. In fact, in clinical practice it is common to misinterpret catatonic symptoms, including mutism, stereotypic speech, repetitive behaviors, echolalia, posturing, mannerisms, purposeless agitation and rigidity, as features of ASDs. The current medical treatment algorithm for catatonia in ASDs recommends the use of benzodiazepines. Electroconvulsive therapy (ECT) is indicated when patients are unresponsive, or insufficiently responsive, to benzodiazepines. Other pharmacological options are also described for the treatment of catatonic patients resistant to benzodiazepines and ECT, and there is evidence for the effectiveness of a psychological treatment, co-occurring with medical treatments, in order to support the management of these patients. In this article we provide a summary of studies exploring catatonia in ASDs and our clinical experience in the management and treatment of this syndrome through the presentation of three brief case studies. Moreover, we review the mechanisms underlying symptoms of catatonia in ASDs, as well as the diagnostic challenges, providing an outline for the management and treatment of this syndrome in this clinical population.

  7. Increased biogenic catecholamine and metabolite levels in two patients with malignant catatonia

    Directory of Open Access Journals (Sweden)

    Nisijima K

    2013-08-01

    Full Text Available Koichi Nisijima Department of Psychiatry, Jichi Medical University, Tochigi, Japan Abstract: The pathophysiology of malignant catatonia, a rare life-threatening psychiatric syndrome, has not yet been elucidated. This paper reports on two patients with malignant catatonia who showed elevated urinary or plasma catecholamine levels. Patient 1 had high catecholamine and metabolite levels in a 24-hour urine sample, and patient 2 had elevated plasma catecholamine levels. These findings indicate the presence of peripheral sympathetic nervous system hyperactivity in malignant catatonia. Symptoms of autonomic dysfunction, including tachycardia, labile blood pressure, and diaphoresis, are typical features of malignant catatonia and may be related to the increased levels of biogenic amines in these cases. Although the findings in the present study cannot entirely explain the pathophysiology of malignant catatonia, they do indicate that hyperactivity of the sympathetic nervous system may be involved in the pathology of this condition. Keywords: malignant catatonia, catecholamine levels, neuroleptic malignant syndrome

  8. Resignation syndrome: Catatonia? Culture-bound?

    Directory of Open Access Journals (Sweden)

    Karl eSallin

    2016-01-01

    Full Text Available Resignation syndrome (RS designates a long-standing disorder predominately affecting psychologically traumatised children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterised by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependent on the restoration of hope to the family.Descriptions of disorders resembling RS can be found in the literature and the condition is unlikely novel. Nevertheless, the magnitude and geographical distribution stand out. Several hundred cases have been reported exclusively in Sweden in the past decade prompting the Swedish National Board of Health and Welfare to recognise RS as a separate diagnostic entity. The currently prevailing stress hypothesis fails to account for the regional distribution and contributes little to treatment. Consequently, a re-evaluation of diagnostics and treatment is required. Psychogenic catatonia is proposed to supply the best fit with the clinical presentation. Treatment response, altered brain metabolism or preserved awareness would support this hypothesis.Epidemiological data suggests culture-bound beliefs and expectations to generate and direct symptom expression and we argue that culture-bound psychogenesis can accommodate the endemic distribution.Last, we review recent models of predictive coding indicating how expectation processes are crucially involved in the placebo and nocebo effect, delusions and conversion disorders. Building on this theoretical framework we propose a neurobiological model of RS in which the impact of overwhelming negative expectations are directly causative of the down-regulation of higher order and lower order behavioural systems in particularly vulnerable individuals.

  9. Resignation Syndrome: Catatonia? Culture-Bound?

    Science.gov (United States)

    Sallin, Karl; Lagercrantz, Hugo; Evers, Kathinka; Engström, Ingemar; Hjern, Anders; Petrovic, Predrag

    2016-01-01

    Resignation syndrome (RS) designates a long-standing disorder predominately affecting psychologically traumatized children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterized by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependent on the restoration of hope to the family. Descriptions of disorders resembling RS can be found in the literature and the condition is unlikely novel. Nevertheless, the magnitude and geographical distribution stand out. Several hundred cases have been reported exclusively in Sweden in the past decade prompting the Swedish National Board of Health and Welfare to recognize RS as a separate diagnostic entity. The currently prevailing stress hypothesis fails to account for the regional distribution and contributes little to treatment. Consequently, a re-evaluation of diagnostics and treatment is required. Psychogenic catatonia is proposed to supply the best fit with the clinical presentation. Treatment response, altered brain metabolism or preserved awareness would support this hypothesis. Epidemiological data suggests culture-bound beliefs and expectations to generate and direct symptom expression and we argue that culture-bound psychogenesis can accommodate the endemic distribution. Last, we review recent models of predictive coding indicating how expectation processes are crucially involved in the placebo and nocebo effect, delusions and conversion disorders. Building on this theoretical framework we propose a neurobiological model of RS in which the impact of overwhelming negative expectations are directly causative of the down-regulation of higher order and lower order behavioral systems in particularly vulnerable individuals. PMID:26858615

  10. Catatonia in systemic lupus erythematosus: a case report and review of literature.

    Science.gov (United States)

    Grover, S; Parakh, P; Sharma, A; Rao, P; Modi, M; Kumar, A

    2013-05-01

    Although, neuropsychiatric morbidity is quite high in patients with systemic lupus erythematosus (SLE), catatonia has been rarely reported. We report a case of a 22-year-old female who presented with catatonic symptoms at the time of relapse of SLE and have discussed the presentation in the context of existing literature with regard to phenomenology of catatonia, psychiatric co-morbidity and treatment of catatonia in patients with SLE.

  11. Some patients with advanced malignancies also have reversible catatonia or limbic encephalitis

    OpenAIRE

    Joseph Martin Alisky

    2015-01-01

    Two potentially treatable disorders, paraneoplastic catatonia and paraneoplastic limbic encephalitis, may be hidden within the presentation of end stage cancer patients, because catatonia and limbic encephalitis usually feature severely altered mental status, confusion, anorexia, and minimal responsiveness that are also common with people dying of cancer. If catatonia and limbic encephalitis are correctly diagnosed and treated, there should be definite and dramatic improvement that would tran...

  12. Catatonia in Autistic Disorder: A Sign of Comorbidity or Variable Expression?

    Science.gov (United States)

    Realmuto, George M.; August, Gerald J.

    1991-01-01

    Case studies are presented of three autistic adolescents who exhibited catatonia, and it is concluded that catatonia may be a sign of a comorbid condition (such as bipolar disorder) in autistic individuals. Autistic individuals with various other psychiatric, neurological, medical, and drug-related conditions may be at greater risk for catatonic…

  13. Catatonia in Older Adult Individuals with Intellectual Disabilities

    Directory of Open Access Journals (Sweden)

    Megan White

    2015-01-01

    Full Text Available Catatonia has been described in children with intellectual disabilities (IDs. These are the first three published cases of catatonia in adults older than 50 years of age with IDs. They were followed using the KANNER scale and, in one case, creatinine phosphokinase (CPK monitoring. Case 1 is a 67-year-old Caucasian who probably had been having intermittent episodes of undiagnosed catatonia withdrawal for many years. His episodes of agitation and withdrawal behavior responded to lorazepam up to 8 mg/day. Case 2 is a 63-year-old Caucasian male who had probably had undiagnosed catatonic episodes since age 25. An agitation episode that rated 88 on Part 2 of the KANNER scale ended within minutes after he received 1 mg of intramuscular lorazepam. He had no symptom relapses for 4 years after getting stable oral lorazepam doses (3–8.5 mg/day. Case 3 is a 55-year-old African-American male with severe ID and bradycardia (with a pacemaker. He had been “institutionalized” since age 22 and his undiagnosed catatonic episodes appeared to have been intermittently present for at least the last ten years. As he became tolerant and experienced symptom relapse, oral lorazepam was slowly increased (1.5–18 mg/day. Electroconvulsive therapy was ruled out due to his pacemaker.

  14. Treatment of Catatonia With Ultrabrief Right Unilateral Electroconvulsive Therapy: A Case Series.

    Science.gov (United States)

    Kugler, Joseph L; Hauptman, Aaron J; Collier, Samuel J; Walton, Amy E; Murthy, Smitha; Funderburg, Linda G; Garcia, Keith S

    2015-09-01

    Catatonia is a syndrome heterogeneous with regard to presentation and etiology. Electroconvulsive therapy (ECT) remains the first-line treatment for catatonia. Literature review reveals only a few published case reports on the use of right unilateral (RUL) ECT in catatonia, 1 case report on ultrabrief RUL ECT, and an absence of evidence on the relative effectiveness and tolerability of RUL versus bilateral ECT in treating catatonia. In contrast, there are multiple reports in the literature of robustly dosed bilateral ECT, often administered on consecutive days. Reasons for choosing this intervention over the better-tolerated RUL treatment include assumptions about its relative speed and/or breadth of efficacy. Here we present a case series of 13 catatonic patients treated in an academic center over the course of the last 3 years. Our experience suggests that ultrabrief RUL ECT can rapidly and effectively treat catatonia from diverse etiologies.

  15. Catatonia in the History of Psychiatry: Construction and Deconstruction of a Disease Concept.

    Science.gov (United States)

    Tang, Victor Mark; Duffin, Jacalyn

    2014-01-01

    Catatonia is a psychomotor disorder that has gone through numerous descriptions since 1874, reflecting the many changes in psychiatric disease conceptualization that have occurred within that time frame. Catatonia has been variously described as a distinct disease entity, as a part of schizophrenia, and as a nonspecific manifestation of many disorders. Because of its association with schizophrenia, the description of catatonia was particularly affected by the psychopharmacological era, beginning in the 1950s, and by the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Changing trends in psychiatric research--especially the brain-based disease model, research methods favoured by the evidence-based medicine movement, and the codes and categories of the DSM--also profoundly influenced the evolving concept of catatonia. This paper discusses these important factors that affected recognition, treatment, and study of catatonia in order to reveal the biases and assumptions made when constructing a disease concept.

  16. Catatonia from its creation to DSM-V: Considerations for ICD.

    Science.gov (United States)

    Fink, Max

    2011-07-01

    Catatonia was delineated only as a type of schizophrenia in the many American Psychiatric Association DSM classifications and revisions from 1952 until 1994 when "catatonia secondary to a medical condition" was added. Since the 1970s the diagnosis of catatonia has been clarified as a syndrome of rigidity, posturing, mutism, negativism, and other motor signs of acute onset. It is found in about 10% of psychiatric hospital admissions, in patients with depressed and manic mood states and in toxic states. It is quickly treatable to remission by benzodiazepines and by ECT. The DSM-V revision proposes catatonia in two major diagnostic classes, specifiers for 10 principal diagnoses, and deletion of the designation of schizophrenia, catatonic type. This complex recommendation serves no clinical or research purpose and confuses treatment options. Catatonia is best considered in the proposed ICD revision as a unique syndrome of multiple forms warranting a single unique defined class similar to that of delirium.

  17. [Successful amantadine treatment of a patient with ECT-resistant catatonia].

    Science.gov (United States)

    Walstra, A N; den Broek, M VAN; Giltay, E J; van Paassen, J; van Noorden, M S

    2016-01-01

    Catatonia is a common neuropsychiatric syndrome. There is a life-threatening subtype of this disease known as malignant catatonia. One of the hypotheses regarding the pathogenesis is an imbalance of multiple neurotransmitters (gaba, glutamate and dopamine). The first step in treatment is to administer benzodiazepines; if the response is insufficient, the treatment can be replaced by electroconvulsive therapy (ect). So far, there is no consensus with regard to the tertiary treatment step. On the basis of a case report we describe the beneficial effects of administering an nmda receptor antagonist, amantadine, as the tertiary step for treating a patient with treatment-resistant malignant catatonia. PMID:27527886

  18. Treatment of a Prader-Willi Patient with Recurrent Catatonia

    Directory of Open Access Journals (Sweden)

    Hana M. Poser

    2015-01-01

    Full Text Available Prader-Willi is a genetic disorder characterized by neonatal hypotonia, hyperphagia, short stature, hypogonadism, and mental delay. This disorder can result from multiple mechanisms, most commonly a deletion of paternal chromosome 15, leaving a single maternally derived chromosome 15. Individuals who have a maternal uniparental disomy of chromosome 15 have a higher risk for developing psychosis compared to other forms of Prader-Willi. The following report details the treatment course of a 24-year-old female with Prader-Willi and recurrent catatonia. The patient initially had a positive lorazepam challenge test but subsequently failed treatment with benzodiazepines. She then received eight electroconvulsive therapy (ECT treatments after which she showed improvement from initial catatonic state. However, the resolution in her symptoms did not follow a linear course but would show periods of improvement followed by a return of catatonic features. This case provides an example of the complexity of treatment of a patient with a genetic disorder and recurrent catatonia.

  19. Catatonia in DSM 5: controversies regarding its psychopathology, clinical presentation and treatment response.

    Science.gov (United States)

    Ungvari, Gabor S

    2014-12-01

    Over the past two decades, there has been an upsurge of interest in catatonia, which is reflected in the attention it received in DSM 5, where it appears as a separate subsection of the Schizophrenia Spectrum and Other Psychotic Disorders (APA, 2013). This commentary argues that due to the lack of solid scientific evidence, the extended coverage of catatonia in DSM 5 was a premature, and consequently, a necessarily ambiguous decision. The psychopathological foundations of the modern catatonia concept are lacking therefore its boundaries are fuzzy. There are only a few, methodologically sound clinical, treatment response and small-scale neurobiological studies. The widely recommended use of benzodiazepines for the treatment of catatonia is based on case reports and open-label studies instead of placebo-controlled, randomized trials. In conclusion, the catatonic concept espoused by DSM 5 is necessarily vague reflecting the current state of knowledge.

  20. Some patients with advanced malignancies also have reversible catatonia or limbic encephalitis

    Directory of Open Access Journals (Sweden)

    Joseph Martin Alisky

    2015-12-01

    Full Text Available Two potentially treatable disorders, paraneoplastic catatonia and paraneoplastic limbic encephalitis, may be hidden within the presentation of end stage cancer patients, because catatonia and limbic encephalitis usually feature severely altered mental status, confusion, anorexia, and minimal responsiveness that are also common with people dying of cancer. If catatonia and limbic encephalitis are correctly diagnosed and treated, there should be definite and dramatic improvement that would translate into better quality of life and perhaps even resumption of cancer therapy. This editorial reviews basic features of catatonia and limbic encephalitis, and then presents a strategy to systematically screen for these in end stage cancer patients who are about to enter hospice. A protocol is outlined that could be adapted for clinical practice or for designing clinical studies.

  1. Systemic lupus erythematous presenting as catatonia and its response to electroconvulie therapy

    Directory of Open Access Journals (Sweden)

    Arshad Hussain

    2015-01-01

    Full Text Available Neuropsychiatric systemic lupus erythematous (SLE encompasses various psychiatric and neurological manifestations that develop in SLE patients, secondary to involvement of central nervous system. Neuropsychiatric SLE, presenting as catatonia is very uncommon, and treatment of this condition is not well defined. Previously the role of benzodiazepines, immunosuppression, plasma exchange, and electroconvulsive therapy (ECT has been described in its management. Here we describe a case of neuropsychiatric lupus presenting as catatonia that did not respond to benzodiazepines or immunosuppression. The symptoms of catatonia showed improvement with ECT. Furthermore, we have discussed the pathology of the disorder and the role of ECT in the treatment of cases of catatonia associated with SLE, who do not respond to benzodiazepines.

  2. Rapidly-progressive catatonia responsive to zolpidem in a patient with ovarian teratoma-associated paraneoplastic encephalitis.

    Science.gov (United States)

    Amorim, Edilberto; McDade, Eric M

    2016-08-01

    Psychiatric symptoms and catatonia are key components of the clinical presentation of paraneoplastic encephalitis; additionally symptoms can be long-lasting and often difficult to treat. We report a 73-year-old patient with rapidly progressive catatonia not responsive to immunotherapy, tumor resection, electroconvulsive therapy, or benzodiazepines who had significant improvement after zolpidem administration. This report suggests that zolpidem is an option in the treatment of patients with refractory catatonia and paraneoplastic encephalitis. PMID:26964475

  3. Catatonia in Down syndrome; a treatable cause of regression

    Directory of Open Access Journals (Sweden)

    Ghaziuddin N

    2015-04-01

    Full Text Available Neera Ghaziuddin,1 Armin Nassiri,2 Judith H Miles3 1Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, 2Community Psychiatry, San Jose, California, 3Thompson Center for Autism and Neurodevelopmental Disorders and Department of Child Health, University of Missouri, Columbia, Missouri, USA Objective: The main aim of this case series report is to alert physicians to the occurrence of catatonia in Down syndrome (DS. A second aim is to stimulate the study of regression in DS and of catatonia. A subset of individuals with DS is noted to experience unexplained regression in behavior, mood, activities of daily living, motor activities, and intellectual functioning during adolescence or young adulthood. Depression, early onset Alzheimer’s, or just “the Down syndrome” are often blamed after general medical causes have been ruled out. Clinicians are generally unaware that catatonia, which can cause these symptoms, may occur in DS.Study design: Four DS adolescents who experienced regression are reported. Laboratory tests intended to rule out causes of motor and cognitive regression were within normal limits. Based on the presence of multiple motor disturbances (slowing and/or increased motor activity, grimacing, posturing, the individuals were diagnosed with unspecified catatonia and treated with anti-catatonic treatments (benzodiazepines and electroconvulsive therapy [ECT].Results: All four cases were treated with a benzodiazepine combined with ECT and recovered their baseline functioning.Conclusion: We suspect catatonia is a common cause of unexplained deterioration in adolescents and young adults with DS. Moreover, pediatricians and others who care for individuals with DS are generally unfamiliar with the catatonia diagnosis outside schizophrenia, resulting in misdiagnosis and years of morbidity. Alerting physicians to catatonia in DS is essential to prompt diagnosis, appropriate treatment, and identification of the frequency

  4. Rapid Relief of Catatonia in Mood Disorder by Lorazepam and Diazepam

    Directory of Open Access Journals (Sweden)

    Yu-Chi Huang

    2013-02-01

    Full Text Available Background: Catatonia has risks of severe morbidity and mortality and needs early treatment. In this study, we investigated more patients to discuss the efficacy of this treatment in patients with major depressive disorder (MDD or bipolar I disorder (BPI. Methods: During a period of 9 years, we identified 12 catatonic patients with mood disorder, with MDD (n = 10 and BPI (n = 2 in the emergency department, inpatient and outpatient units of a general hospital. The patients received intramuscular injection (IMI of 2 mg lorazepam once or twice during the first 2 h. If intramuscular lorazepam failed, intravenous dripping (IVD of 10 mg diazepam in 500 mL normal saline every 8 h for 1 day was prescribed. Results: Eight patients had full remission of catatonia after receiving one dose of 2 mg lorazepam IMI. Two patients needed two doses of 2 mg lorazepam IMI. Two patients with BPI recovered from catatonia using one dose of 10 mg diazepam IVD over 8 h after they failed to respond to two doses of 2 mg lorazepam IMI. The response rate to lorazepam IMI was 83.3%. All catatonic features remitted in 24 h with 100% response rate. Conclusions: The lorazepam-diazepam treatment strategy is a safe and effective method to relieve catatonia in mood disorder within 1 day. Psychiatrist consultation is helpful for final diagnosis and rapid treatment of catatonia.

  5. Comparison of catatonia presentation in patients with schizophrenia and mood disorder in Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    Afe Taiwo

    2011-01-01

    Full Text Available "nObjective: To compare the clinical profile and pattern of catatonic symptoms of patients with schizophrenia and mood disorder. "n "nMethod: Records of 13,968 patients seen between 1983-1985 and 2003- 2005 were reviewed for symptoms of catatonia by resident doctors in psychiatry. Cases in which the diagnosis were schizophrenia or mood disorder were then noted. Socio-demographic and clinical features were described for each diagnosis. "nResults: There were a total of 98 cases with catatonia out of the 13,968 case notes reviewed. Schizophrenia accounted for 82.5% and 53.4% in the two periods, while the proportion associated with mood disorders increased from 10% to 20.7%. Male to female  ratio was 1.2:1 in schizophrenia and 1:3 in mood disorder. Those with schizophrenia were younger and with an earlier age of onset of symptoms than those with mood disorders. "nConclusion:Catatonia associated with mood disorder was found to be increasing over the years when compared with schizophrenia. Differences were observed in socio-demographic characteristics and number of predominant catatonic symptoms. Having a separate category for catatonia due to the mood disorders in the current diagnostic guidelines (10th edition of the International Classification of Diseases and the 4th edition of the Diagnostic and Statistical Manual will help in better diagnosis of catatonia.

  6. Red Lentil Extract: Neuroprotective Effects on Perphenazine Induced Catatonia in Rats

    Science.gov (United States)

    Tarahomi, Shahram; Arzi, Ardeshir; Goudarzi, Mehdi; Bahadoram, Mohammad; Rashidi-Nooshabadi, Mohammadreza

    2016-01-01

    Introduction Parkinsonism is a neurodegenerative disease that is defined by certain symptoms such as muscle rigidity, impaired movement, catatonia, tremor and disorientation of body. Aim The aim was to investigate the effect of red lentil extract on perphenazine-induced Catatonia in model of rat. Materials and Methods This experimental study was done on 48 male albino rats (weight 180–200g) of the Sprague-Dawley strain. Animals were randomly divided into six groups and were pre-treated with a single dose of red lentil extract (200, 400, 800 and 1000 mg/kg), most effective dose of bromocriptine (30mg/kg) and normal saline (5ml/kg) via intraperitoneal (IP) route. perphenazine (5 mg/kg) was after 30 minutes, administered (IP) to induce catatonia. The scoring method of Morpurgo was used to determine the muscular rigidity of animals. Results The results showed that the 200mg/kg red lentil extract treated group had no significant reduction in catatonic responses after perphenazine administration in comparison with control group while the groups that received 800 and 1000mg/kg of red lentil extract showed significant difference (pCatatonia induced by perphenazine in rats. So this extract may be probably beneficial for catatonia in Parkinsonism. PMID:27504309

  7. Successful use of right unilateral ECT for catatonia: a case series.

    Science.gov (United States)

    Cristancho, Pilar; Jewkes, Delaina; Mon, Thetsu; Conway, Charles

    2014-03-01

    Catatonia is a neuropsychiatric syndrome involving motor signs in association with disorders of mood, behavior, or thought. Bitemporal electrode placement electroconvulsive therapy (ECT) is a proven effective treatment for catatonia, and this mode of ECT delivery is the preferred method of treatment in this condition. Studies in major depressive disorder have demonstrated that suprathreshold, nondominant (right) hemisphere, unilateral electrode placement ECT has fewer adverse effects, especially cognitive adverse effects, than bitemporal ECT. This case series describes the use of right unilateral (RUL) ECT in 5 patients with catatonia. Before ECT, all 5 patients in this series initially failed therapy with benzodiazepines and psychotropic medications. Each catatonic patient received a series of 8 to 12 RUL ECT in an every-other-day series. After ECT, 4 of the 5 patients had a full recovery from catatonia. One patient achieved only partial response to RUL ECT, and no additional benefit was obtained with bitemporal ECT. All patients in this case series tolerated RUL ECT without major adverse effects. This case series illustrates successful use of RUL ECT in patients with catatonia and adds to the early literature demonstrating its effective use in treating this complex condition.

  8. Red Lentil Extract: Neuroprotective Effects on Perphenazine Induced Catatonia in Rats

    Science.gov (United States)

    Tarahomi, Shahram; Arzi, Ardeshir; Goudarzi, Mehdi; Bahadoram, Mohammad; Rashidi-Nooshabadi, Mohammadreza

    2016-01-01

    Introduction Parkinsonism is a neurodegenerative disease that is defined by certain symptoms such as muscle rigidity, impaired movement, catatonia, tremor and disorientation of body. Aim The aim was to investigate the effect of red lentil extract on perphenazine-induced Catatonia in model of rat. Materials and Methods This experimental study was done on 48 male albino rats (weight 180–200g) of the Sprague-Dawley strain. Animals were randomly divided into six groups and were pre-treated with a single dose of red lentil extract (200, 400, 800 and 1000 mg/kg), most effective dose of bromocriptine (30mg/kg) and normal saline (5ml/kg) via intraperitoneal (IP) route. perphenazine (5 mg/kg) was after 30 minutes, administered (IP) to induce catatonia. The scoring method of Morpurgo was used to determine the muscular rigidity of animals. Results The results showed that the 200mg/kg red lentil extract treated group had no significant reduction in catatonic responses after perphenazine administration in comparison with control group while the groups that received 800 and 1000mg/kg of red lentil extract showed significant difference (pextract of red lentil has protective effect on Catatonia induced by perphenazine in rats. So this extract may be probably beneficial for catatonia in Parkinsonism.

  9. Catatonia and neuroleptic malignant syndrome: two disorders on a same spectrum? Four case reports.

    Science.gov (United States)

    Luchini, Federica; Lattanzi, Lorenzo; Bartolommei, Natalia; Cosentino, Luca; Litta, Antonella; Kansky, Christine; Mauri, Mauro; Cassano, Giovanni Battista; Fagiolini, Andrea; Casamassima, Francesco

    2013-01-01

    We present the history of four bipolar patients who developed neuroleptic malignant syndrome (NMS) after antipsychotic treatment, focusing on the relationship between NMS and catatonia. In all cases, the administration of antipsychotics has been suspended as soon as fever and autonomic disturbances occurred. A supportive therapy was initiated to stabilize general conditions, then every patient started electroconvulsive therapy (ECT) in combination with benzodiazepines (BDZ). The risk of complications was reduced by the quick adoption of supportive care, whereas the combination of ECT and BDZ was effective in resolving the clinical picture. These cases may provide further support to the hypothesis that catatonia and NMS are disorders pertaining to the same spectrum of illness because the onset or exacerbation of catatonic symptoms coincided with the administration of antipsychotics. Our experience confirms the efficacy and safety of ECT in combination with BDZ as treatment of NMS and residual catatonia.

  10. Consultation Dilemma Catatonia in a Patient with Prior TBI: MentaI or Medical Disorder?

    Science.gov (United States)

    Khalafian, Andrey; Dukes, Charles; Tucker, Phebe

    2015-08-01

    Mr. R, a 27 year old Hispanic male with history of traumatic brain injury (TBI) over ten years prior but no psychiatric history, presents to the psychiatric consultation service with recent onset of mutism, psychotic behavior and new diagnosis of epilepsy. The differential diagnosis is broad and includes both medical and psychiatric causes: post-ictal state, non-convulsive status epilepticus, delirium due to metabolic conditions, drugs, catatonia, conversion disorder, major depression with psychotic features, new onset schizophrenia or a combination of these possible diagnoses. We explore different medical causes that can present with symptoms of catatonia, as it is crucial to rule out a possible treatable medical cause.

  11. Malignant catatonia and neuroleptic malignant syndrome in relation to disulfiram overdose

    Directory of Open Access Journals (Sweden)

    Kiran K Kumar

    2016-01-01

    Full Text Available Disulfiram is a widely used drug in the management of alcohol dependence syndrome as an aversive agent. Although a drug of high efficacy, it has a large number of side effects. Disulfiram-induced catatonia is a known rare side effect of the drug and herein we report a case of what appeared to be the sequential development of malignant catatonia and neuroleptic malignant syndrome in a patient with a diagnosis of alcohol dependence syndrome and co-morbid paranoid schizophrenia following disulfiram overdose. Clinicians need to be vigilant on the emergence of such rare side effects.

  12. Neuromyelitis optica presenting with psychiatric symptoms and catatonia: a case report.

    Science.gov (United States)

    Alam, Abdulkader; Patel, Rachit; Locicero, Briana; Rivera, Nicole

    2015-01-01

    Neuromyelitis optica (NMO) is an aggressive disease characteristically affecting the spinal cord and optic nerves that has recently been differentiated from multiple sclerosis. We present a case of a 16-year-old Antiguan female previously diagnosed with NMO who presented with a 1-week history of confusion and agitation. She had symptoms of psychosis, including delusional thinking and auditory and visual hallucinations, and scored 11/23 on the Bush-Francis Catatonia Scale. This case demonstrates an NMO exacerbation that presented with psychotic symptoms and catatonia.

  13. Malignant Catatonia and Neuroleptic Malignant Syndrome in Relation to Disulfiram Overdose

    Science.gov (United States)

    Kumar, Kiran K.; Bondade, Swapna; Sattar, Fiaz Ahmed; Singh, Niharika

    2016-01-01

    Disulfiram is a widely used drug in the management of alcohol dependence syndrome as an aversive agent. Although a drug of high efficacy, it has a large number of side effects. Disulfiram-induced catatonia is a known rare side effect of the drug and herein we report a case of what appeared to be the sequential development of malignant catatonia and neuroleptic malignant syndrome in a patient with a diagnosis of alcohol dependence syndrome and co-morbid paranoid schizophrenia following disulfiram overdose. Clinicians need to be vigilant on the emergence of such rare side effects. PMID:27570348

  14. Antiretroviral treatment induced catatonia in 16-year-old boy

    Directory of Open Access Journals (Sweden)

    Anand Lingeswaran

    2014-01-01

    Full Text Available We present a 16-year-old boy, who had presented to us with catatonic features of mutism, withdrawal, passive negativism, grimacing, gesturing, echopraxia, and excitement of 5 days duration while taking antiretroviral therapy (ART for a period of 2 years. He had history of birth asphyxia and acquired HIV infection from his father when the same syringe and needle was used on both of them in a medical setting where the father and son had consulted for treatment of pyrexia of unknown origin. He was the eldest of a three children family in which the biologic father had acquired HIV through extramarital sexual contact with HIV-infected sex workers but was unaware of his HIV positive status till our patient, the 16-year-old was admitted and treated for pulmonary tuberculosis at 14 years of age. The boy′s mother had only acquired HIV after having three children with the HIV-positive husband, thus leaving the other two children HIV negative. The catatonia completely resolved within 2 days after the ART was withheld, and risperidone 1 mg twice a day was prescribed. This case highlights the risks of ART and breach of universal precautions.

  15. Catatonia em um adolescente após uso de mefedrona como droga recreativa = Catatonia in a teenager after use of mephedrone as a recreational drug

    Directory of Open Access Journals (Sweden)

    Antunes, Joaquina

    2013-01-01

    Conclusões: Segundo a bibliografia consultada, este é o primeiro relato publicado de catatonia associada ao consumo de mefedrona. O caso ilustra uma manifestação psiquiátrica grave secundária à exposição a essa droga recreativa, facilmente adquirida pelos adolescentes apesar de já terem sido descritos casos fatais associados ao seu consumo

  16. [Catatonia and neuroleptic malignant syndrome in view of a psychopathological and pathophysiological overlap: a brief review].

    Science.gov (United States)

    Asztalos, Zoltán; Egervári, Luca; Andrássy, Gábor; Faludi, Gábor; Frecska, Ede

    2014-03-01

    Catatonia was first described in the 19th century as a syndrome with motor, affective and behavioral symptoms. During the 20th century it was rather regarded as a rare motoric manifestation of schizophrenia and that classification has almost resulted in the disappearance of catatonia among patients outside of the schizophrenia spectrum. With the introduction of neuroleptics, the incidence of catatonic schizophrenia also declined which was attributed to effective treatment. Simultaneously, neuroleptic malignant syndrome was described, which shows many similarities with catatonia. Recently, several researchers suggested a common origin of the two disorders. In this paper we review case reports of the last five years, in which both neuroleptic malignant syndrome and catatonia had emerged as a diagnosis. Additionally, based on the relevant literature, we propose a common hypothetical pathomechanism with therapeutic implications for the two syndromes. Besides underlining the difficulties of differential diagnosis, the reviewed cases demonstrate a transition between the two illnesses. The similarities and the possible shifts may suggest a neuropathological and pathophysiological overlap in the background of the two syndromes. Electroconvulsive therapy and benzodiazepines seem to be an effective treatment in both syndromes. These two treatment approaches can be highly valuable in clinical practice, especially if one considers the difficulties of differential diagnosis.

  17. Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia.

    Science.gov (United States)

    Raffin, Marie; Zugaj-Bensaou, Laetitia; Bodeau, Nicolas; Milhiet, Vanessa; Laurent, Claudine; Cohen, David; Consoli, Angèle

    2015-04-01

    We aimed to (1) describe the treatment used in a large sample of young inpatients with catatonia, (2) determine which factors were associated with improvement and (3) benzodiazepine (BZD) efficacy. From 1993 to 2011, 66 patients between the ages of 9 and 19 years were consecutively hospitalized for a catatonic syndrome. We prospectively collected sociodemographic, clinical and treatment data. In total, 51 (77%) patients underwent a BZD trial. BZDs were effective in 33 (65%) patients, who were associated with significantly fewer severe adverse events (p = 0.013) and resulted in fewer referrals for electroconvulsive therapy (ECT) (p = 0.037). Other treatments included ECT (N = 12, 18%); antipsychotic medications, mostly in combination; and treatment of an underlying medical condition, when possible. For 10 patients, four different trials were needed to achieve clinical improvement. When all treatments were combined, there was a better clinical response in acute-onset catatonia (p = 0.032). In contrast, the response was lower in boys (p = 0.044) and when posturing (p = 0.04) and mannerisms (p = 0.008) were present as catatonic symptoms. The treatment response was independent of the underlying psychiatric or systemic medical condition. As in adults, BZDs should be the first-line symptomatic treatment for catatonia in young patients, and ECT should be a second option. Additionally, the absence of an association between the response to treatment and the underlying psychiatric condition suggests that catatonia should be considered as a syndrome.

  18. [Anti-NMDA encephalitis in psychiatry; malignant catatonia, atypical psychosis and ECT].

    Science.gov (United States)

    Kanbayashi, Takashi; Tsutsui, Ko; Tanaka, Keiko; Omori, Yuki; Takaki, Manabu; Omokawa, Mayu; Mori, Akane; Kusanagi, Hiroaki; Nishino, Seiji; Shimizu, Tetsuo

    2014-01-01

    The symptoms of malignant (lethal) catatonia has been reported similar to initial symptoms of anti-NMDAR encephalitis. Subsequently, this autoimmune limbic encephalitis has been noticed in many psychiatrists. We have experienced several cases with malignant catatonia having anti-NMDAR antibody without clinical signs of encephalitis. Thereafter, we have also found anti-NMDAR antibody positive patients of young females with acute florid psychiatric symptoms without clinical signs of encephalitis. The features of these patients mirror-those of "Atypical psychosis" proposed by Mitsuda in Japan, a notion derived from "Cycloid psychosis" conceptualized by German psychiatrist, Leonhard. Both cycloid and atypical psychosis have coinciding features of acute onset, emotional disturbances, psychomotor disturbances, alternations of consciousness, high prevalence in women and oriented premorbid personality. Both malignant catatonia and atypical psychosis have been known to be effectively treated with modified electro convulsion therapy (m-ECT). Our 5 cases with anti-NMDAR antibody, m-ECT treatments were effective. Infectious encephalitis is contra indication of m-ECT, but this autoimmune encephalitis would be careful indication. Schizophrenia is a common, heterogeneous, and complex disorder with unknown etiology. There is established evidence of NMDAR hypofunction as a central component of the functional disconnectivity; this is one of the most accepted models for schizophrenia. Moreover, autoimmune mechanisms have been proposed to be involved, at least in subgroups of schizophrenia patients. Further research of anti-NMDAR antibody and encephalitis would be important clues for the investigation of schizophrenia, catatonia and atypical psychosis.

  19. Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study

    Directory of Open Access Journals (Sweden)

    Santosh Ramdurg

    2013-01-01

    Full Text Available Aim: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. Materials and Methods: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India from January 2009 to December 2010 was undertaken. Results: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35 was the most commonly entertained diagnosis and affective disorder (18%, N=11 being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT. Conclusion: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study

  20. [Catatonia: resurgence of a concept. A review of the international literature].

    Science.gov (United States)

    Pommepuy, N; Januel, D

    2002-01-01

    Catatonia was first described in 1874 by Kahlbaum as being a cyclic disease mixing motor features and mood variations. Because most cases ended in dementia, Kraepelin recognized catatonia as a form of dementia praecox and Bleuler included it within his wide group of schizophrenias. This view influenced the psychiatric practice for more than 70 years. But catatonia was recently reconsidered and this because of the definition of more precise diagnosis criteria, the discovery of a striking association with mood disorders, and the emphasis on effective therapeutics. Peralta et al empirically developed a performant diagnostic instrument with the 11 most discriminant signs among catatonic features. Diagnostic threshold is three or more signs with sensitivity of 100% and specificity of 99%. These signs are: immobility/stupor (extreme passivity, marked hypokinesia); mutism (includes inaudible whisper); negativism (resistance to instructions, contrary comportment to whose asked); oppositionism, other called gegenhalten (resistance to passive movement which increases with the force exerted); posturing (patient adopts spontaneously odd postures); catalepsy (patient retains limb positions passively imposed during examination; waxy flexibility); automatic obedience (exaggerated co-operation to instructed movements); echo phenomena (movements, mimic and speech of the examiner are copied with modification and amplifications); rigidity (increased muscular tone); verbigeration (continuous and directionless repetition of single words or phrases); withdrawal/refusal to eat or drink (turning away from examiner, no eye contact, refusal to take food or drink when offered). Using this diagnostic tool, prevalence of catatonic syndrome appears to be close to 8% of psychiatric admissions. Other signs are also common but less specific: staring, ambitendance, iterations, stereotypes, mannerism, overactivity/excitement, impulsivity, combativeness. Some authors complete this description by

  1. Multiple-etiology delirium and catatonia in an alcoholic with tubercular meningoencephalitis

    Directory of Open Access Journals (Sweden)

    Suneet Kumar Upadhyaya

    2011-01-01

    Full Text Available Delirium is a clinical entity with a variety of possible etiological conditions. Clinicians must be vigilant for the possibility of additional etiological factors. Secondly, catatonic patients should be carefully looked for general medical conditions. This case report depicts a chronic alcoholic who presented with withdrawal delirium, later on developed catatonia and then was diagnosed to have tubercular meningoencephalitis, a rare clinical sequence.

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

    OpenAIRE

    Caroff, Stanley N.; Hurford, Irene; Bleier, Henry R.; Gorton, Gregg E.; Campbell, E. Cabrina

    2015-01-01

    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, syn...

  3. Prolonged Delirium With Catatonia Following Orthotopic Liver Transplant Responsive to Memantine.

    Science.gov (United States)

    Brown, Gregory D; Muzyk, Andrew J; Preud'homme, Xavier A

    2016-03-01

    A 59-year-old man with nonalcoholic steatohepatitis cirrhosis underwent an orthotopic liver transplant and experienced a complicated postoperative course, including a prolonged delirium. After discharge to rehabilitation, he had 2 subsequent admissions for delirium. On the first readmission, the transplant team started the patient on risperidone and resumed treatment with sertraline. On his second readmission, neurology and psychiatry were consulted. On evaluation, the patient demonstrated signs of catatonia. On the basis of recommendations from psychiatry, the risperidone and sertraline were stopped, and the patient was started on mirtazapine. He failed to demonstrate improvement within the next 48 hours. Extensive work-up demonstrated a multifactorial etiology for his delirium, including calcineurin-related neuropsychiatric toxicity from tacrolimus leading to possible posterior reversible encephalopathy syndrome. However, after the initiation of memantine on hospital day 3-before the cessation of tacrolimus-the patient demonstrated marked improvement in mental status and motor symptoms. His magnetic resonance imaging, in addition to findings that raised concerns about posterior reversible encephalopathy syndrome, had demonstrated bilateral basal ganglia abnormalities on T1 imaging of uncertain origin. It is postulated that these findings served as predisposing factors for the patient's catatonic symptoms. Although it has been described in case reports following liver transplant, catatonia remains an underrecognized neuropsychiatric complication following liver transplant. This case demonstrates the effectiveness of memantine, an N-methyl-D-aspartic acid antagonist that decreases glutamine excitotoxicity, as a potential treatment for catatonia in postliver transplant patients. PMID:27138082

  4. Catatonia and jaw dislocation in the postoperative period with epidural morphine

    Directory of Open Access Journals (Sweden)

    Satyen Parida

    2011-01-01

    Full Text Available We report a case of temporomandibular joint dislocation occurring in the postoperative period in a patient, who developed catatonia following administration of a single dose of epidural morphine. The catatonic response to epidural morphine was delayed by several hours in the postoperative period, and might have resulted from intrathecal migration of the drug, through an initial dural puncture while locating the epidural space. The temporomandibular joint dislocation was diagnosed only after reversal of the effects of morphine with naloxone, when the patient complained of inability to fully close her mouth.

  5. Pernicious anemia presenting as catatonia: correlating vitamin B12 levels and catatonic symptoms.

    Science.gov (United States)

    Bram, Damien; Bubrovszky, Maxime; Durand, Jean-Paul; Lefevre, Guillaume; Morell-Dubois, Sandrine; Vaiva, Guillaume

    2015-01-01

    Pernicious anemia has been associated with various psychiatric manifestations, such as depression, mania and psychosis. Psychiatric symptoms can sometimes occur without hematological and neurological abnormalities and can be prodromal of vitamin B12 deficiency. We report a case of autoimmune B12 deficiency presenting as catatonia without signs of anemia or macrocytosis, in which a correlation was found between the patient's B12 blood levels and catatonic symptoms over time. This catatonic episode was successfully treated with only lorazepam and adequate doses of cyanocobalamin.

  6. Lorazepam, fluoxetine and packing therapy in an adolescent with pervasive developmental disorder and catatonia.

    Science.gov (United States)

    Consoli, Angèle; Gheorghiev, Charles; Jutard, Claire; Bodeau, Nicolas; Kloeckner, Anja; Pitron, Victor; Cohen, David; Bonnot, Olivier

    2010-12-01

    Packing therapy is an adjunct symptomatic treatment used for autism and/or catatonia. Here, we report the case of a 15-year-old boy with pervasive developmental disorder who developed catatonia. At admission, catatonic symptoms were severe and the patient required a feeding tube. Lorazepam up to 15 mg/day moderately improved the catatonic symptoms. On day 36 we added fluoxetine and on day 62 we added packing therapy (twice per week, 10 sessions). After three packing sessions, the patient showed a significant clinical improvement (Ppsychoanalysis and neuroscience. Indeed, better body representation following packing sessions, as shown in patient's drawing, paralleled clinical improvement, and supports the concept of embodied self. This concept may serve as a link between psychoanalysis and attachment theory, developmental psychology with the early description of "sense of self", and cognitive neurosciences that more and more support the concept of embodied cognition. Further clinical studies are necessary to clarify the efficacy and underlying mechanism of packing treatment and to understand how patient's experience may illustrate the concept of embodied self.

  7. Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review.

    Science.gov (United States)

    Bica, B E R G; Moro, A L D; Hax, V; Nicol, N A; Campos, G S; Rivera, L M S; da Costa, A F C; Xavier, R M; Monticielo, O A

    2015-10-01

    Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.

  8. Systematic mutation analysis of KIAA0767 and KIAA1646 in chromosome 22q-linked periodic catatonia

    Directory of Open Access Journals (Sweden)

    Gawlik Micha

    2005-10-01

    Full Text Available Abstract Background Periodic catatonia is a familial subtype of schizophrenia characterized by hyperkinetic and akinetic episodes, followed by a catatonic residual syndrome. The phenotype has been evaluated in two independent genome-wide linkage scans with evidence for a major locus on chromosome 15q15, and a second independent locus on chromosome 22qtel. Methods In the positional and brain-expressed candidate genes KIAA0767 and KIAA1646, we searched for variants in the complete exons and adjacent splice-junctions as well as in parts of the 5'- and 3'-untranslated regions by means of a systematic mutation screening in individuals from chromosome 22q-linked pedigrees. Results The mutation scan revealed 24 single nucleotide polymorphisms, among them two rare codon variants (KIAA0767: S159I; KIAA1646: V338G. However, both were neither found segregating with the disease in the respective pedigree nor found at a significant frequency in a case-control association sample. Conclusion Starting from linkage signals at chromosome22qtel in periodic catatonia, we screened two positional brain-expressed candidate genes for genetic variation. Our study excludes genetic variations in the coding and putative promoter regions of KIAA0767 and KIAA1646 as causative factors for periodic catatonia.

  9. Differences in the Treatment Response to Antithyroid Drugs versus Electroconvulsive Therapy in a Case of Recurrent Catatonia due to Graves’ Disease

    Directory of Open Access Journals (Sweden)

    Takahiro Saito

    2012-01-01

    Full Text Available We reported a case which presented recurrent episodes of catatonia as a result of Graves’ disease with hyperthyroidism. The patient showed different treatment response in each episodes; in the first episode, psychiatric and physical symptoms were resolved by a combination of antithyroid and anxiolytic therapies, while in the second episode, the combination therapy did not ameliorate her symptoms and ECT was indicated. We postulated that decreased CSF level of TTR and the resulting susceptibility to the derangement of peripheral thyroid function might be involved in this different treatment response.

  10. PANDAS with Catatonia: A Case Report

    Science.gov (United States)

    Elia, Josephine; Dell, Mary Lynn; Friedman, David F.; Zimmerman, Robert A.; Balamuth, Naomi; Ahmed, Asim A.; Pati, Susmita

    2005-01-01

    This is a report of an 11-year-old, prepubertal boy with acute-onset urinary urgency and frequency, obsessions and compulsions related to urination, severe mood lability, inattention, impulsivity, hyperactivity, and intermittent periods of immobilization. Fever, cough, otitis, and sinusitis preceded neuropsychiatric symptoms. Antistreptolysin O…

  11. Catatonia : Disappeared or under-diagnosed?

    NARCIS (Netherlands)

    Tuinier, S; Arts, NJM; Hoogendoorn, MLC; Kahn, RS; Verhoeven, WMA

    2005-01-01

    Background: Over the last century, especially during the latter half, the prevalence of the diagnosis of catatonic schizophrenia decreased considerably. Several explanations for this phenomenon have been put forward. Sampling and Methods: The present study investigated the frequency of the diagnosis

  12. Catatonia: an unusual manifestation of Wilson's disease.

    Science.gov (United States)

    Basu, Aniruddha; Thanapal, Sivakumar; Sood, Mamta; Khandelwal, Sudhir K

    2015-01-01

    Wilson's disease, characterized by abnormal copper accumulation in the human body, may present with psychiatric manifestations in about one-fifth of patients. The authors report a patient with Wilson's disease who initially presented with acute psychosis and later developed catatonic symptoms. The atypical presentation led to a delay in diagnosis and institution of appropriate treatment. Wilson's disease can be ruled out in all young patients presenting with psychiatric symptoms for the first time by screening for a Kayser-Fleischer ring.

  13. Resignation Syndrome: Catatonia? Culture-Bound?

    OpenAIRE

    Sallin, Karl; Lagercrantz, Hugo; Evers, Kathinka; Engström, Ingemar; Hjern, Anders; Petrovic, Predrag

    2016-01-01

    Resignation syndrome (RS) designates a long-standing disorder predominately affecting psychologically traumatized children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterized by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependen...

  14. 经前紧张有法消除%Food therapies for catatonia before menstruation

    Institute of Scientific and Technical Information of China (English)

    郭振东

    2008-01-01

    经前紧张症是妇女在月经来潮前出现的一种症状,多发生在生育期年龄的妇女。多数人在月经来潮前,没有不良反应。而少数人在月经前出现严重的反常现象,甚至影响工作和生活,有时很象某脏器发生病变一样。

  15. Unrecognized catatonia as a cause for delayed weaning in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Rupesh Gupta

    2015-01-01

    Full Text Available The cause of altered sensorium in critical care settings includes metabolic derangements, drug and toxin overdose, central nervous system infections, neurodegenerative disorders, vascular events, hypo-perfusion states, and septic encephalopathy. Here, we present a case of an elderly woman who presented to us with altered sensorium with respiratory failure requiring mechanical ventilation. Her metabolic parameters, imaging, and cerebrospinal fluid study were all normal despite that she continued to remain in altered sensorium and had an unrecognized behavioral state that delayed her weaning.

  16. Malignant catatonia due to anti-NMDA-receptor encephalitis in a 17-year-old girl: case report

    Directory of Open Access Journals (Sweden)

    Vidailhet Marie

    2011-05-01

    Full Text Available Abstract Anti-NMDA-Receptor encephalitis is a severe form of encephalitis that was recently identified in the context of acute neuropsychiatric presentation. Here, we describe the case of a 17-year-old girl referred for an acute mania with psychotic features and a clinical picture deteriorated to a catatonic state. Positive diagnosis of anti-NMDA-receptor encephalitis suggested specific treatment. She improved after plasma exchange and immunosuppressive therapy. Post-cognitive sequelae (memory impairment disappeared within 2-year follow-up and intensive cognitive rehabilitation.

  17. Catatonia, Neuroleptic Malignant Syndrome, and Cotard Syndrome in a 22-Year-Old Woman: A Case Report

    Directory of Open Access Journals (Sweden)

    C. Weiss

    2013-01-01

    Full Text Available The following case study describes a 22-year-old woman with depression and symptoms of psychosis who developed neuroleptic malignant syndrome after using Risperidone, thus requiring life support equipment and Bromocriptine, later recovering after seven days. From a psychiatric and neurological point of view, however, the persistence of catatonic syndrome and Cotard syndrome delusions was observed, based on assertions such as “I do not have a heart,” “my heart is not beating,” “I can not breathe,” “I am breaking apart,” “I have no head” (ideas of negation and statements about the patient being responsible for the “death of the whole world” (ideas of enormity. Brain NMR revealed leukoencephalopathy, interpreted as scar lesions caused by perinatal neurological damage, after discarding other pathologies. The patient responded well to electroconvulsive therapy after 11 sessions. Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed.

  18. Lithium as a rescue therapy for regression and catatonia features in two SHANK3 patients with autism spectrum disorder: case reports

    OpenAIRE

    Serret, Sylvie; Thümmler, Susanne; Dor, Emmanuelle; Vesperini, Stephanie; Santos, Andreia; Askenazy, Florence

    2015-01-01

    Background Phelan-Mc Dermid syndrome is a contiguous disorder resulting from 22q13.3 deletion implicating the SHANK3 gene. The typical phenotype includes neonatal hypotonia, moderate to severe intellectual disability, absent or delayed speech, minor dysmorphic features and autism or autistic-like behaviour. Recently, point mutations or micro-deletions of the SHANK3 gene have been identified, accompanied by a phenotype different from the initial clinically description in Phelan McDermid syndro...

  19. Prevalence of the catatonic syndrome in an acute inpatient sample

    OpenAIRE

    Mirella eStuivenga; Manuel eMorrens

    2014-01-01

    OBJECTIVE: In this exploratory open label study we investigated the prevalence of catatonia in an acute psychiatric inpatient population. In addition, differences in symptom presentation of catatonia depending on the underlying psychiatric illness were investigated.METHODS: 130 patients were assessed with the Bush-Francis Catatonia Rating Scale (BFCRS), the Positive and Negative Syndrome Scale (PANSS), the Young Mania Rating Scale (YMRS) and the Simpson-Angus Scale (SAS). A factor analysis wa...

  20. Malign katatoni, et neuropsykiatrisk syndrom

    DEFF Research Database (Denmark)

    Moltke, Katinka; Lublin, Henrik

    2010-01-01

    This case report describes a 36-year-old schizophrenic man who developed malignant catatonia during a hospital stay. He was treated with benzodiazepines (BZD) and 26 sessions of electroconvulsive therapy (ECT). After the therapy his condition normalised. Malignant catatonia is a rare condition...

  1. Organisk kataton tilstand efter apopleksi

    DEFF Research Database (Denmark)

    Jørgensen, Anders; Jørgensen, Martin Balslev

    2009-01-01

    , stereotyped movements and repetition of meaningless sounds. The condition responded to benzodiazepine and electroconvulsive therapy. Catatonia should be considered as a differential diagnosis when the described symptoms occur in patients with a known organic cerebral disorder. Udgivelsesdato: 2009-Aug...

  2. Parsing the components of the psychomotor syndrome in schizophrenia

    NARCIS (Netherlands)

    Docx, L.; Morrens, M.; Bervoets, C.; Hulstijn, W.; Hert, M. De; Baeken, C.; Audenaert, K.; Sabbe, B.G.C.C.

    2012-01-01

    Objective: Catatonia, extrapyramidal signs, psychomotor slowing, and (motoric) neurological soft signs are well-known psychomotor symptoms in schizophrenia. This study aims at investigating the interrelations between these symptoms. In addition, associations between psychomotor symptoms, clinical sy

  3. Pop & rock / Lauri Sommer

    Index Scriptorium Estoniae

    Sommer, Lauri, 1973-

    2001-01-01

    Heliplaatide Catatonia "Paper Scissors Stone", Khan "No Comprendo", Carlos Santana "Divine Light. Reconstrction & Mix: Bill Laswell", Carlos, Blink 182 "Take Off Your Jacket & Pants", Emmi "Solitary Movements", Neu "Neu!", "No Hidden Catch. Eesti Depeche Mode tribuut" tutvustused

  4. Brain Stimulation Therapies

    Science.gov (United States)

    ... case of suicide risk and catatonia, for example). ECT: Why it’s done ECT is most often used ... first week, and older individuals respond especially quickly. ECT: How it works Before ECT is administered, a ...

  5. Catatonic syndrome associated with lead intoxication: a case report

    OpenAIRE

    Modabbernia, Mohammad Jafar; Mirsafa, Ali Reza; Modabbernia, Amirhossein; Pilehroodi, Farhad; Shirazi, Maryam

    2009-01-01

    Introduction Little is known about catatonia associated with lead intoxication. Case presentation A retired printing house worker man presented with one week history of refusal to eat and mutism. He was treated with possible diagnosis of catatonia with administration of Lorazepam 3 mg P.O. daily. Significant improvement occurred after 48 hours. In further examinations, there was no evidence of physical and mental disorders while impairment in neuropsychiatry test, identification of Dohle body...

  6. Electroconvulsive therapy and anticoagulation after pulmonary embolism: a case report

    Directory of Open Access Journals (Sweden)

    Julio Cesar Lazaro

    2014-07-01

    Full Text Available Introduction Electroconvulsive therapy (ECT is considered the most effective treatment for catatonia regardless its underlying condition. The rigid fixed posture and immobility observed in catatonia may lead to several clinical complications, of which, pulmonary embolism (PE is one of the most severe. The rapid improvement of the psychiatric condition in catatonia-related PE is essential, since immobility favors the occurrence of new thromboembolic events and further complications. In that scenario, ECT should be considered, based on a risk-benefit analysis, aiming at the faster resolution of the catatonia. Methods Case report and literature review. Results A 66-years-old woman admitted to the psychiatric ward with catatonia due to a depressive episode presented bilateral PE. Clinically stable, but still severely depressed after a trial of antidepressants, she was treated with ECT in the course of full anticoagulation with enoxaparin. After five ECT sessions, her mood was significantly better and she was walking and eating spontaneously. She did not present complications related either to PE or to anticoagulation. After the eighth ECT session, she evolved with hypomania, which was managed with oral medication adjustments. The patient was completely euthymic at discharge. Conclusion The case we presented provides further evidence to the anecdotal case reports on the safety of ECT in the course of concomitant full anticoagulant therapy after PE, and illustrates how, with the proper precautions, the benefits of ECT in such condition might outweigh its risks.

  7. Cotard's syndrome: Two case reports and a brief review of literature.

    Science.gov (United States)

    Grover, Sandeep; Aneja, Jitender; Mahajan, Sonali; Varma, Sannidhya

    2014-11-01

    Cotard's syndrome is a rare neuropsychiatric condition in which the patient denies existence of one's own body to the extent of delusions of immortality. One of the consequences of Cotard's syndrome is self-starvation because of negation of existence of self. Although Cotard's syndrome has been reported to be associated with various organic conditions and other forms of psychopathology, it is less often reported to be seen in patients with catatonia. In this report we present two cases of Cotard's syndrome, both of whom had associated self-starvation and nutritional deficiencies and one of whom had associated catatonia. PMID:25540544

  8. Cotard′s syndrome: Two case reports and a brief review of literature

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2014-01-01

    Full Text Available Cotard′s syndrome is a rare neuropsychiatric condition in which the patient denies existence of one′s own body to the extent of delusions of immortality. One of the consequences of Cotard′s syndrome is self-starvation because of negation of existence of self. Although Cotard′s syndrome has been reported to be associated with various organic conditions and other forms of psychopathology, it is less often reported to be seen in patients with catatonia. In this report we present two cases of Cotard′s syndrome, both of whom had associated self-starvation and nutritional deficiencies and one of whom had associated catatonia.

  9. A Systematic Review of Interventions Used to Treat Catatonic Symptoms in People with Autistic Spectrum Disorders

    Science.gov (United States)

    DeJong, Hannah; Bunton, Penny; Hare, Dougal J.

    2014-01-01

    A systematic review was conducted to examine the efficacy of a range of treatments for autistic catatonia. The review identified 22 relevant papers, reporting a total of 28 cases including both adult and paediatric patients. Treatment methods included electroconvulsive therapy (ECT), medication, behavioural and sensory interventions. Quality…

  10. Transient Stuttering in Catatonic Bipolar Patients

    Directory of Open Access Journals (Sweden)

    Anthony B. Joseph

    1991-01-01

    Full Text Available Two cases of transient stuttering occurring in association with catatonia and bipolar disorder are described. Affective decompensation has been associated with lateralized cerebral dysfunction, and it is hypothesized that in some bipolar catatonic patients a concomitant disorder of the lateralization of language function may lead to a variety of clinical presentations including aphasia, mutism, and stuttering.

  11. Top-down modulation, emotion, and hallucination

    NARCIS (Netherlands)

    Aleman, A; Kahn, RS

    2002-01-01

    We argue that the pivotal role assigned by Northoff to the principle of top-down modulation in catatonia might successfully be applied to other symptoms of schizophrenia, for example, hallucinations. Second, we propose that Northoffs account would benefit from a more comprehensive analysis of the co

  12. Pop / Mart Juur

    Index Scriptorium Estoniae

    Juur, Mart, 1964-

    2002-01-01

    Heliplaatidest Kiss "The Very Best of Kiss". Andrew Lloyd Webber presents: "A R Rahman's Bombay Dreams". Naughty By Nature "Ilkons". Erinevad esinejad "One word one sound". Diana King "Respect". Caater "Club Space (Estonian Edition)". J.M.K.E. "Ainult planeet". Collage "Parimad lood 1970-1976". Cinematic Orchestra "Every Day". Catatonia "Greatest Hits". Boards of Canada "Geogaddi"

  13. Prevalence of the catatonic syndrome in an acute inpatient sample

    Directory of Open Access Journals (Sweden)

    Mirella eStuivenga

    2014-12-01

    Full Text Available OBJECTIVE: In this exploratory open label study we investigated the prevalence of catatonia in an acute psychiatric inpatient population. In addition, differences in symptom presentation of catatonia depending on the underlying psychiatric illness were investigated.METHODS: 130 patients were assessed with the Bush-Francis Catatonia Rating Scale (BFCRS, the Positive and Negative Syndrome Scale (PANSS, the Young Mania Rating Scale (YMRS and the Simpson-Angus Scale (SAS. A factor analysis was conducted in order to generate 6 catatonic symptom clusters. Composite scores based on this principal component analysis were calculated. RESULTS: When focusing on the first 14 items of the BFCRS, 101 patients (77.7% had at least 1 symptom scoring 1 or higher, whereas 66 patients (50.8% had at least 2 symptoms. Interestingly, when focusing on the DSM-5 criteria of catatonia, 22 patients (16.9% could be considered for this diagnosis. Furthermore, different symptom profiles were found, depending on the underlying psychopathology. Psychotic symptomatology correlated strongly with excitement symptomatology (r=.528,p<.001 and to a lesser degree with the stereotypy/mannerisms symptom cluster (r=.289; p=.001 and the echo/perseveration symptom cluster (r=.185;p=.035. Similarly, manic symptomatology correlated strongly with the excitement symptom cluster (r=.596;p<.001 and to a lesser extent with the stereotypy/mannerisms symptom cluster (r=.277;p=.001.CONCLUSION: There was a high prevalence of catatonic symptomatology. Depending on the criteria being used, we noticed an important difference in exact prevalence, which makes it clear that we need clear-cut criteria. Another important finding is the fact that the catatonic presentation may vary depending on the underlying pathology, although an unambiguous delineation between these catatonic presentations cannot be made. Future research is needed to determine diagnostical criteria of catatonia which are clinically

  14. Disturbed neural circuits in a subtype of chronic catatonic schizophrenia demonstrated by F-18-FDG-PET and F-18-DOPA-PET

    International Nuclear Information System (INIS)

    Permanent verbal, visual scenic and coenaestetic hallucinations are the most prominent psychopathological symptoms aside from psychomotor disorders in speech-sluggish catatonia, a subtype of chronic catatonic schizophrenia according to Karl Leonhard. These continuous hallucinations serve as an excellent paradigm for the investigation of the assumed functional disturbances of cortical circuits in schizophrenia. Data from positron emission tomography (F-18-FDG-PET and F-18-DOPA-PET) from three patients with this rare phenotype were available (two cases of simple speech-sluggish catatonia, one case of a combined speech-prompt/speech-sluggish subtype) and were compared with a control collective. During their permanent hallucinations, all catatonic patients showed a clear bitemporal hypometabolism in the F-18-FDG-PET. Both patients with the simple speech-sluggish catatonia showed an additional bilateral thalamic hypermetabolism and an additional bilateral hypometabolism of the frontal cortex, especially on the left side. In contrast, the patient with the combined speech-prompt/speech-sluggish catatonia showed a bilateral thalamic hypo-metabolism combined with a bifrontal cortical hypermetabolism. However, the left/right ratio of the frontal cortex also showed a lateralization effect with a clear relative hypometabolism of the left frontal cortex. The F-18-DOPA-PET of both schizophrenic patients with simple speech-sluggish catatonia showed a normal F-18-DOPA storage in the striatum, whereas in the right putamen of the patient with the combined form a higher right/left ratio in F-DOPA storage was discernible, indicating an additional lateralized influence of the dopaminergic system in this subtype of chronic catatonic schizophrenia. (author)

  15. Lorazepam provocation test in purported schizophrenia with lack of treatment response

    Directory of Open Access Journals (Sweden)

    John E. Berg

    2014-09-01

    Full Text Available Some patients with severe mental disorders are refractory to psychotherapeutic or psychopharmacological interventions. We present a patient who at the age of 19 developed several schizophrenia - suspect symptoms. Soon inexplicable general seizures where observed. He was treated with antipsychotics, but had two bouts of malignant neuroleptic syndrome. Electroconvulsive therapy (ECT gave some symptom relief and he continued on maintenance ECT for years with weekly intervals. Interruption of this treatment pattern rapidly increased symptom load. After seven years a lorazepam provocation test was performed as he had a new relapse after 3 weeks without ECT. In the ensuing hours his aggressiveness and nonsense speaking rapidly diminished. Kahlbaums observation of seizures as part of a catatonia was not understood in this case. The publication of the new DSM-V diagnosis of catatonia may hopefully reduce the probability of treating a patient for schizophrenia for years without access to a more targeted medication and ECT plan.

  16. A case of pervasive refusal syndrome: a diagnostic conundrum.

    LENUS (Irish Health Repository)

    McNicholas, Fiona

    2013-01-01

    A case is presented of an 11-year-old girl with pervasive refusal syndrome (PRS) who ultimately recovered acutely and completely after an 18-month paediatric hospitalisation. There was an apparent absence of previously proposed important aetiological factors in PRS, such as family pathology and markedly traumatic or abusive experiences, and her recovery was sudden and complete. The authors consider the differential diagnoses of PRS paying particular attention to the possibility of a conversion disorder or catatonia, given the absence of PRS in the North American literature. Consideration of catatonia is important as it has a diagnostic test and responds rapidly to appropriate treatment, in contrast to conventional treatment for PRS and conversion disorder.

  17. Maurycy Urstein: forgotten Polish contributor to German psychiatry

    OpenAIRE

    Marcinowski, Filip

    2014-01-01

    Polish psychiatrist Maurycy Urstein (1872–1940) is nowadays almost forgotten. He is not mentioned in the history of Polish psychiatry which only partially may be explained by the fact that his most essential works were published in German language. His scientific oeuvre contains dozens of publications, including four monographs on catatonia. Urstein was an ardent advocate of the autointoxication theory of psychiatric disorders, fierce opponent of psychoanalysis and enthusiast of the use of bi...

  18. Alteration in the level of endogenous hypothalamic prostaglandins induced by delta 9-tetrahydrocannabinol in the rat.

    OpenAIRE

    Coupar, I M; Taylor, D A

    1982-01-01

    1 Whole brain and regional brain levels of prostaglandin E2 (PGE2)-like material have been determined following administration of delta 9-tetrahydrocannabinol (delta 9 -THC) in rats. 2 Intravenous administration of delta 9-THC 2 mg/kg, resulted in marked behavioural changes and hypothermia. The behavioural changes consisted mainly of catatonia (most apparent at 30 min after administration of delta 9-THC), followed by sedation (most evident at 60 min). Hypothermia was marked from 30 min after ...

  19. [Onset and course of schizophrenia (the results of a statistical study)].

    Science.gov (United States)

    Angst, J; Baastrup, P C; Grof, P; Hippius, H; Peldinger, V

    1975-01-01

    The report contains the results of an examination of 709 patients with catatonia, paranoid, schizoaffective forms of schizophrenia. The study involved an investigation of the form, sex, general amount of psychotic episodes depending upon the time of observation, duration of productive episodes and the intervals between them. The achieved results indicate to a close correlation between the productive manifestations in schixophrenia and affective psychosis. PMID:1179895

  20. Anti-NMDA receptor encephalitis: an important differential diagnosis in psychosis.

    LENUS (Irish Health Repository)

    Barry, Helen

    2012-02-01

    We present four cases of confirmed anti-NMDA receptor encephalitis; three presented initially with serious psychiatric symptoms and the other developed significant psychiatric symptoms during the initial phase of illness. Brain biopsy findings of one patient are also described. Psychiatrists should consider anti-NMDA receptor encephalitis in patients presenting with psychosis and additional features of dyskinesias, seizures and catatonia, particularly where there is no previous history of psychiatric disorder.

  1. Introduction of a Venous Thromboembolism Prophylaxis Protocol for Older Adult Psychiatric Patients.

    OpenAIRE

    Croxford, Anna; Clare, Adam; McCurdy, Kathleen

    2015-01-01

    Hospital-Acquired venous thromboembolism (VTE) is a common cause of morbidity and mortality in older adults. In psychiatric patients these risks are increased due to multiple factors including poor mobility, restraint, catatonia, sedation, and conventional antipsychotic use. Diagnosis and treatment of psychiatric patients presenting with signs and symptoms of a VTE can be delayed due to a patient's communication difficulties, non-compliance, or attribution of symptoms to a psychosomatic cause...

  2. Is quetiapine suitable for treatment of acute schizophrenia with catatonic stupor? A case series of 39 patients

    Directory of Open Access Journals (Sweden)

    Yoshimura B

    2013-10-01

    Full Text Available Bunta Yoshimura,1,2 Tomoya Hirota,3 Manabu Takaki,2 Yoshiki Kishi,11Department of Psychiatry, Okayama Psychiatric Medical Center, 2Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; 3Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USAPurpose: We aimed to determine which antipsychotic is most effective for the treatment of acute schizophrenia with catatonic stupor.Patients and methods: Data were obtained from the medical records of 450 patients with the diagnosis of schizophrenia, who had received acute psychiatric inpatient treatment between January 2008 and December 2010 at our hospital. Among them, 39 patients (8.7% met the definition of catatonic stupor during hospitalization. The diagnoses of schizophrenia in all 39 patients were reconfirmed during the maintenance phase. We retrospectively reviewed the medical records of these 39 patients to investigate which antipsychotics were chosen for treatment during the period from admission to recovery from catatonia, at the time of discharge, and 12 and 30 months after discharge.Results: As compared to other antipsychotics, it was found out that use of quetiapine had better outcomes and hence was used more often. A total of 61.5% of patients were on quetiapine at the time of recovery from catatonia and 51.3% of patients were on quetiapine at the time of discharge as compared to only 17.9% of patients on quetiapine on admission. However, at 12 and 30 months after discharge, the rates had decreased to 38.4% and 25.6%. Similarly, of 29 patients who were not administered electroconvulsive therapy, quetiapine was used at significantly higher rates at the time of recovery from catatonia (48.3% than at the time of admission (17.2%. All 39 patients had received an antipsychotic as the first-line treatment and some antipsychotics might have contributed to the development of catatonia

  3. Maurycy Urstein: forgotten Polish contributor to German psychiatry

    Directory of Open Access Journals (Sweden)

    Marcinowski, Filip

    2014-02-01

    Full Text Available Polish psychiatrist Maurycy Urstein (1872–1940 is nowadays almost forgotten. He is not mentioned in the history of Polish psychiatry which only partially may be explained by the fact that his most essential works were published in German language. His scientific oeuvre contains dozens of publications, including four monographs on catatonia. Urstein was an ardent advocate of the autointoxication theory of psychiatric disorders, fierce opponent of psychoanalysis and enthusiast of the use of biological methods of treatment in psychiatry. Both some eccentric views and specific personality probably equally contributed to his almost complete isolation among psychiatrists in the interwar Poland.

  4. The catatonic dilemma expanded

    Directory of Open Access Journals (Sweden)

    Weder Natalie

    2006-09-01

    Full Text Available Abstract Catatonia is a common syndrome that was first described in the literature by Karl Kahlbaum in 1874. The literature is still developing and remains unclear on many issues, especially classification, diagnosis, and pathophysiology. Clinicians caring for psychiatric patients with catatonic syndromes continue to face many dilemmas in diagnosis and treatment. We discuss many of the common problems encountered in the care of a catatonic patient, and discuss each problem with a review of the literature. Focus is on practical aspects of classification, epidemiology, differential diagnosis, treatment, medical comorbidity, cognition, emotion, prognosis, and areas for future research in catatonic syndromes.

  5. Augmentative Asenapine in a Recurrent Manic Catatonic Patient with Partial Response to Clozapine

    Directory of Open Access Journals (Sweden)

    Massimiliano Buoli

    2013-01-01

    Full Text Available Catatonia is a severe but treatable neuropsychiatric syndrome known since the middle of the nineteenth century. It has been considered for a long time as a subtype of schizophrenia, even though this association occurs only in 10% of cases. In contrast, it is frequently observed in bipolar patients. First-line treatment consists of benzodiazepines, while in case of resistance electroconvulsive therapy (ECT and clozapine have shown positive results. In addition, recent studies reported the efficacy of some atypical antipsychotics. The present case shows the clinical response to augmentative asenapine in a catatonic manic patient with a partial response to clozapine.

  6. Electroconvulsive Therapy and Corpus Callosum Aplasia: A 3-Year Followup

    Directory of Open Access Journals (Sweden)

    Ulrich Palm

    2011-01-01

    Full Text Available Electroconvulsive Therapy (ECT is a powerful treatment option in severe or chronic catatonic states and has been reported to be useful in oligophrenic patients. We report the followup medical history of a patient with corpus callosum aplasia (or agenesis who was continuously treated with ECT over three years. First, he improved considerably after a series of ECT, but relapses of catatonia made a continuous, weekly ECT necessary. Due to the severity of the brain malformation, an add-on medication with benzodiazepines and second generation antipsychotics was necessary to treat catatonic symptoms. This case emphasises the benefits of long-term ECT in oligophrenic patients.

  7. Singlid.File under : White American Rock : Sound / Märt Milter

    Index Scriptorium Estoniae

    Milter, Märt

    1998-01-01

    Uutest singlitest : Urban Species "Woman", Cesaria Evora "Sangue De Beirona (remix de Francois K)", Catatonia "Strange Glue", Chris Isaak "Please", Echobeatz "Mas Que Nada", Morcheeba "Blindfold", Chris Rea "Sweet Summer Day", 187 Lockdown "The Don", Bebe Winars "Stay/Thank You", Embrace "My Weakness Is None Of Your Business", Goo Goo Dolls "Iris" ja ameerika popi plaatidest Better Than Ezra "How Does Your Garden Grow?", Barenaked Ladies "Stunt", The Uninvited "The Uninvited, Lilys "Better Can't Make Your Life Better", CIV "Civ", Hootie & The Blowfish "Musical Chairs"

  8. [Maurycy Urstein: forgotten Polish contributor to German psychiatry].

    Science.gov (United States)

    Marcinowski, Filip

    2014-01-01

    Polish psychiatrist Maurycy Urstein (1872-1940) is nowadays almost forgotten. He is not mentioned in the history of Polish psychiatry which only partially may be explained by the fact that his most essential works were published in German language. His scientific oeuvre contains dozens of publications, including four monographs on catatonia. Urstein was an ardent advocate of the autointoxication theory of psychiatric disorders, fierce opponent of psychoanalysis and enthusiast of the use of biological methods of treatment in psychiatry. Both some eccentric views and specific personality probably equally contributed to his almost complete isolation among psychiatrists in the interwar Poland.

  9. Clinical analysis of safety and effectiveness of electroconvulsive therapy [Analiza kliniczna skuteczności i bezpieczeństwa leczenia elektrowstrząsowego

    Directory of Open Access Journals (Sweden)

    Dąbrowski, Marek

    2012-06-01

    Full Text Available Aim. The aim of the study was to assess efficacy and safety of electroconvulsive therapy. Methods. 43 patients included into the study were hospitalised in The Institute of Psychiatry and Neurology and received all together over 400 bilateral electroconvulsive procedures. Most of the patients (N=25 were qualified for electroconvulsive therapy due to treatment resistant depression (58.1%. Six patients: 2 with catatonia and 4 with depression had life saving indications for electroconvulsive therapy. Three patients (7% were excluded from electroconvulsive therapy, following 1 or 2 electroconvulsive procedures. Forty patients continued electroconvulsive therapy. Results. There were no complications and serious adverse events in patients who continued electroconvulsive therapy. Generally, electroconvulsive therapy was well tolerated and treatment had been cut down in only one case due to adverse events and high risk related to the procedure. Transient cardiac arrhythmias (10% of patients were the most often occurring adverse events and patients (35% mostly reported headaches. We observed remission in 22 patients (58% and improvement in 14 patients (35% following electroconvulsive treatment. Only 4 patients (10% had no benefit after a series of electroconvulsive procedures. Electroconvulsive treatment was most effective in patients with catatonia (80% patients had full recovery and in depressive patients with bipolar disorder (73% patients had full recovery. Conclusion. Electroconvulsive procedures were safe and effective. Electroconvulsive treatment was most effective in catatonic patients with schizophrenia and in depressive patients with bipolar disorder.

  10. Rapid response of long-standing, treatment-resistant non-catatonic mutism in paranoid schizophrenia with single ECT session

    Directory of Open Access Journals (Sweden)

    Mansoor Ahmad Dar

    2014-01-01

    Full Text Available Context: Mutism is a common manifestation of catatonia, but mutism due to other forms of psychopathology and neurological disorders have also been described. Although not common, long-standing mutism has also been a feature of non-catatonic schizophrenia and traditionally responds less to conventional therapies. Case Report: We describe a rare case of paranoid schizophrenia presenting with continuous mutism for about 4 years. This 26-year-old male had symptoms of schizophrenia without catatonia. After failed trial of adequate pharmacotherapy and psychological intervention and considering his level of dysfunction, he was started on electroconvulsive therapy (ECT. To our surprise, he improved with a single session of ECT while he was on concurrent pharmacotherapy. We also discuss the possible explanation for this rapid effect of ECT in such clinical presentation. To our knowledge, this is the first case of non-catatonic mutism of schizophrenia of this long duration responding so promptly to ECT, although there are other reports as well in literature, but multiple ECT sessions were applied in those cases. Conclusion: Non-catatonic mutism is perhaps presenting as a cultural variant in this part of the world and whenever encountered, ECT should be an option. Further research should be carried out to validate this idea.

  11. Photovoltaic solar energy like an alternative in the urban spaces; La energia solar fotovoltaica como una alternativa en los espacios urbanos

    Energy Technology Data Exchange (ETDEWEB)

    Bosque, G. S.; Domingo, M. N.; Puig, J.

    2008-07-01

    The present report is a study about the possibility and viability of installing photovoltaic panels at the roof of neighbourhood buildings in the Districte de l'Eixmple of Barcelona. Its purpose is to raise awareness among the population about the actual problem of climate change, having the cities as a key element to encourage energy saving and reducing emissions of carbon dioxide (CO{sub 2}). The results show and approximate value of surface and power needed to satisfy the household energy consumption for the inhabitants in Barcelona and Catatonia with solar energy. The results also show a comparative in the Districte de l'Eixample in its three main dimensions: socio-economic, environmental and politic. (Author)

  12. Electroconvulsive Therapy: A Current Review

    Directory of Open Access Journals (Sweden)

    Gokben Hizli Sayar

    2014-06-01

    Full Text Available Most of the electroconvulsive therapy guidelines state that severe major depression with psychotic features, manic delirium, or catatonia are conditions where there is a clear consensus favoring early electroconvulsive therapy. The decision to administer electroconvulsive therapy is based on an evaluation of the risks and benefits for the individual patient and involves a combination of factors, including psychiatric diagnosis, type and severity of symptoms, prior treatment history and response, identification of possible alternative treatment options, and consumer preference. In this review history, mechanisms of action, side effects that have been referenced in the literature and clinical experience are discussed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 107-125

  13. Atypical neuroleptic malignant syndrome. “Doing more harm than gain”

    Directory of Open Access Journals (Sweden)

    Khalid Javid Bhat

    2013-08-01

    Full Text Available Neuroleptic malignant syndrome (NMS a rare, idiosyncratic, and potentially fatal adverse reaction can be deceptive especially when the hallmark features are lacking. Most diagnostic criteria include fever and muscle rigidity, although NMS may present without either. Delirium, agitation and catatonia can be the earliest features of NMS and in acute care settings, concomitant use of sedatives and anti-psychotics by the attending clinicians may even obscure the sentinel signs of NMS and further aggravate the underlying insult. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment and the strict adherence to the classical criteria of NMS may lead to a diagnostic delay and dire consequences for these patients and sometimes this delay can procure death. [Int J Res Med Sci 2013; 1(4.000: 601-603

  14. Osseous metaplasia in gliosarcoma: an unusual histologic finding. Case report

    Directory of Open Access Journals (Sweden)

    Eduardo Cambruzzi

    2014-04-01

    Full Text Available Gliosarcoma (GS is a malignant neoplasm of the central nervous system that has coexisting glial and mesenchymal components. GSs are rarely related to osseous metaplasia. The authors report a case of GS in a male patient presenting apathy and catatonia. Computed tomography/magnetic resonance imaging showed an expansive process affecting the left frontal lobe. At microscopy, a malignant glioma constituted by highly atypical glial cells intermingled with spindle-shaped cells was identified. The lesion showed areas of necrosis with pseudopalisading formation, focus of osseous metaplasia, and positive immunoexpression of S100, CD99 and vimentin in both elements. Only the sarcomatous component exhibited negative immunoexpression of glial fibrillary acidic protein (GFAP. The diagnosis of GS was then established.

  15. Atypical Creutzfeldt-Jakob Disease Evolution after Electroconvulsive Therapy for Catatonic Depression

    Directory of Open Access Journals (Sweden)

    Iria Grande

    2011-01-01

    Full Text Available We describe a case report of an 80-year-old woman who presented with symptomatology compatible with an episode of major depression with catatonia. After psychiatric admission, electroconvulsive therapy (ECT was applied, but symptoms progressed with cognitive impairment, bradykinesia, widespread stiffness, postural tremor, and gait disturbance. After compatible magnetic resonance imaging (MRI, diffusion changes, and electroencephalogram (EEG findings the case was reoriented to Creutzfeldt-Jakob disease (CJD. The genetic study found a methionine/valine heterozygosity at codon 129 of the prion protein gene PrPSc. On followup, a significant clinical recovery turned out. For this reason, EEG and MRI were repeated and confirmed the findings. The patient subsequently demonstrated progressive clinical deterioration and died 21 months later. The diagnosis was verified postmortem by neuropathology. The vCJD subtype MV2 is indeed characterized by early and prominent psychiatric symptoms and a prolonged disease duration however no frank clinical recovery has before been reported.

  16. A subtle mimicker in emergency department

    Science.gov (United States)

    Angelis, Maria Vittoria De; Giacomo, Roberta Di; Muzio, Antonio Di; Onofrj, Marco; Bonanni, Laura

    2016-01-01

    Abstract Background: Movement disorder emergencies include any movement disorder which develops over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality. Movement disorder emergencies include acute dystonia: sustained or intermittent muscle contractions causing abnormal, often repetitive, movements. Acute dystonia is a serious challenge for emergency room doctors and neurologists, because of the high probability of misdiagnosis, due to the presence of several mimickers including partial seizures, meningitis, localized tetanus, serum electrolyte level abnormalities, strychnine poisoning, angioedema, malingering, catatonia, and conversion. Methods: We describe 2 examples, accompanied by videos, of acute drug-induced oro-mandibular dystonia, both subsequent to occasional haloperidol intake. Results: Management and treatment of this movement disorder are often difficult: neuroleptics withdrawal, treatment with benzodiazepines, and anticholinergics are recommended. Conclusion: Alternative treatment options are also discussed. PMID:27741141

  17. Treatment of refractory catatonic schizophrenia with low dose aripiprazole

    Directory of Open Access Journals (Sweden)

    Sasaki Tsuyoshi

    2012-05-01

    Full Text Available Abstract This case is of 54-year-old female with catatonic schizophrenia, characterized by treatment resistance to the pharmacotherapy with olanzapine, risperidone, flunitrazepam, and ECT. Olanzapine and risperidone and flunitrazepam did not improve her catatonic and psychotic symptoms, and induced the extrapyramidal symptoms. The effects of ECT did not continue even for a month. However, the treatment with low-dose aripiprazole dramatically improved the patient’s psychotic symptoms and extrapyramidal symptoms. The mechanisms underlying the effects of low-dose aripiprazole in this case remain unclear, but unlike other antipsychotics, aripiprazole is a dopamine D2 partial agonist. In this regard, our results suggest that aripiprazole has numerous advantages, especially in cases of stuporous catatonia and a defective general status.

  18. [Movement disorders is psychiatric diseases].

    Science.gov (United States)

    Hidasi, Zoltan; Salacz, Pal; Csibri, Eva

    2014-12-01

    Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases. PMID:25577484

  19. Estimulação magnética transcraniana na esquizofrenia Transcranial magnetic stimulation (TMS in schizophrenia

    Directory of Open Access Journals (Sweden)

    Marina Odebrecht

    2004-01-01

    Full Text Available A estimulação magnética transcraniana (EMT é uma nova técnica capaz de estimular o cérebro através de um método indolor, não-invasivo e simples de ser aplicado. A utilização da EMT em pacientes com esquizofrenia tem sido alvo de alguns estudos. Neste artigo é feita uma revisão destes estudos. Inicialmente é feita uma breve descrição dos fundamentos fisiopatológicos que explicariam a sua eficácia e o seu possível mecanismo de ação. A seguir, são analisados os primeiros estudos não controlados e, depois, os estudos sobre os efeitos em sintomas positivos, sintomas negativos e na catatonia. O número de pesquisas neste assunto é crescente, mas a utilização da EMT ainda está no início e é muito cedo para ser usada na prática clínica diária.Transcranial magnetic stimulation (TMS is a new technique capable of stimulating the brain through a painless, non-invasive and simple method. Its use in patients with schizophrenia has been the target of some studies. This article reviews these studies. Initially a brief discussion is offered about phisiopathologic basis that could explain its efficacy and its possible mechanism of action. The first open studies are analysed and, at last, studies about effects on positive and negative symptoms and catatonia are discussed. Research in this field is growing, although the use of TMS is in its beginning and it is early to draw any conclusions about its practical use on daily practice.

  20. Electroconvulsive therapy and/or plasmapheresis in autoimmune encephalitis?

    Science.gov (United States)

    Gough, Jessica L; Coebergh, Jan; Chandra, Brunda; Nilforooshan, Ramin

    2016-01-01

    Autoimmune encephalitis is a poorly understood condition that can present with a combination of neurological and psychiatric symptoms, either of which may predominate. There are many autoantibodies associated with a variety of clinical syndromes - anti-N-Methyl-D-Aspartate receptor (NMDAR) is the commonest. Currently, the most widely used therapy is prompt plasmapheresis and steroid treatment (and tumour resection if indicated), followed by second line immunosuppression if this fails. Given the growing awareness of autoimmune encephalitis as an entity, it is increasingly important that we consider it as a potential diagnosis in order to provide timely, effective treatment. We discuss several previously published case reports and one new case. These reports examined the effects of electroconvulsive therapy (ECT) on patients with autoimmune encephalitis, particularly those in whom psychiatric symptoms are especially debilitating and refractory to standard treatment. We also discuss factors predicting good outcome and possible mechanisms by which ECT may be effective. Numerous cases, such as those presented by Wingfield, Tsutsui, Florance, Sansing, Braakman and Matsumoto, demonstrate effective use of ECT in anti-NMDAR encephalitis patients with severe psychiatric symptoms such as catatonia, psychosis, narcolepsy and stupor who had failed to respond to standard treatments alone. We also present a new case of a 71-year-old female who presented to a psychiatric unit initially with depression, which escalated to catatonia, delusions, nihilism and auditory hallucinations. After anti-NMDAR antibodies were isolated, she was treated by the neurology team with plasmapheresis and steroids, with a partial response. She received multiple sessions of ECT and her psychiatric symptoms completely resolved and she returned to her premorbid state. For this reason, we suggest that ECT should be considered, particularly in those patients who are non-responders to standard therapies. PMID

  1. Electroconvulsive therapy and/or plasmapheresis in autoimmune encephalitis?

    Science.gov (United States)

    Gough, Jessica L; Coebergh, Jan; Chandra, Brunda; Nilforooshan, Ramin

    2016-08-16

    Autoimmune encephalitis is a poorly understood condition that can present with a combination of neurological and psychiatric symptoms, either of which may predominate. There are many autoantibodies associated with a variety of clinical syndromes - anti-N-Methyl-D-Aspartate receptor (NMDAR) is the commonest. Currently, the most widely used therapy is prompt plasmapheresis and steroid treatment (and tumour resection if indicated), followed by second line immunosuppression if this fails. Given the growing awareness of autoimmune encephalitis as an entity, it is increasingly important that we consider it as a potential diagnosis in order to provide timely, effective treatment. We discuss several previously published case reports and one new case. These reports examined the effects of electroconvulsive therapy (ECT) on patients with autoimmune encephalitis, particularly those in whom psychiatric symptoms are especially debilitating and refractory to standard treatment. We also discuss factors predicting good outcome and possible mechanisms by which ECT may be effective. Numerous cases, such as those presented by Wingfield, Tsutsui, Florance, Sansing, Braakman and Matsumoto, demonstrate effective use of ECT in anti-NMDAR encephalitis patients with severe psychiatric symptoms such as catatonia, psychosis, narcolepsy and stupor who had failed to respond to standard treatments alone. We also present a new case of a 71-year-old female who presented to a psychiatric unit initially with depression, which escalated to catatonia, delusions, nihilism and auditory hallucinations. After anti-NMDAR antibodies were isolated, she was treated by the neurology team with plasmapheresis and steroids, with a partial response. She received multiple sessions of ECT and her psychiatric symptoms completely resolved and she returned to her premorbid state. For this reason, we suggest that ECT should be considered, particularly in those patients who are non-responders to standard therapies. PMID

  2. Síndrome de Cotard asociado a Trastorno Depresivo Mayor con síntomas catatónicos. Informe de caso / Cotard Syndrome Associated to Major Depressive Disorder with Catatonic Symptoms. Case report / Síndrome de Cotard associada ao transtorno depressivo maior com sintomas catatônicos. Relato de caso

    Directory of Open Access Journals (Sweden)

    Daniel Mauricio Torrado-Arenas

    2015-07-01

    Full Text Available Introduction: Catatonia is a neuropsychiatric syndrome with abnormal postures, mutism and stupor. Colombia has a prevalence of 11.4% of psychiatric patients. Objective: To discuss the clinical curse of a 34-year-old woman with major depressive disorder that presents to emergency department with nihilistic delirium and catatonic symptoms. Case presentation: A young woman with history of unipolar major depression with psychotic features was hospitalized nine months ago. She was medicated with a pharmacological treatment she did not remember. At admission, the patient had three days of bizarre behavior, mutism and negativism. Paraclinics and brain computer tomography did not report any abnormality or changes. Treatment began with benzodiazepine, which achieved full remission of catatonic symptoms. After this, she developed anhedonia, sadness and nihilistic delusions and was considered as a relapse of a previous depressive episode from nine months ago, associated with Cotard’s syndrome. Sertraline was added with gradual increase to 100mg and 5mg of olanzapine, getting a complete remission of psychotic and mood symptoms. Discussion: Affective disorders are most common cause of catatonia. There has already been a history of similar reports, but in few times these three entities were associated; this is the first case reported in Hospital Universitario de Santander, with informed consent. Conclusions: It is unusual for a depressed patient to present denial delusions and catatonic symptoms simultaneously; therefore this case is unusual and may contribute to literature. The catatonic symptoms make it difficult to explore other mental spheres, though they may be secondary to a medical condition, therefore, it is essential to dismiss organic pathologies and give initial treatment, so we can discover the underlying etiopsychopathology. [Torrado-Arenas DM, Santos-Gutiérrez KE, Ruiz-Higuera SM, Zabala-Arias LM, Niño-García JA. Síndrome de Cotard

  3. On the clinical impact of cerebral dopamine D2 receptor scintigraphy

    International Nuclear Information System (INIS)

    The present review describes findings and clinical indications for the dopamine D2 receptor scintigraphy. Methods for the examination of D2 receptors are positron emission tomography (PET) using 11C- or 18F-labelled butyrophenones or benzamides or single photon emission tomography (SPECT) using 123I-iodobenzamide (IBZM) respectively. The most important indication in neurology is the differential diagnosis of Parkinsonism: Patients with early Parkinson's disease show an increased D2 receptor binding (D2-RB) compared to control subjects. However, patients suffering from Steele-Richardson-Olszewski-Syndrome or Multiple System Atrophy show a decreased D2-RB and are generally non-responsive to treatment. Postsynaptic blockade of D2 receptors results in a drug induced Parkinsonian syndrome, which can be diagnosed by D2 scintigraphy. Further possible indications occur in psychiatry: The assessment of receptor occupancy is useful in schizophrenic patients treated with neuroleptics. Additionally, D2 receptor scintigraphy might help to clarify the differential diagnosis between neuroleptic malignant syndrome and lethal catatonia. The method might be useful for supervising neurobiochemical changes in drug dependency and during withdrawal. Assessment of dopamine D2 receptor binding can simplify the choice of therapy in depressive disorder: Patients showing a low D2 binding are likely to improve following an antidepressive drug treatment whereas sleep deprivation is promising in patients with high D2 binding. (orig.)

  4. How does our brain constitute defense mechanisms? First-person neuroscience and psychoanalysis.

    Science.gov (United States)

    Northoff, Georg; Bermpohl, Felix; Schoeneich, Frank; Boeker, Heinz

    2007-01-01

    Current progress in the cognitive and affective neurosciences is constantly influencing the development of psychoanalytic theory and practice. However, despite the emerging dialogue between neuroscience and psychoanalysis, the neuronal processes underlying psychoanalytic constructs such as defense mechanisms remain unclear. One of the main problems in investigating the psychodynamic-neuronal relationship consists in systematically linking the individual contents of first-person subjective experience to third-person observation of neuronal states. We therefore introduced an appropriate methodological strategy, 'first-person neuroscience', which aims at developing methods for systematically linking first- and third-person data. The utility of first-person neuroscience can be demonstrated by the example of the defense mechanism of sensorimotor regression as paradigmatically observed in catatonia. Combined psychodynamic and imaging studies suggest that sensorimotor regression might be associated with dysfunction in the neural network including the orbitofrontal, the medial prefrontal and the premotor cortices. In general sensorimotor regression and other defense mechanisms are psychoanalytic constructs that are hypothesized to be complex emotional-cognitive constellations. In this paper we suggest that specific functional mechanisms which integrate neuronal activity across several brain regions (i.e. neuronal integration) are the physiological substrates of defense mechanisms. We conclude that first-person neuroscience could be an appropriate methodological strategy for opening the door to a better understanding of the neuronal processes of defense mechanisms and their modulation in psychoanalytic psychotherapy. PMID:17426413

  5. Electroconvulsive Therapy In Neuropsychiatry : Relevance Of Seizure Parameters

    Directory of Open Access Journals (Sweden)

    Gangadhar BN

    2000-01-01

    Full Text Available Electroconvulsive therapy (ECT is used to induce therapeutic seizures in various clinical conditions. It is specifically useful in depression, catatonia, patients with high suicidal risk, and those intolerant to drugs. Its beneficial effects surpass its side effects. Memory impairment is benign and transient. Its mechanism of action is unknown, though numerous neurotransmitters and neuroreceptors have been implicated. The standards of ECT practice are well established but still evolving in some particularly in unilateral ECT. Assessment of threshold by formula method may deliver higher stimulus dose compared with titration method. Cerebral seizure during ECT procedure is necessary. Motor (cuff method and EEG seizure monitoring are mandatory. Recent studies have shown some EEG parameters (amplitude, fractal dimension, symmetry, and post ictal suppression to be associated with therapeutic outcome. Besides seizure monitoring, measuring other physiological parameters such as heart rate (HR and blood pressure (BP may be useful indicators of therapeutic response. Use of ECT in neurological conditions as well as its application in psychiatric illnesses associated with neurological disorders has also been reviewed briefly.

  6. Catatonía, a propósito de un caso.

    Directory of Open Access Journals (Sweden)

    Nora Olazabal Eizaguirre

    2011-01-01

    Full Text Available Presentamos un cuadro clínico de mutismo, acinesia y estupor con fiebre y retención urinaria en una mujer de 65 años como ejemplo de catatonia. La sintomatología catatónica se ha establecido como un síndrome común a múltiples etiologías tanto médicas como psiquiátricas. Además se han descrito factores precipitantes de tipo farmacológico, tóxico y orgánico para esta entidad. Por tanto, es necesaria una aproximación multidisciplinar a este tipo de cuadros para afinar el diagnóstico etiológico. Varios autores apuntan a un infradiagnóstico de este síndrome. Durante la evaluación, diagnóstico y tratamiento de esta paciente, hallamos la necesidad de criterios diagnósticos claros y actualizados y de algoritmos de tratamiento basados en evidencias. Las benzodiazepinas y la terapia electroconvulsiva suponen el tratamiento de primera línea, junto con las medidas de soporte y la prevención de complicaciones. Se han publicado otras estrategias no protocolizadas de tratamiento alternativas en casos refractarios.

  7. Deep venous thrombosis and pulmonary embolism in psychiatric settings

    Directory of Open Access Journals (Sweden)

    Els G. Van Neste

    2009-03-01

    Full Text Available Background and objectives: Deep venous thrombosis and pulmonary embolism are serious, possibly life-threatening events which are often ignored in psychiatric settings. This article investigates which psychiatric patients are at increased risk of developing a venous thromboembolism. To our knowledge we are the first to perform a literature review of clinical studies relating venous thrombosis and pulmonary embolism to psychotropic drugs and mental disorders. Methods: A Medline search for English studies using the appropriate search terms was performed. In addition, cross references of the relevant articles` literature references were considered. We withheld 12 observational studies, 29 case-reports and one review-article. Results: We found evidence that low potency antipsychotic drugs like chlorpromazine and thioridazine, and clozapine for treatment of resistant schizophrenia have an increased risk of venous thromboembolism. There is no evidence that antidepressants, benzodiazepines or mood stabilizers have a similar effect. Also psychiatric conditions like physical restraint, catatonia and neuroleptic malignant syndrome are related to a higher incidence of deep venous thrombosis. Conclusions: Limitations of the studies and hypotheses about underlying biological mechanisms are reviewed. The rationale for prophylactic measures is discussed and recommendations to prevent deep venous thrombosis and pulmonary embolism are given.

  8. Stereotypic Movements in Case of Sporadic Creutzfeldt-Jakob Disease: Possible Role of Anti-NMDA Receptor Antibodies

    Directory of Open Access Journals (Sweden)

    Michelle Molina

    2012-12-01

    Full Text Available Sporadic Creutzfeldt-Jakob disease (sCJD and anti-NMDA receptor antibody encephalitis (NMDAE can both produce a rapidly progressive dementia with resulting state of catatonia or akinetic mutism. Both are associated with movement disorders. In published case series, myoclonus appears to be the most frequent movement disorder in sCJD, while stereotypic, synchronized, one-cycle-per-second movements such as arm or leg elevation, jaw opening, grimacing, head turning, and eye deviation are seen in NMDAE. We report a case of a 59-year-old woman with rapidly worsening cognitive disturbance leading to a nearly catatonic state interrupted by stereotypic movements. sCJD was diagnosed via periodic sharp wave complexes on EEG as well as cerebrospinal fluid (CSF 14-3-3 and tau protein elevation. Characteristic movement disorder of NMDAE was present in absence of ovarian mass or CSF pleiocytosis. Given prior case reports of presence of anti-NMDA receptor antibodies in sCJD, we propose that the movement disorder in this case was caused by anti-NMDA receptor antibodies whose formation was secondary to neuronal damage from prion disease. It is important to consider sCJD even in cases that have some clinical features suggestive of NMDAE.

  9. Catatonic syndrome in anti-NMDA receptor encephalitis

    Directory of Open Access Journals (Sweden)

    Starlin Vijay Mythri

    2016-01-01

    Full Text Available Anti-N-methyl-D-aspartate (NMDA receptor encephalitis is a newly recognised autoimmune condition. With its typical clinical pattern, consistent association with the presence of auto antibodies and rapid improvement with immunotherapy, this condition is giving insights into the boundaries between psychiatry and other neurosciences, and is opening avenues for future research. In a young lady who presented with catatonia, we considered anti-NMDA receptor encephalitis, after ruling out other aetiologies. After a positive antibody test we treated her with immunotherapy. She showed gradual improvement in her psychotic and catatonic symptoms. Knowledge regarding the nature and function of NMDA receptors and pathophysiology of this particular encephalitis is important for psychiatric practice. The great opportunity for research in this area due to its association with psychotic disorders is evident but an appeal to temper the enthusiasm by considering the historical lessons learnt from Karl Jaspers′ critique of General Paresis of Insane, is in place. Catatonic syndrome has to be conceptualised broadly and should be recognised with a separate nosological position.

  10. The potent opioid agonist, (+)-cis-3-methylfentanyl binds pseudoirreversibly to the opioid receptor complex in vitro and in vivo: Evidence for a novel mechanism of action

    Energy Technology Data Exchange (ETDEWEB)

    Band, L.; Xu, Heng; Bykov, V.; Rothman, R.B.; Kim, Chongho; Newman, A.; Jacobson, A.E.; Rice, K.C. (NIDDK, Bethesda, MD (USA)); Greig, N. (NIA, Bethesda, MD (USA))

    1990-01-01

    The present study demonstrates that pretreatment of rat brain membranes with (+)-cis-3-methylfentanyl ((+)-cis-MF), followed by extensive washing of the membranes, produces a wash-resistant decreasing in the binding of ({sup 3}H)-(D-ala{sup 2}, D-leu{sup 5})enkephalin to the d binding site of the opioid receptor complex ({delta}{sub cx} binding site). Intravenous administration of (+)-cis-MF (50 {mu}g/kg) to rats produced a pronounced catalepsy and also produced a wash-resistant masking of {delta}{sub cx} and {mu} binding sites in membranes prepared 120 min post-injection. Administration of 1 mg/kg i.v. of the opioid antagonist, 6-desoxy-6{beta}-fluoronaltrexone (cycloFOXY), 100 min after the injection of (+)-cis-MF (20 min prior to the preparation of membranes) completely reversed the catatonia and restored masked {delta}{sub cx} binding sites to control levels. This was not observed with (+)-cycloFOXY. The implications of these and other findings for the mechanism of action of (+)-cis-MF and models of the opioid receptors are discussed.

  11. Clinical features of delirious mania: a series of five cases and a brief literature review

    Directory of Open Access Journals (Sweden)

    Lee Bo-Shyan

    2012-06-01

    Full Text Available Abstract Background Little is known about the cause and psychopathology of delirious mania, a type of disorder where delirium and mania occur at the same time. This condition still has no formal diagnostic classification. To provide more information about this potentially life-threatening condition, we studied five patients with delirious mania. Methods We describe the cases of five patients with delirious mania admitted to an acute inpatient psychiatric unit between January 2005 and January 2007, and discuss the cases in the context of a selective review of the clinical literature describing the clinical features and treatment of delirious mania. Results Two patients had two episodes of delirious mania. Delirium usually resolved faster than mania though not always the case. Delirious mania remitted within seven sessions of the electroconvulsive therapy (ECT. Conclusions Delirious mania is a potentially life-threatening but under-recognized neuropsychiatric syndrome. Delirious mania that is ineffectively treated may induce a new-onset manic episode or worsen an ongoing manic episode, and the patient will need prolonged hospitalization. Delirious mania also has a close relationship with catatonia. Early recognition and aggressive treatment, especially with electroconvulsive therapy, can significantly reduce morbidity and mortality.

  12. Evaluation of total creatine kinase levels in a spectrum of neuro-psychiatric disorders in a tertiary neurosciences centre

    Directory of Open Access Journals (Sweden)

    Anshu Gupta

    2015-01-01

    Full Text Available Introduction: To study usefulness of total creatine kinase (CK as a screening tool in various neurological and psychiatric disorders in emergency setting of a tertiary care hospital. Materials and Methods: A 1-year retrospective study was conducted on 102 patients with complaints pertaining to neurological and psychiatric disorders in a tertiary neurosciences centre in a metropolitan city. Blood samples in plain vial were received in Emergency Laboratory and total CK levels were measured by automated analyzer and its correlation with various diseases was analyzed. Results: It was observed that CK activity was raised in various psychiatric conditions-acute transient psychotic disorder, alcohol dependence syndrome, delirium, psychosis, mental retardation, catatonia, bipolar affective disorder (BAD, depression and mania and also in neurological disorders-seizures, meningitis, myasthenia gravis (multiple sclerosis, Guillain-Barre syndrome, extra pyramidal syndrome, neuroleptic malignant syndrome and infarct. Conclusion: This study demonstrated that CK is a sensitive and an important screening parameter in diagnosis and monitoring of various neurological and psychiatric disorders in emergency setting. It is also helpful in identifying people at high risk for various neuro-psychiatric diseases.

  13. The computational anatomy of psychosis

    Directory of Open Access Journals (Sweden)

    Rick A Adams

    2013-05-01

    Full Text Available This paper considers psychotic symptoms in terms of false inferences or beliefs. It is based on the notion that the brain is an inference machine that actively constructs hypotheses to explain or predict its sensations. This perspective provides a normative (Bayes optimal account of action and perception that emphasises probabilistic representations; in particular, the confidence or precision of beliefs about the world. We will consider hallucinosis, abnormal eye movements, sensory attenuation deficits, catatonia and delusions as various expressions of the same core pathology: namely, an aberrant encoding of precision. From a cognitive perspective, this represents a pernicious failure of metacognition (beliefs about beliefs that can confound perceptual inference. In the embodied setting of active (Bayesian inference, it can lead to behaviours that are paradoxically more accurate than Bayes optimal behaviour. Crucially, this normative account is accompanied by a neuronally plausible process theory based upon hierarchical predictive coding. In predictive coding, precision is thought to be encoded by the postsynaptic gain of neurons reporting prediction error. This suggests that both pervasive trait abnormalities and florid failures of inference in the psychotic state can be linked to factors controlling postsynaptic gain – such as NMDA receptor function and (dopaminergic neuromodulation. We illustrate these points using biologically plausible simulations of perceptual synthesis, smooth pursuit eye movements and attribution of agency – that all use the same predictive coding scheme and pathology: namely, a reduction in the precision of prior beliefs, relative to sensory evidence.

  14. Corticosteroid-related central nervous system side effects

    Directory of Open Access Journals (Sweden)

    Miriam Ciriaco

    2013-01-01

    Full Text Available Corticosteroids have been used since the 50s as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Corticosteroids have three principal mechanisms of action: 1 inhibit the synthesis of inflammatory proteins blocking NF-kB, 2 induce the expression of anti-inflammatory proteins by IkB and MAPK phosphatase I, and 3 inhibit 5-lipoxygenase and cyclooxygenase-2. The efficacy of glucocorticoids in alleviating inflammatory disorders results from the pleiotropic effects of the glucocorticoid receptors on multiple signaling pathways. However, they have adverse effects: Growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. Less is known about psychiatric or side effects on central nervous system, as catatonia, decreased concentration, agitation, insomnia, and abnormal behaviors, which are also often underestimated in clinical practice. The aim of this review is to highlight the correlation between the administration of corticosteroids and CNS adverse effects, giving a useful guide for prescribers including a more careful assessment of risk factors and encourage the use of safer doses of this class of drugs.

  15. Twenty years of electroconvulsive therapy in a psychiatric unit at a university general hospital

    Directory of Open Access Journals (Sweden)

    Amilton dos Santos Jr.

    2013-01-01

    Full Text Available Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02. Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5% reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.

  16. Catatonic Syndrome in Anti-NMDA Receptor Encephalitis

    Science.gov (United States)

    Mythri, Starlin Vijay; Mathew, Vivek

    2016-01-01

    Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a newly recognised autoimmune condition. With its typical clinical pattern, consistent association with the presence of auto antibodies and rapid improvement with immunotherapy, this condition is giving insights into the boundaries between psychiatry and other neurosciences, and is opening avenues for future research. In a young lady who presented with catatonia, we considered anti-NMDA receptor encephalitis, after ruling out other aetiologies. After a positive antibody test we treated her with immunotherapy. She showed gradual improvement in her psychotic and catatonic symptoms. Knowledge regarding the nature and function of NMDA receptors and pathophysiology of this particular encephalitis is important for psychiatric practice. The great opportunity for research in this area due to its association with psychotic disorders is evident but an appeal to temper the enthusiasm by considering the historical lessons learnt from Karl Jaspers’ critique of General Paresis of Insane, is in place. Catatonic syndrome has to be conceptualised broadly and should be recognised with a separate nosological position. PMID:27114630

  17. ["My disease is one of the mind and difficult to define": Robert Walser (1879-1956) and his mental illness].

    Science.gov (United States)

    Partl, S; Pfuhlmann, B; Jabs, B; Stöber, G

    2011-01-01

    Robert Walser (1878-1956) is among the most prominent German-speaking writers born in Switzerland. His early writings are fascinating due to his intensive affectivity and oneiric experiences; his late work impresses through his idiosyncratic use of language and his micrographs. Due to a psychotic disease he stayed in Swiss Mental State Hospitals (Waldau and Herisau) throughout the final 27 years of his life. According to his case records Robert Walser suffered from a schizophrenic disorder (ICD-10) and from a combined sluggish/manneristic catatonia according to K. Leonhard. Walser's psychotic disorder was characterized by a chronic course with sharp-cut symptomatology with stiff postures, repetitive behaviour, movement mannerisms and omissions (manneristic component) complemented by loss of incentive, severe autism and persistent verbal hallucinations (speech-sluggish component). In the late stages his psychopathology affected the process of thinking and writing in a specific manner: his handwriting became illegibly small, and his train of thoughts did not get to the point. At age 54 he stopped writing when transferred from Waldau to Herisau, and subsequently, due to manneristic omission, he was never again able to restart literary writing. The analysis of Robert Walser's psychotic disease may contribute to a deeper understanding of his literary production, which influenced such classical German authors like Franz Kafka, Hermann Hesse and Robert Musil.

  18. [Schizophrenia and other psychotic disorders in DSM-5: summary of the changes compared to DSM-IV].

    Science.gov (United States)

    Paulzen, M; Schneider, F

    2014-05-01

    With the introduction of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) numerous changes in the area of the schizophrenia spectrum and psychotic disorders have been implemented. Establishing a metastructure based on the characteristics of the spectrum of psychopathological disturbances should improve clarity. The classical subtypes of schizophrenia were eliminated and specific psychopathological dimensions for the assessment of disease severity were added. The special role of Schneiderian first rank symptoms was abandoned and a higher delineation towards schizoaffective disorders is made. The nosological status of catatonia is clarified and occurs together with a consistent use of catatonic disturbances over all chapters. The attenuated psychosis syndrome is added as a new condition for further study. The shared psychotic disorder in the sense of a folie à deux is no longer maintained. However, the initial goal to integrate more disorder-specific etiopathogenetic information into the reconceptualization could not be achieved. Contemporaneously to the development process of DSM-5 the National Institute of Mental Health (NIMH) carried out the research domain criteria project (RDoC) attempting to incorporate the current growth in knowledge of genetics, neurocognitive and cognitive sciences in future diagnostic systems. This article gives an overview of the changes that have been made within the revision process from DSM-IV to DSM-5.

  19. Anaesthetic, cardiovascular and respiratory effects of a new steroidal agent CT 1341: a comparison with other intravenous anaesthetic drugs in the unrestrained cat.

    Science.gov (United States)

    Child, K J; Davis, B; Dodds, M G; Twissell, D J

    1972-10-01

    1. The anaesthetic, cardiovascular, respiratory and adverse effects produced by the intravenous injection of CT 1341, thiopentone, methohexitone, pentobarbitone, propanidid and ketamine have been compared in unrestrained cats prepared with chronically implanted venous and arterial cannulae. Aortic blood pressure and heart rates were monitored before, during and after loss of consciousness.2. CT 1341 produced rapid induction of anaesthesia followed by moderately rapid recovery, was active over a wide range of doses and caused minimal respiratory depression and few adverse effects. It caused an initial short-lasting tachycardia and fall in aortic blood pressure succeeded by a secondary depressor response.3. The safety margin was narrower with the barbiturate drugs than with CT 1341, and large doses induced apnoea and respiratory depression. Small doses of methohexitone elicited excitatory effects and large doses caused severe respiratory and circulatory depression, and recovery from anaesthesia was protracted.4. Propanidid induced short-lasting light anaesthesia. The safety margin was narrowest with this drug and induction was associated with adverse circulatory, respiratory and other effects.5. Ketamine was active over a wide range of doses but exhibited qualitatively different properties from the other anaesthetics. Induction was slower after small doses and these produced circulatory stimulation, catatonia and bizarre behavioural effects. Large doses caused respiratory and circulatory depression and recovery was protracted.6. It is concluded that CT 1341 has a wider therapeutic latitude, produces less respiratory depression and has other advantages over the currently used intravenous anaesthetics. PMID:4651769

  20. Catatonic Dilemma in a 33-Year-Old Woman: A Discussion

    Directory of Open Access Journals (Sweden)

    Alexander Koch

    2013-01-01

    Full Text Available Case. We report a case of catatonia with elevated CK, elevated temperature, and hypoferritinemia after abrupt discontinuation of clozapine in a patient with known proneness to catatonic symptoms. Reinstatement of clozapine therapy was contraindicated due to leukopenia. Neuroleptic malign syndrome could not be ruled out by the administration of quetiapine; this prevented the quick use of other potent D2 antagonists. Some improvement was achieved through supportive therapy, high dose of lorazepam, and a series of 10 ECT sessions. Returning to baseline condition was achieved by a very careful increase of olanzapine. Discussion. Catatonic symptoms in schizophrenia as well as in NMS might be caused by a lack of striatal dopamine (CS or dopamine D2 antagonism (NMS. CS might be a “special” kind of schizophrenia featuring both hypo- and hyperactivity of dopaminergic transmission. ECT has been described as a “psychic rectifier” or a “reset for the system.” The desirable effect of ECT in cases of CS might be dopaminergic stimulation in the striatum and decrease of both the dopaminergic activity in the limbic system and the serotonergic activity on 5-HT2 receptors. The desirable effect of ECT in NMS would be explained by activation of dopaminergic transmission and/or liberation of dopaminergic receptors from the causative neuroleptics.

  1. Excited delirium: Consideration of selected medical and psychiatric issues

    Directory of Open Access Journals (Sweden)

    Edith Samuel

    2009-01-01

    Full Text Available Edith Samuel1, Robert B Williams1, Richard B Ferrell21Department of Psychology, Atlantic Baptist University, Moncton, New Brunswick Canada; 2Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire, USAAbstract: Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these. This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions.Keywords: excited delirium, excited states, cocaine misuse, restraint or in custody deaths

  2. Acute psychosis due to non-paraneoplastic anti-NMDA-receptor encephalitis in a teenage girl: Case report.

    Science.gov (United States)

    Kramina, Sandra; Kevere, Laura; Bezborodovs, Nikita; Purvina, Santa; Rozentals, Guntis; Strautmanis, Jurgis; Viksna, Zane

    2015-12-01

    Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a disease occurring when antibodies produced by the body's own immune system attack NMDA-type glutamate receptors in the brain. Most anti-NMDAR encephalitis cases are associated with paraneoplastic syndrome. We analyze the case of a 15-year-old girl who was hospitalized in a child psychiatry clinic in Riga, Latvia, with de novo acute polymorphic psychotic disorder gradually progressing to a catatonic state. The patient received antipsychotic and electroconvulsive therapy with no beneficial effect. The council of doctors discussed differential diagnoses of schizophrenia-induced catatonia and the autoimmune limbic encephalitis-induced catatonic condition. When the diagnosis of anti-NMDAR autoimmune encephalitis was finally confirmed by repeated immunological assays (specific immunoglobulin [Ig] G and IgM in her blood serum and cerebrospinal fluid), and a paraneoplastic process was ruled out, she was started on immunomodulating therapy (methylprednisolone, Ig, plasmapheresis, rituximab), which changed the course of her disease. On immunomodulating treatment, her physical and mental health have gradually improved to almost complete reconvalescence. Psychiatrists should consider anti-NMDAR encephalitis as a differential diagnosis in first-episode psychosis patients presenting with disorientation, disturbed consciousness, pronounced cognitive deficits, movement disorder, dysautonomia, or rapid deterioration, and test for specific IgG NR1 autoantibodies, even if there are no specific findings on routine neuroimaging, electroencephalography (EEG), or cerebrospinal fluid tests. PMID:26663628

  3. Anti-N-methyl-D-aspartate-receptor encephalitis: diagnosis, optimal management, and challenges

    Directory of Open Access Journals (Sweden)

    Mann AP

    2014-07-01

    Full Text Available Andrea P Mann,1 Elena Grebenciucova,2 Rimas V Lukas21Department of Psychiatry and Behavioral Neuroscience, 2Department of Neurology, University of Chicago, Chicago, IL, USAObjective: Anti-N-methyl-D-aspartate-receptor (NMDA-R encephalitis is a new autoimmune disorder, often paraneoplastic in nature, presenting with complex neuropsychiatric symptoms. Diagnosed serologically, this disorder is often responsive to immunosuppressant treatment. The objective of this review is to educate clinicians on the challenges of diagnosis and management of this disorder.Materials and methods: A review of the relevant literature on clinical presentation, pathophysiology, and recommended management was conducted using a PubMed search. Examination of the results identified articles published between 2007 and 2014.Results: The literature highlights the importance of recognizing early common signs and symptoms, which include hallucinations, seizures, altered mental status, and movement disorders, often in the absence of fever. Although the presence of blood and/or cerebrospinal fluid autoantibodies confirms diagnosis, approximately 15% of patients have only positive cerebrospinal fluid titers. Antibody detection should prompt a search for an underlying teratoma or other underlying neoplasm and the initiation of first-line immunosuppressant therapy: intravenous methylprednisolone, intravenous immunoglobulin, or plasmapheresis, or a combination thereof. Second-line treatment with rituximab or cyclophosphamide should be implemented if no improvement is noted after 10 days. Complications can include behavioral problems (eg, aggression and insomnia, hypoventilation, catatonia, and autonomic instability. Those patients who can be managed outside an intensive care unit and whose tumors are identified and removed typically have better rates of remission and functional outcomes.Conclusion: There is an increasing need for clinicians of different specialties, including

  4. Downward and suspended sediment fluxes in the Palamós submarine canyon (North-Western Mediterranean)

    Science.gov (United States)

    Palanques, A.; Martín, J.; Puig, P.; Guillén, J.

    2003-04-01

    The Palamós canyon is deeply incised in the Northern Catatonia continental shelf (North-western Mediterranean) which favour an active shelf-slope sediment transfer. To study particle dynamics in this canyon, seven moorings arrays equipped with current meters, turbidimeters and sediment traps were deployed near the bottom along the main canyon axis (400, 1200 and 1700 m depth), on both canyon walls (1200 m depth) and on the adjacent slope (1200 m depth). One set of these instruments was also deployed at intermediate waters (400 m water depth) in the canyon axis. At surface and mid-depths, suspended sediment fluxes were oriented along the mean flow direction (NE-SW), whereas near-bottom sediment fluxes were more constrained by the local bathymetry. The higher near-bottom downward and suspended particle fluxes were not recorded in the canyon head but in the mid-canyon axis, suggesting additional sediment supplies through or over the canyon walls and/or sediment resuspension in the mid canyon region. Several events of sharp sediment flux increases took place in the mid-canyon axis site during the water stratification season. These events could be related to the action of internal waves and even to fishing activities. In the canyon walls, downward and suspended particle fluxes were higher in the southern wall, where currents were lower than in the northern wall, evidencing an asymmetrical pattern. In the adjacent slope sediment fluxes were significantly lower than in the canyon. An important increase of downward particle fluxes in the canyon axis and both walls occurred by mid-November when a severe storm took place. The pattern of the sediment fluxes in the Palamós Canyon has some differences in relation to those observed in other Mediterranean submarine canyons and has downward particle fluxes from 2 to10 times higher than other studied canyons of this region.

  5. Neuroprotective effect of Tinospora cordifolia ethanol extract on 6-hydroxy dopamine induced Parkinsonism

    Directory of Open Access Journals (Sweden)

    Jayasankar Kosaraju

    2014-01-01

    Full Text Available Objective: The present study investigates the neuroprotective activity of ethanol extract of Tinospora cordifolia aerial parts against 6-hydroxy dopamine (6-OHDA lesion rat model of Parkinson′s disease (PD. Materials and Methods: T. cordifolia ethanol extract (TCEE was standardized with high performance thin layer chromatography using berberine. Experimental PD was induced by intracerebral injection of 6-OHDA (8 μg. Animals were divided into five groups: sham operated, negative control, positive control (levodopa 6 mg/kg and two experimental groups (n = 6/group. Experimental groups received 200 and 400 mg/kg of TCEE once daily for 30 days by oral gavage. Biochemical parameters including dopamine level, oxidative stress, complex I activity and brain iron asymmetry ratio and locomotor activity including skeletal muscle co-ordination and degree of catatonia were assessed. Results: TCEE exhibited significant neuroprotection by increasing the dopamine levels (1.96 ± 0.20 and 2.45 ± 0.40 ng/mg of protein and complex I activity (77.14 ± 0.89 and 78.50 ± 0.96 nmol/min/mg of protein at 200 and 400 mg/kg respectively when compared with negative control group. Iron asymmetry ratio was also significantly attenuated by TCEE at 200 (1.57 ± 0.18 and 400 mg/kg (1.11 ± 0.15 when compared with negative control group. Neuroprotection by TCEE was further supported by reduced oxidative stress and restored locomotor activity in treatment groups. Conclusion: Results show that TCEE possess significant neuroprotection in 6-OHDA induced PD by protecting dopaminergic neurons and reducing the iron accumulation.

  6. Shape theory. Functional connections of information, energy, and temperature in phasics and physiology; Gestalttheorie. Funktionelle Zusammenhaenge von Information, Energie und Temperatur in Physik und Physiologie

    Energy Technology Data Exchange (ETDEWEB)

    Wengel, Claus

    2012-11-01

    Starting from the phenomenon of the information input and the information output system in the central nervous system, which was conceived in physiology, as well as from the phenomenon of the disturbance oc consciousness, which was in neuropsychiatry psychopathometrically and by this quantitatively determinable, the author was occupied by the general question: How systems can be described, which possess and exchange temperature, energy, and information? A connection of thermodynamics and information theory was found and presented in this work. It came to the redefinition of several quantities, which can be applied both in mathematical physics and in mathematical physiology. First the negentropy was defined in fact as first partial derivation of the total information on the absolute temperature. Further definitions follow: That of the shape (measured in bit.J/K), that of the action (measured in bit.J), as well that of the structure (measured in bit.J/K{sup 2}). Functional connections of information, energy, and temperature as well as of further quantities became recognizable and were written. Mathematical physics were thereby enriched, also by conservation laws. But also mathematical physiology was extended. Here diseases like the inflammatory diseases catatonia, epilepsy, tumor, vegetative dystonies, anorexy, dementia, as well as the phenomenon vitality and the phenomenon sleeping were comprehended by formulas. As consequences resulted proposals resulted for the prophylaxis and for the therapy and for the design of a live-preserving and live-elongating way of life. These proposals are in the sections, which treat the diseases, detailedly listed and derived. Furthermore a first law of psychodynamics was formulated - in analogy to the first law of thermodynamics.

  7. The role of memantine in the treatment of psychiatric disorders other than the dementias: a review of current preclinical and clinical evidence.

    Science.gov (United States)

    Sani, Gabriele; Serra, Giulia; Kotzalidis, Giorgio D; Romano, Silvia; Tamorri, Stefano M; Manfredi, Giovanni; Caloro, Matteo; Telesforo, C Ludovica; Caltagirone, Saverio S; Panaccione, Isabella; Simonetti, Alessio; Demontis, Francesca; Serra, Gino; Girardi, Paolo

    2012-08-01

    Memantine, a non-competitive NMDA receptor antagonist approved for Alzheimer's disease with a good safety profile, is increasingly being studied in a variety of non-dementia psychiatric disorders. We aimed to critically review relevant literature on the use of the drug in such disorders. We performed a PubMed search of the effects of memantine in animal models of psychiatric disorders and its effects in human studies of specific psychiatric disorders. The bulk of the data relates to the effects of memantine in major depressive disorder and schizophrenia, although more recent studies have provided data on the use of the drug in bipolar disorder as an add-on. Despite interesting preclinical data, results in major depression are not encouraging. Animal studies investigating the possible usefulness of memantine in schizophrenia are controversial; however, interesting findings were obtained in open studies of schizophrenia, but negative placebo-controlled, double-blind studies cast doubt on their validity. The effects of memantine in anxiety disorders have been poorly investigated, but data indicate that the use of the drug in obsessive-compulsive disorder and post-traumatic stress disorder holds promise, while findings relating to generalized anxiety disorder are rather disappointing. Results in eating disorders, catatonia, impulse control disorders (pathological gambling), substance and alcohol abuse/dependence, and attention-deficit hyperactivity disorder are inconclusive. In most psychiatric non-Alzheimer's disease conditions, the clinical data fail to support the usefulness of memantine as monotherapy or add-on treatment However, recent preclinical and clinical findings suggest that add-on memantine may show antimanic and mood-stabilizing effects in treatment-resistant bipolar disorder. PMID:22784018

  8. Phenotype-Based Genetic Association Studies (PGAS—Towards Understanding the Contribution of Common Genetic Variants to Schizophrenia Subphenotypes

    Directory of Open Access Journals (Sweden)

    Hannelore Ehrenreich

    2014-02-01

    Full Text Available Neuropsychiatric diseases ranging from schizophrenia to affective disorders and autism are heritable, highly complex and heterogeneous conditions, diagnosed purely clinically, with no supporting biomarkers or neuroimaging criteria. Relying on these “umbrella diagnoses”, genetic analyses, including genome-wide association studies (GWAS, were undertaken but failed to provide insight into the biological basis of these disorders. “Risk genotypes” of unknown significance with low odds ratios of mostly <1.2 were extracted and confirmed by including ever increasing numbers of individuals in large multicenter efforts. Facing these results, we have to hypothesize that thousands of genetic constellations in highly variable combinations with environmental co-factors can cause the individual disorder in the sense of a final common pathway. This would explain why the prevalence of mental diseases is so high and why mutations, including copy number variations, with a higher effect size than SNPs, constitute only a small part of variance. Elucidating the contribution of normal genetic variation to (disease phenotypes, and so re-defining disease entities, will be extremely labor-intense but crucial. We have termed this approach PGAS (“phenotype-based genetic association studies”. Ultimate goal is the definition of biological subgroups of mental diseases. For that purpose, the GRAS (Göttingen Research Association for Schizophrenia data collection was initiated in 2005. With >3000 phenotypical data points per patient, it comprises the world-wide largest currently available schizophrenia database (N > 1200, combining genome-wide SNP coverage and deep phenotyping under highly standardized conditions. First PGAS results on normal genetic variants, relevant for e.g., cognition or catatonia, demonstrated proof-of-concept. Presently, an autistic subphenotype of schizophrenia is being defined where an unfortunate accumulation of normal genotypes, so

  9. Common psychotic symptoms can be explained by the theory of ecological perception.

    Science.gov (United States)

    Golembiewski, Jan Alexander

    2012-01-01

    welcome. Automatic behaviours that carry a negative bias, however, are unwelcome and like hallucinations, occur without a sense of choice. These include crying, stereotypies, perseveration, ataxia, utilization and imitation behaviours and catatonia.

  10. [Functional pathophysiology of consciousness].

    Science.gov (United States)

    Jellinger, Kurt A

    2009-01-01

    from important somatic and sensory pathways and acts as a control system of neuronal activities of the cerebral cortex. The principal function of the ARAS is to focus our alertness on specific stimuli or internal processes, which run via complex neuronal cell groups and numerous neurotransmitters that influence various aspects of consciousness and wakefulness. Stimulation of the ARAS produces an arousal reaction as the electric correlate of consciousness; its destruction causes coma and related states. The highest level are cortical (prefrontal and association) networks for recognition, motor activity, longterm memory and attention, the left hemisphere being considered as the dominant one. Different levels of consciousness are distinguished: 1. hyperalertness, 2. alertness (normal state of wakefulness), 3. somnolence or lethargy, 4. obtundation with tendency to fall asleep, 5. stupor, 6. coma and its subtypes, like akinetic mutism, apallic syndrome or persistent vegative state, locked-in syndrome, delirium, and catatonia. They are caused by damages in various functional levels of the brain, by psychogenic factors or experimentally, and are accompanied by characteristic neurological and psychiatric disorders. The relevant morphological lesions can be detected by electrophysiological and imaging studies. The bases of functional anatomy and pathophysiology of consciousness, its cognitive aspects and its major disorders, their causes and functional substrates with reference to sleep and both spontaneous and iatrogenic disorders of consciousness are critically summarized.

  11. On the clinical impact of cerebral dopamine D{sub 2} receptor scintigraphy; Zur klinischen Wertigkeit der zerebralen Dopamin-D{sub 2}-Rezeptorszintigraphie

    Energy Technology Data Exchange (ETDEWEB)

    Larisch, R. [Duesseldorf Univ. (Germany). Klinik fuer Nuklearmedizin; Klimke, A. [Duesseldorf Univ. (Germany). Psychiatrische Klinik

    1998-12-31

    The present review describes findings and clinical indications for the dopamine D{sub 2} receptor scintigraphy. Methods for the examination of D{sub 2} receptors are positron emission tomography (PET) using {sup 11}C- or {sup 18}F-labelled butyrophenones or benzamides or single photon emission tomography (SPECT) using {sup 123}I-iodobenzamide (IBZM) respectively. The most important indication in neurology is the differential diagnosis of Parkinsonism: Patients with early Parkinson`s disease show an increased D{sub 2} receptor binding (D{sub 2}-RB) compared to control subjects. However, patients suffering from Steele-Richardson-Olszewski-Syndrome or Multiple System Atrophy show a decreased D{sub 2}-RB and are generally non-responsive to treatment. Postsynaptic blockade of D{sub 2} receptors results in a drug induced Parkinsonian syndrome, which can be diagnosed by D{sub 2} scintigraphy. Further possible indications occur in psychiatry: The assessment of receptor occupancy is useful in schizophrenic patients treated with neuroleptics. Additionally, D{sub 2} receptor scintigraphy might help to clarify the differential diagnosis between neuroleptic malignant syndrome and lethal catatonia. The method might be useful for supervising neurobiochemical changes in drug dependency and during withdrawal. Assessment of dopamine D{sub 2} receptor binding can simplify the choice of therapy in depressive disorder: Patients showing a low D{sub 2} binding are likely to improve following an antidepressive drug treatment whereas sleep deprivation is promising in patients with high D{sub 2} binding. (orig.) [Deutsch] Die vorliegende Arbeit gibt eine Uebersicht ueber Befunde und klinische Indikationen zur Dopamin-D{sub 2}-Rezeptorszintigraphie. Methoden zur Untersuchung der D{sub 2}-Rezeptoren sind die Positronen-Emissions-Tomographie (PET) mit {sup 11}C- oder {sup 18}F-markierten Butyrophenonen oder Benzamiden oder die Einzelphotonen-Emissions-Tomographie (SPECT) mit {sup 123}I

  12. [Functional pathophysiology of consciousness].

    Science.gov (United States)

    Jellinger, Kurt A

    2009-01-01

    from important somatic and sensory pathways and acts as a control system of neuronal activities of the cerebral cortex. The principal function of the ARAS is to focus our alertness on specific stimuli or internal processes, which run via complex neuronal cell groups and numerous neurotransmitters that influence various aspects of consciousness and wakefulness. Stimulation of the ARAS produces an arousal reaction as the electric correlate of consciousness; its destruction causes coma and related states. The highest level are cortical (prefrontal and association) networks for recognition, motor activity, longterm memory and attention, the left hemisphere being considered as the dominant one. Different levels of consciousness are distinguished: 1. hyperalertness, 2. alertness (normal state of wakefulness), 3. somnolence or lethargy, 4. obtundation with tendency to fall asleep, 5. stupor, 6. coma and its subtypes, like akinetic mutism, apallic syndrome or persistent vegative state, locked-in syndrome, delirium, and catatonia. They are caused by damages in various functional levels of the brain, by psychogenic factors or experimentally, and are accompanied by characteristic neurological and psychiatric disorders. The relevant morphological lesions can be detected by electrophysiological and imaging studies. The bases of functional anatomy and pathophysiology of consciousness, its cognitive aspects and its major disorders, their causes and functional substrates with reference to sleep and both spontaneous and iatrogenic disorders of consciousness are critically summarized. PMID:19573504