Catatonia – a psychopathological syndrome which main component are motive violations (a stupor or excitement). The combination to consciousness obscuring, nonsense, hallucinations and other psychopathological frustration is possible. Can arise at a depression, bipolar affective disorder, schizophrenia, infectious diseases, heavy intoxications and organic damages of a brain. The diagnosis is established taking into account the clinical symptoms yielded the anamnesis and results of additional researches. Treatment – therapy of the main disease, medicinal and electroconvulsive therapy for elimination of a catatonia.
Catatonia – the psychopathological syndrome including motive frustration and some other violations. It was for the first time described by the German psychiatrist Kalbaum at the end of the 19th century, in the beginning was considered as an independent mental disease. Later other German psychiatrist Krepelin considered this frustration one of displays of schizophrenia. Now it is established that the catatonia most often develops at affective frustration (a depression, bipolar affective disorder), however can meet also at other diseases, injuries and intoxications. Treatment experts in the field of psychiatry, in some cases – with assistance of neurologists carry out, oncologists, narcologists and doctors of other specialties.
The catatonic syndrome can arise at schizophrenia and different types of psychoses (organic, infectious, intoksikatsionny, abstinent, somatic and so forth). It is observed at some patients with autism. Develops at brain tumors, craniocereberal injuries (usually – in the remote period), serious infectious diseases, epilepsy, sharp mental disorders in the postnatal period, trombotsitopenichesky purple, vascular damages of a brain, a kokainomaniya, some other drug addiction and legal treatment by some medicines relating to group of psychoactive agents.
The immediate cause of emergence of this syndrome is not found out yet, however there are several hypotheses explaining its emergence. Scientists assume that insufficiency of GAMK in a cerebral cortex, a sudden global lack of dopamine and some other metabolic violations of a brain can provoke development of a catatonia. There is also a theory connecting emergence of the given frustration with the primitive reactions of fear characteristic of all mammals that is, with dying down at the sight of a predator. Supporters of this theory consider that the catatonic stupor is reaction of an organism to a subjective presentiment of inevitable death.
Classification of a catatonia
At a catatonia two types of motive violations can be observed: catatonic stupor and catatonic excitement. In a condition of excitement the patient is mobile, actively makes some purposeful or not purposeful actions. Allocate three forms of excitement:
- Pathetic. Develops gradually. The patient is in high spirits, is excited, a little excited, speaks pathos phrases, ekholaliya are possible. In the subsequent excitement accrues, the behavior of the patient becomes foolish, not purposeful. Consciousness is kept.
- Impulsive. Arises suddenly, it is characterized by speed, cruelty and destructiveness of actions. Perhaps persistent repeated repetition of words, phrases or actions. The patient constitutes danger to himself and people around.
- Mute. Senseless aggressive actions during which the patient silently puts heavy damages to himself or other people. Some experts consider mute excitement extreme extent of impulsive excitement.
In a condition of a stupor the patient is slowed down. The speech is absent, the tone of muscles is raised. Distinguish three forms of a stupor:
- Cataleptic (with wax flexibility). The patient for a long time fades in one pose, including – extremely inconvenient, given him by other person. Reaction to the usual speech is absent, at the same time the patient can react to whisper. At night the stupor sometimes weakens.
- Negativistichesky. As well as in the previous case, the expressed motive block is observed, at the same time the patient resists attempts of people around to change his pose.
- With catalepsy. Is followed by the most expressed block and increase in a tone of muscles. Patients often lie in an embryo pose.
The stupor can turn into excitement and back, one type of a stupor – in another. In some cases pathetic excitement is replaced by impulsive. Taking into account existence or lack of violations of consciousness and productive symptomatology allocate three types of a catatonia: lyutsidny, "empty" and oneyroidny.
At a "empty" catatonia the patient repeatedly reproduces the same poses, the movements and phrases, repeats words and the movements after other people. The active, passive or paradoxical negativism is observed. At active negativism the patient does something, not corresponding to instructions, at passive – ignores any requirements, at paradoxical – carries out something, opposite to a request. The katalepsiya comes to light – a state at which the patient long keeps one pose or parts of his body for a long time stiffen in any, even uncomfortable position.
At a lyutsidny and oneyroidny catatonia the listed displays of a disease are supplemented with productive symptomatology. At a lyutsidny form of a disease the nonsense, hallucinations and changes of mood arise against the background of clear consciousness. At a oneyroidny catatonia consciousness violations are observed. After an exit from a catatonia the patient partially or completely forgets what happened to it or at his presence, but keeps sketchy or detailed memories of displays of a disease.
Catatonic excitement proceeds continuously or is replaced by a catatonic stupor. The catatonic stupor is shown by delay or almost total disappearance of movements and increase in a muscular tone. At a stupor , the gipersalivation, a lowering of arterial pressure, puffiness and cyanosis of extremities often develop. The clinical picture of a stupor is supplemented with other manifestations of a catatonia.
Certain features of symptomatology and current of a catatonia depending on age of patients are observed. At children repetitions of words of people around and the rhythmical stereotypic movements often come to light. The behavior corresponding to early age is possible (children of preschool age behave as kids of first or second of life). The clearest and bright picture of a catatonia is observed at teenagers and young people having schizophrenia, especially – at emergence of a stupor. Usually the first attack develops up to 40 years, later beginning is observed seldom. At women of climacteric and preklimakterichesky age for the first time the arisen catatonia at the initial stages can remind hysteria.
Diagnostics of a catatonia
In the course of diagnostics the psychiatrist needs to reveal symptoms of a catatonia and to define the main pathology which provoked development of a catatonic syndrome. At suspicion of schizophrenia, a depression or a mania the doctor finds out the anamnesis from the patient's relatives. At contact preservation the psychiatrist talks to the patient for identification of productive symptomatology. If the contact is impossible, existence of nonsense and hallucinations is established indirectly, taking into account behavior of the patient. All patient perform neurologic inspection.
Diagnosis "catatonic schizophrenia" requires existence at least of one of the listed signs for 2 weeks: catatonic arousing, catatonic stupor, any kind of negativism, katalepsiya, wax flexibility, rigidnost and automatic submission to instructions of medical personnel. For diagnosing of a depression or a mania with psychotic symptoms existence of a stupor suffices, other signs are not obligatory.
Intoxications and postintoksikatsionny states reveal on the basis of the anamnesis (registration in connection with drug addiction, treatment in narcological clinic), words of relatives and objective signs of the use of psychoactive agents. At suspicion of organic pathology of a brain (malignant and good-quality new growths, ChMT, vascular diseases) appoint consultations of the corresponding experts: neurologist, neurosurgeon, oncologist etc. The volume of additional researches is defined by the revealed pathology.
The obligatory list of researches includes the general blood test, biochemical blood test, the analysis of urine on drugs, determination of level of sugar blood and determination of level of hormones of a thyroid gland. Depending on results of survey KT of a brain, brain MRT, an electroencephalography, the ECG, a spinal puncture, a blood serum research can be appointed to antibodies, analyses on HIV and on syphilis, blood and urine.
Treatment of a catatonia
Treatment is carried usually out in the conditions of psychiatric office. At a serious somatic illness perform hospitalization in office of the corresponding profile (neurologic, oncological). Patients with excitement can constitute danger to themselves or other people, in similar cases carry out fixing, inject soothing drugs. Constant observation, high-quality leaving and tracking of the vital functions is necessary. At a long catatonia parenteral food and intravenous administration of liquids for prevention of dehydration, and also regular change of position of a body of the patient for the prevention of the thromboses caused by a long immovability can be required.
The plan of treatment of the main disease is made taking into account the revealed pathology. Medical actions for removal from a catatonia include introduction of benzodiazepines (are effective both at excitement, and at a stupor), electroconvulsive therapy (it is applied at insufficient efficiency of benzodiazepines). Antipsychotic means are appointed with care as they can provoke development of a malignant antipsychotic syndrome. Use of carbamazepine, a zolpidem and their analogs is possible. Some authors note efficiency of anti-glutamate medicines. The forecast is defined by the main disease, adequacy and timeliness of an initiation of treatment and quality of observation of the patient.