catatonia


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Catatonia

 

Definition

Catatonia is a condition marked by changes in muscle tone or activity associated with a large number of serious mental and physical illnesses. There are two distinct sets of symptoms that are characteristic of this condition. In catatonic stupor the individual experiences a deficit of motor (movement) activity that can render him/her motionless. Catatonic excitement, or excessive movement, is associated with violent behavior directed toward oneself or others.
Features of catatonia may also be seen in Neuroleptic Malignant Syndrome (NMS) which is an uncommon (but potentially lethal) reaction to some medications used to treat major mental illnesses. NMS is considered a medical emergency since 25% of untreated cases result in death. Catatonia can also be present in individuals suffering from a number of other physical and emotional conditions such as drug intoxication, depression, and schizophrenia. It is most commonly associated with mood disorders.

Description

In catatonic stupor, motor activity may be reduced to zero. Individuals avoid bathing and grooming, make little or no eye contact with others, may be mute and rigid, and initiate no social behaviors. In catatonic excitement the individual is extremely hyperactive although the activity seems to have no purpose. Violence toward him/herself or others may also be seen.
NMS is observed as a dangerous side effect associated with certain neuroleptic (antipsychotic) drugs such as haloperidol (Haldol). It comes on suddenly and is characterized by stiffening of the muscles, fever, confusion and heavy sweating.
Catatonia can also be categorized as intrinsic or extrinsic. If the condition has an identifiable cause, it is designated as extrinsic. If no cause can be determined following physical examination, laboratory testing, and history taking, the illness is considered to be intrinsic.

Causes and symptoms

The causes of catatonia are largely unknown although research indicates that brain structure and function are altered in this condition. While this and other information point to a physical cause, none has yet been proven. A variety of medical conditions also may lead to catatonia including head trauma, cerebrovascular disease, encephalitis, and certain metabolic disorders. NMS is an adverse side effect of certain antipsychotic drugs.
A variety of symptoms are associated with catatonia. Among the more common are echopraxia (imitation of the gestures of others) and echolalia (parrot-like repetition of words spoken by others). Other signs and symptoms include violence directed toward him/herself, the assumption of inappropriate posture, selective mutism, negativism, facial grimaces, and animal-like noises.
Catatonic stupor is marked by immobility and a behavior known as cerea flexibilitas (waxy flexibility) in which the individual can be made to assume bizarre (and sometimes painful) postures that they will maintain for extended periods of time. The individual may become dehydrated and malnourished because food and liquids are refused. In extreme situations such individuals must be fed through a tube. Catatonic excitement is characterized by hyperactivity and violence; the individual may harm him/herself or others. On rare occasions, isolation or restraint may be needed to ensure the individual's safety and the safety of others.

Diagnosis

Recognition of catatonia is made on the basis of specific movement symptoms. These include odd ways of walking such as walking on tiptoes or ritualistic pacing, and rarely, hopping and skipping. Repetitive odd movements of the fingers or hands, as well as imitating the speech or movements of others also may indicate that catatonia is present. There are no laboratory or other tests that can be used to positively diagnose this condition, but medical and neurological tests are necessary to rule out underlying lesions or disorders that may be causing the symptoms observed.

Treatment

Treatment of catatonia includes medications such as benzodiazipines (which are the preferred treatment) and rarely barbiturates. Antipsychotic drugs may be appropriate in some cases, but often cause catatonia to worsen. Electroconvulsive therapy may prove beneficial for clients who do not respond to medication. If these approaches are unsuccessful, treatment will be redirected to attempts to control the signs and symptoms of the illness.

Prognosis

Catatonia usually responds quickly to medication interventions.

Prevention

There is currently no known way to prevent catatonia because the cause has not yet been identified. Research efforts continue to explore possible origins. Avoiding excessive use of neuroleptic drugs can help minimize the risk of developing catatonic-like symptoms.

Resources

Books

Frisch, Noreen Cavan, and Lawrence E. Frisch. Psychiatric Mental Health Nursing. Albany, NY: Delmar Publishers, 1998.

Key terms

Barbiturates — A group of medicines that slow breathing and lower the body temperature and blood pressure. They can be habit forming and are now used chiefly for anesthesia.
Benzodiazipines — This group of medicines is used to help reduce anxiety (especially before surgery) and to help people sleep.
Electroconvulsive therapy — This type of therapy is used to treat major depression and severe mental illness that does not respond to medications. A measured dose of electricity is introduced into the brain in order to produce a convulsion. Electroconvulsive therapy is safe and effective.
Mutism — The inability or refusal to speak.
Negativism — Behavior characterized by resistance, opposition, and refusal to cooperate with requests, even the most reasonable ones.
Neuroleptic drugs — Antipsychotic drugs, including major tranquilizers, used in the treatment of psychoses like schizophrenia.

catatonia

 [kat″ah-to´ne-ah]
a wide group of motor abnormalities, most involving extreme under- or overactivity, associated primarily with catatonic schizophrenia but also with other disorders. Included are motoric immobility, excessive motor activity, extreme negativism or mutism, unusual mannerisms, sterotypy, waxy flexibility, pecularities of voluntary movement, echolalia, and echopraxia. adj., adj cataton´ic.

cat·a·to·ni·a

(kat'ă-tō'nē-ă),
A syndrome of psychomotor disturbances characterized by periods of physical rigidity, negativism, or stupor; may occur in schizophrenia, mood disorders, or organic mental disorders.
[G. katatonos, stretching down, depressed, fr. kata, down, + tonos, tone]

catatonia

/cata·to·nia/ (kat″ah-to´ne-ah) a wide group of motor abnormalities, most involving extreme under- or overactivity, associated primarily with catatonic schizophrenia.cataton´ic

catatonia

(kăt′ə-tō′nē-ə)
n.
An abnormal condition variously characterized by stupor, stereotypy, mania, and either rigidity or extreme flexibility of the limbs. It is most often associated with schizophrenia.

cat′a·ton′ic (-tŏn′ĭk) adj. & n.
cat′a·ton′i·cal·ly adv.

catatonia

[kat′ətō′nē·ə]
Etymology: Gk, kata + tonos, tension
a state of psychologically induced immobility with muscular rigidity at times interrupted by agitation. It is manifested usually as immobility with extreme muscular rigidity or, less commonly, as excessive, impulsive activity. See also catatonic schizophrenia. catatonic, adj.

catatonia

Neurology A psychomotor disturbance characterized by periodic muscle rigidity, fixed posture, inability to move or talk and unresponsiveness, finding typical of schizophrenic disorders. See Cataplexy, Schizophrenia.

cat·a·to·ni·a

(kat'ă-tō'nē-ă)
A syndrome of psychomotor disturbances characterized by periods of physical rigidity, negativism, or stupor; may occur in schizophrenia, mood disorders, or organic mental disorders.
[G. katatonos, stretching down, depressed, fr. kata, down, + tonos, tone]

catatonia

A syndrome of abnormalities of movement or position associated with psychiatric conditions, hysteria or organic brain disease. There may be stereotyped movements, meaningless violence, overactivity, CATALEPSY, negativism or stupor.

catatonia (ka·t·tōˑ·nē·),

n extreme psychological state characterized by excessively rigid muscles combined with incidental periods of activity; occasionally manifests as impulsive, extreme activity.

catatonia (kat´ətō´nēə),

n a form of schizophrenia characterized by alternating stupor and excitement. A patient's arms often retain any position in which they are placed.
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