Catatonia

Cbnvulsions, steroid-induced catatonia, increased intracranial pressure with papilledema (usually after treatment is discontinued), vertigo, headache, neuritis or paresthesia, steroid psychosis, insomnia... 

Campbell R, Schaffer CB, TupinJ Catatonia associated with glutethimide withdrawal. J Clin Psychiatry 44 32—33, 1983... 

Physical catatonia. An ability to maintain exaggerated and often bizarre postures for long periods. 

Optimize the dose of mood stabilizing medication(s) before adding on lithium, lamotrigine, or antidepressant (e.g., bupropion or an SSRI) if psychotic features are present, add on an antipsychotic ECT used for severe or treatment-resistant depressive episodes or for psychosis or catatonia... 

Second, if response is inadequate, consider adding a benzodiazepine (lorazepam or clonazepam) for shortterm adjunctive treatment of agitation or insomnia if needed lorazepam is recommended for catatonia Third, if response is inadequate, consider a three-drug combination ... 

Fourth, if response is inadequate, consider ECT for mania with psychosis or catatonia 6 or add clozapine for treatment-refractory illness Fifth, if response is inadequate, consider adding adjunctive therapies8... 

An interesting question comes up in connection with psychotic patients suffering from dementia praecox catatonia. The psychosis is due unquestionably to an over-dispersed state, and we must therefore conclude either that the sleep of such patients is theoretically quite different from ordinary sleep or that the centers of consciousness may be over-agglomerated while some centers of thinking are over-dispersed. So far as I can learn, these patients do sleep normally as a rule. Consequently one portion of the brain must be over-agglomerated at times, even though another portion of the brain is over-dispersed. 

Movements restlessness, sedation Twitch, tremor, ataxia, catatonia,... 

Neuroleptic malignant syndrome is an acute iatrogenic condition caused by neuroleptics, characterized by tremor, catatonia, fluctuating consciousness, hyperthermia, and cardiovascular instability. It is relatively uncommon, occuring in 1-1.5% of patients but is fatal in 11-38%, most often due to cardiovascular collapse (Jahan et al. 1992). The pathogenesis of neuroleptic malignant syndrome is poorly understood, but it is believed to result from altered dopamine and serotonin transmission in the hypothalamus, spinal cord, and striatum. Treatment includes discontinuation of neuroleptics and administration of drugs that increase dopamine transmission bromocriptine or L-dopa (Jahan etal. 1992 Baldessarini 1996). 

Brief Psychotic Disorder. This disorder occurs in the immediate aftermath of a markedly stressful event (or series of events). It is marked by emotional turmoil in conjunction with one or more psychotic symptoms such as delusions, hallucinations, disorganization, or catatonia. On presentation, a brief psychotic disorder can be difficult to distinguish from psychotic depression or mania. The presence of a precipitating stressor is not always helpful, because episodes of psychotic mood disorders (especially early in the course of illness) are also commonly triggered by stressful life events. Careful evaluation for symptoms of emerging depression or... 

Paranoid Delusions Hallucination Disorganized thoughts Disorganized behavior Mutism, catatonia Flat affect... 

Shock Therapy. Insulin coma treatments were used in the early 1900s but offered no tangible improvement. Electroconvulsive therapy (ECT) arose in the 1930s and 1940s and was the hrst treatment to provide some relief from psychosis. However, its effects are only temporary and it proved too costly for continuous use. ECT continues to have some use for life-threatening catatonia, but it is mainly used to treat refractory depression or bipolar disorder. 

Tbe aporphines constitute one of the largest groups of isoquinoline alkaloids and have a wide range of physiological activity. For example, bulbocapinine (93) (see Scheme 15) affects the central nervous system and causes catatonia, boldine... 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Motor disturbances are manifold and can extend from clumsiness and motor dysharmony to strange postures, stupor, and symptoms of catatonia. Bizarre movements and motor stereotypies such as finger stereotypies are frequent. Initially, and also during the course of the disorder, compulsive acts or rituals resulting in strange and unexpected movements can also be observed. 

Other diagnostic indications. A few less well-known diagnostic indications for ECT exist. The use of ECT in patients with Parkinson s disease is receiving greater interest. ECT is an effective treatment for depressions associated with this illness and may also be of benefit for the motor manifestations [see C. H. Kellner et al. 1994 for review]. Other conditions in which the use of ECT may be appropriate include catatonia and the neuroleptic malignant syndrome [Sackeim et al. 1995]. 

T3 by itself probably is not beneficial as an antidepressant and causes intolerable thyrotoxicity [Prange et al. 1976]. We are unaware of early studies with T4 alone, but in a single study [Gjessing and Jenner 1976], T4 was used to treat periodic catatonia with moderate success. This issue is not clear yet. To my knowledge, at least one ongoing current study addresses the possibility of stand-alone T4 as treatment for depression. 

Gjessing R, Jenner F (eds) Somatology of Periodic Catatonia. Oxford, England, Pergamon, 1976... 

U.S. Food and Drug Administration for the treatment of insomnia, almost all benzodiazepines may be used for this purpose. Benzodiazepines are most clearly valuable as hypnotics in the hospital setting, where high levels of sensory stimulation, pain, and acute stress may interfere with sleep. The safe, effective, and time-limited use of benzodiazepine hypnotics may, in fact, prevent chronic sleep difficulties (NIMH/NIH Consensus Development Conference Statement 1985). Benzodiazepines are also used to treat akathisia and catatonia and as adjuncts in the treatment of acute mania. 

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