Catatonic state

The mental status examination remains an essential part of the evaluation. Often patients with schizophrenia will appear nnkempt or otherwise oddly dressed. Sometimes they will be friendly and affable, but when they are paranoid, they can be angry and hostile. Patients may have odd stereotypical movements that can become extreme in catatonic states. The patient with schizophrenia is usually quite alert and well oriented to his/her surroundings. This observation helps to distinguish the psychosis of schizophrenia from that of a delirium due to a medical illness or substance use. 

In summary, when properly administered, ECT is an effective treatment for the most severe mood and psychotic disorders encountered in clinical practice, especially those warranting hospital care. Its efficacy is even more striking given the fact that 50% of those successfully treated have previously been nonresponsive to one or more adequate courses of medication. Although primarily used for severe depression, it is also an effective antimanic therapy, and may be lifesaving in catatonic states. ECT has also been used successfully to treat special populations, other psychotic disorders, and various organic conditions, such as NMS and Parkinson s disease. 

Two women developed secondary bipolar disorder associated with glucocorticoid treatment and deteriorated to depressive-catatonic states without overt hallucinations and delusions (103). 

Wada K, Suzuki H, Taira T, Akiyama K, Kuroda S. Successful use of intravenous clomipramine in depressive-catatonic state associated with corticosteroid treatment. Int J Psych Clin Pract 2004 8 131-3. 

Caroff SN, Mann SC, Keck PE Jr, Francis A. Residual catatonic state following neuroleptic malignant syndrome. J Clin Psychopharmacol 2000 20(2) 257-9. 

MacLeod s next patient was an hysterical nemotic with a bad family history in this respect. The woman became insane following two months of pregnancy. Mania and morphinism were additional factors to be coped with but the patient was cured by a drastic treatment with sodium bromide. The insanity encountered here must have been the coagulation type to be discussed by Bancroft and Richter in paper mnnber three of this series, for the catatonic state, or peptization insanity, is theoretically incompatible with morphinism as can be readily seen. 

Additionally, ECT is highly effective for mania, catatonic states, and certain cases of schizophrenia. Moreover, it has been reported to ameliorate the motor symptoms of Parkinson s disease and various other movement disorders, such as tardive dyskinesia and neuroleptic malignant syndrome (NMS). ... 

Psilocybin is rapidly dephosphorylated in the body to psilocin, an agonist of serotonin (5-hydroxytryptamine [S-HTJja) receptors. The stimulating of 5-HT receptors by hallucinogenic drugs has given rise to the hypothesis that schizophrenia maybe caused by an imbalance in the metabolism of 5-HT. Depressive and catatonic states in schizophrenic patients are thought to be the result of 5-HT deficiency. 

In 1933, Buchman and Richter (1933) showed that the experimental catatonia produced in monkeys by bulbocapnine could be terminated by the injection of cocaine. The animals behaved normally at once and did not return to the catatonic state. It is now thought that the primary mechanism of cocaine is to block the DAT, which increases the concentration of synaptic dopamine. The effect of dopamine on interneuronal signaling is increased. While taking amphetamine for several days damages dopaminergic neurons in the basal ganglia, cocaine leaves the caudate unscathed. 

Our studies showed that the bulbocapnine-induced catatonic state in wild Norway rats could be temporarily interrupted by intense auditory stimulation, electric shocking that resulted in fighting among the rats, and by immersion in deep water, which necessitated their swimming to safety. Oliver Sacks showed subsequently that catatonia resulting from encephalitis in human beings could be interrupted by the administration of L-dopa, which increases dopamine production and release. 

Psychosis is a disorder that is characterized by a number of symptoms. These include difficulty processing information and reaching a conclusion experiencing delusions or hallucinations being incoherent or in a catatonic state or demonstrating aggressive violent behavior. 

Adverse reactions may include the following acute labyrinthitis agranulocytosis anaphylactic shock anemias anorexia aplastic anemiahemolytic anemia asthma blurred vision bradycardia cardiac arrest catatonic-like states chest tightness chills confusion constipation convulsions dermatitis diarrhea diplopia ... 

Antipsychotics have long since replaced ECT for the treatment of schizophrenia. Several studies, however, have found ECT equal in efficacy to these agents, while one large-sample, controlled trial found it less effective than drugs, but more effective than psychotherapy ( 406). Some clinicians believe that selected patients may benefit when ECT is given concurrently with an antipsychotic. One controlled study, for example, found that ECT in combination with a phenothiazine led to a more rapid remission than the phenothiazine alone ( 407). Clinical experience has clearly documented an important role for ECT in catatonic excitement or withdrawal, as well as for other severe, life-endangering psychotic states. More recently, ECT combined with novel antipsychotics has been reported to benefit previously poorly responsive psychotic patients and was well tolerated (106, 408, 409). 

Although the DSM-IV distinguishes between psychotic features that are either mood-congruent or mood-incongruent, the usefulness of this distinction remains controversial. Pope and Lipinski (12) found that schizophrenic symptoms were present in 20% to 50% of manic patients and that many of the delusions were mood-incongruent (i.e., delusions of persecution, catatonic symptoms, formal thought disorder, and auditory hallucinations not consistent with the mood state). 

May, R. (1959). Catatonic-like states following phenothiazine therapy. American Journal of Psychiatry, 115, 1119-1120. 

The goals of treatment are to reduce the symptoms of acute depression, facilitate the patient s return to a premorbid level (before the onset of the illness) of functioning, and prevent further episodes of depression. Whether or not to hospitahze the patient is often the first decision that is made in consideration of the patient s risk of suicide, physical state of health, social support system, and presence of a psychotic and/or catatonic depression. 

Both dispersion and coagulation states are apparently included under dementia praecox. Since the coagulation form of catatonic excitement apparently involves deterioration, it is included at present under dementia praecox. 

Side effects typically effect the CNS, appearing within 2 weeks of therapy and disappearing after drug withdrawal. They include somnolence, headache, tremor, dysarthria, vertigo, confusion, nervousness, irritability, psychotic states, paranoid reactions, catatonic reactions, twitching, ankle clonus, hyperreflexia, visual disturbances, paresis, and seizures. Large doses or concomitant ingestion of alcohol increases the risk of seizures. Cycloserine is contraindicated in individuals with a history of epilepsy and should be used with caution in individuals with a history of depression. 

Catatonia was first described by Karl Kahlbaum in 1874 and was subsequendy classified as a manifestation of schizophrenia by Eugene Bleuler in 1911. It is manifest by statuesque posturing, muscular immobility, mutism, and what seems to be stupor. The muscles are held in a pliant state called waxy flexibility, and the catatonic person obedi-enfly permits himself to be rearranged into awkward positions that may subsequendy be held for hours. 

In another study of the effects of A -THC on yeast-induced pyrexis, carrageenan-induced edema and yeast-induced rat paw hyperesthesia, the following results were obtained (l) The oral antipyretic potency of A -THC is approximately 2 times that of phenylbutazone, (2) A -THC was essentially devoid of antinociceptive activity except at elevated doses which produced a marked catatonic-like state, and (3) A -THC at doses up to and including 100 mg/kg was totally ineffective in reducing or preventing the edematous response. 

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