Catatonic type

Catatonic type stupor, negativism, rigidity, bizarre posturing, and excessive motor activity... 

Catatonia (withdrawn type) is characterized by prolonged immobility, waxy flexibility, posturing, and grimacing. Because catatonic symptoms can also occur in other types of psychosis, they are not specific to schizophrenia. 

Four major and five minor clinical patterns of acute phencyclidine intoxication have been described in 1000 patients (7). Major patterns were acute brain syndrome (24.8%), toxic psychosis (16.6%), catatonic syndrome (11.7%), and coma (10.6%). Minor patterns included lethargy or stupor (3.8%) and combinations of bizarre behavior, violence, agitation, and euphoria in patients who were alert and oriented (32.5%). Patients with major patterns of toxicity usually required hospitalization and had most of the complications. Patients with minor patterns generally had mild intoxication and did not require hospitalization, except for treatment of injuries or autonomic effects of phencyclidine. There were various types of injuries in 16%, and aspiration pneumonia in 1.0%. There were 22 cases of rhabdomyolysis (2.2%), and three patients required dialysis for renal insufficiency. One patient who had been comatose died suddenly with a pulmonary embolism. 

For a diagnosis of schizophrenia, these three phases must last more than six months and must not be due to a mood disorder. Three types of schizophrenia are delineated catatonic (prominent movement disorder), disorganized (severe thought disorganization), and paranoid (prominent paranoid delusions with mild disorganization of thinking). Undifferentiated and residual types are categories for those who do not fit the above three types but have a mix of features. 

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. 

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