Schizophrenia catatonic

The fact that P(3HB-co-4HB) and P(4HB) are also polymers with potential therapeutic applications has been pointed out in a review [6]. The 4HB units are pharmacologically active compounds, which have been used in the treatment of alcohol withdrawal syndrome [239,240] and narcolepsy [241]. Other potential applications include the treatment of patients with chronic schizophrenia, catatonic schizophrenia, atypical psychoses, chronic brain syndrome, neurosis, drug addiction and withdrawal, Parkinson s disease and other neuropharmacological illnesses, hypertension, ischaemia, circulatory collapse, radiation exposure, cancer and myocardial infarction [242]. 

Kaiser, R., Konneker, M., Henneken, M. et al. (2000). Dopamine D4 receptor 48-bp repeat polymorphism no association with response to antipsychotic treatment, but association with catatonic schizophrenia. Mol. Psychiatry, 5, 418-24. 

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. 

Catatonia (withdrawn type) is characterized by prolonged immobility, waxy flexibility, posturing, and grimacing.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. 

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). 

Martenyi F, Harangozo J, Laszio M. Clonazepam for the treatment of catatonic schizophrenia. Am J Psychiatry 1989 146 1230. 

Catatonic forms of schizophrenia are best managed by intravenous benzodiazepines. After catatonia has ended, antipsychotic drugs may be needed to treat psychotic components of that form of the illness, and remain the mainstay of treatment for this condition. Unfortunately, many patients show little... 

Salokangas RKR, Honkonen T, Stengard E, Koivisto A-M, Hietala J. Negative symptoms and neuroleptics in catatonic schizophrenia. Schizophr Res 2002 59 73-6. 

Catatonic schizophrenia is a controversial syndrome, and there is debate about its etiology and treatment. There has been a report of two cases of catatonic schizophrenia successfully treated with clozapine a 49-year-old woman and a 19-year-old man (18). Both responded to clozapine despite being resistant to several conventional and atypical antipsychotic drugs and, in the second case, a course of electroconvulsive therapy. These two cases are intriguing, because the dose of clozapine required to improve catatonia was about double the dose required to improve psychosis significantly (600 mg/day and 750 mg/day). The two patients had common adverse effects of clozapine the first had mild nocturnal hypersalivation and mild/moderate constipation, and the second had moderate nocturnal hypersalivation. 

Dursun SM, Hallak JE, Haddad P, Leahy A, Byrne A, Strickland PL, Anderson IM, Zuardi AW, Deakin JF. Clozapine monotherapy for catatonic schizophrenia should clozapine be the treatment of choice, with catatonia rather than psychosis as the main therapeutic index J Psychopharmacol 2005 19 432-3. 

A woman with paranoid schizophrenia developed catatonia 5 days after the abrupt withdrawal of olanzapine and alprazolam (26). The catatonic symptoms included mutism, prostration, waxy flexibility, oculogyric movements, and an inability to swallow. Her symptoms disappeared after administration of alprazolam and haloperidol, and there was no recurrence. 

Traditionally, schizophrenia has been subclassified into several categories, including paranoid, catatonic, hebephrenic, and undifferentiated. Paranoid schizophrenia is characterized by predominately delusions and hallucinations, wtith relatively preserved inteipersonal abilities. Catatonic schizophrenia is characterized by predominant motor features, w hile hebephrenic schizophrenia is characterized by a shallow and silly display of emotions. Undifferentiated schizophrenia has predominately negative symptoms. For reasons that are not clear, the prevalence of catatonic and hebephrenic schizophrenia has decreased in the last few decades. 

Takahashi H. Acnte dystonia indnced by adding midodrine, a selective alpha 1 agonist, to risperidone in a patient with catatonic schizophrenia. J Nenropsychiatry Qin Nenrosci 2000 12(2) 285-6. 

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. 

Behavioral effects of PCP range from sleep to catatonic detachment to paranoid psychosis to violent hostility. Users are sometimes amnestic for events that occur under the influence of the drug. Psychoses sometimes last for weeks. Users with a previous history of schizophrenia are especially susceptible to the psychotomimetic effects of the drug. The only truly characteristic behavioral effect of PCP use is its high unpredictability. The signs and symptoms of PCP intoxication are summarized in Table 64-4. 

Schizophrenia A major mental disorder lasting more than 6 months and characterized in part by thought disturbances, misinterpretations of reality, mood change (including blunted affect and inappropriate moods), communication problems (poverty of speech and coherence), and bizarre, withdrawn, or regressive behaviors. The five subtypes are disorganized, catatonic, paranoid, undifferentiated, and residual. 

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 November 1950,1 studied the effect of bulbocapnine on rats, and published the results in the Archives of Neurology and Psychiatry. Bulbocapnine produces all of the motor manifestations of catatonic schizophrenia in human beings. The drug is an aporphine isoquinoline alkaloid that decreases dopaminergic activity in the brain, and inhibits tyrosine hydroxylase, the rate-limiting enzyme in the catecholamine biosynthesis. 

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