1/103. A case of agitated catatonia.Agitation is one of the diagnostic features of catatonia in the DSM IV classification, but permanent forms of agitated catatonia have occasionally been described. We report the case of a 43-year-old man who had already suffered from undifferentiated schizophrenia for 7 years, and in whom we diagnosed agitated catatonia. While our patient was being treated with a neuroleptic during a second episode of paranoia, a state of agitation was observed which persisted for a further 8 months. During this period, he was treated with several different neuroleptics and benzodiazepines, either alone or in association, without any improvement. No organic cause was found. He was then transferred to our electroconvulsive therapy (ECT) unit, with a diagnosis of schizophrenic agitation resistant to drug therapy. ECT was begun, and he was only given droperidol in case of agitation and alimemazine for insomnia, neither of which had any effect. In view of his persistent agitation without any purpose, echolalia and echopraxia, stereotyped movements with mannerisms and marked mimicking and grimacing, we diagnosed him as having agitated catatonia. After the fourth session of ECT, we decided to stop all treatment and gave him lorazepam at a dose of 12.5 mg daily. Twenty-four hours later, all symptoms of agitation had disappeared. In our opinion, permanent catatonic agitation is not rare. In our case, the neuroleptic treatment maintained and may even have worsened the symptomatology. lorazepam can be used as a therapeutic test for this type of agitation, especially if it does not respond to neuroleptics. This also allows the patient to be sedated rapidly and effectively, thus preventing him from injuring himself further.- - - - - - - - - - ranking = 1keywords = catatonic, schizophrenia (Clic here for more details about this article) |
2/103. catatonia under medication with risperidone in a 61-year-old patient.This report describes the case of a 61-year-old female schizophrenic patient with status post-frontal lobotomy some 35 years ago with prominent paranoid delusions. This woman developed severe catatonia under medication with a serotonergic/dopaminergic neuroleptic, risperidone, at a dose of up to 5 mg daily. The catatonic disorder was dose-dependent and subsided immediately after switching the medication to another atypical antipsychotic, clozapine. Given the negative history for catatonia in this patient, the temporal coincidence of administration of risperidone and catatonia is a novel finding.- - - - - - - - - - ranking = 0.99795015986348keywords = catatonic (Clic here for more details about this article) |
3/103. Case series: catatonic syndrome in young people.This article reviews all recent (1977-1997) reports on catatonic adolescents and summarizes the 9 consecutive cases seen at the authors' institution during the past 6 years. catatonia occurs infrequently in adolescents (0.6% of the inpatient population), but it appears to be a severe syndrome in adolescents of both sexes. Diagnoses associated with catatonia are diverse, including in this series: schizophrenia (n = 6), psychotic depression (n = 1), mania (n = 1), and schizophreniform disorder (n = 1). Two patients had a previous history of pervasive developmental disorder. In the literature, catatonia was also reported in children with organic condition (e.g., epilepsy, encephalitis). Therapeutic management depends on the specific causes, but several points need to be stressed: (1) the frequency of neuroleptic-induced adverse effects; (2) the potential efficacy of sedative drugs on motor signs; (3) the possible use of electroconvulsive therapy; and (4) the necessity to manage family reactions and fears, which are frequent causes of noncooperation. It is concluded that catatonia is an infrequent but severe condition in young people. While symptomatology, etiologies, complications, and treatment are similar to those reported in the adult literature, findings differ with regard to the female-male ratio and the relative frequencies of associated mental disorders.- - - - - - - - - - ranking = 4.9918006394539keywords = catatonic, schizophrenia (Clic here for more details about this article) |
4/103. Malignant catatonia-induced respiratory failure with response to ECT.A 47-year-old acutely psychotic schizophrenic man was diagnosed with malignant catatonia. Because of a history of neuroleptic malignant syndrome (NMS), traditional neuroleptics were avoided, and the patient had been treated with reserpine for a period of 10 years. Symptomatically, severe agitation alternated with severe retardation. The syndrome progressed, despite early termination of any neuroleptic medications, to marked catatonic rigidity and dehydration. Worsening was associated with transfer to a medical intensive care unit, intubation, and subsequently a tracheostomy. dantrolene and bromocriptine were unhelpful. lorazepam produced muscular relaxation and resulting decreases in creatine phosphokinase levels but elicited no other improvement. Eleven bilateral electroconvulsive treatments, however, resolved the respiratory impairment and catatonia and improved the psychosis. This report highlights the efficacy of ECT in lethal catatonia despite respiratory impairment and tracheostomy.- - - - - - - - - - ranking = 0.99795015986348keywords = catatonic (Clic here for more details about this article) |
5/103. Ictal catatonia as a manifestation of de novo absence status epilepticus following benzodiazepine withdrawal.To describe ictal catatonia as a manifestation of de novo absence status epilepticus following benzodiazepine withdrawal. Ictal catatonia was documented by concurrent EEG recordings. A catatonic syndrome, first diagnosed as a psychogenic reaction, was found to be an ictal event by EEG recording. De novo absence status and benzodiazepine withdrawal should be considered when a catatonic syndrome suddenly occurs in elderly patients.- - - - - - - - - - ranking = 1.995900319727keywords = catatonic (Clic here for more details about this article) |
6/103. catatonia, autism, and ECT.We describe the clinical presentation, course, and treatment response of a 14-year-old boy with catatonic stupor. This patient, with a preexisting diagnosis of autism, displayed mutism, akinesia, and an extreme level of rigidity, waxy flexibility, posturing, including the psychological pillow, facial grimacing, and other involuntary movements of his upper extremities. In addition he had symptoms suggestive of a depressive disorder as well as some non-specific psychotic symptoms. Intravenous injection of sodium amytal failed to resolve any motor symptoms, although he showed a good response to the zolpidem test. A course of electroconvulsive therapy (ECT) caused dramatic and sustained relief of catatonic stupor without a change in the symptoms of autism. The presentation of catatonia in autism and the use of ECT in children are discussed, and the available literature reviewed. This is the first description of the use of ECT in the treatment of catatonia coinciding with autism and we confirm its efficacy.- - - - - - - - - - ranking = 1.995900319727keywords = catatonic (Clic here for more details about this article) |
7/103. Significance of abnormal brain perfusion in catatonia: a case report.OBJECTIVE: In this case study, the significance of perfusion abnormalities in catatonia is examined. BACKGROUND: Recurrent catatonic symptoms are frequently observed in psychiatric disorders, but the predictors of relapse of the catatonic symptoms remain unknown. perfusion abnormalities have been reported during catatonic states; however, little is known about brain functioning of catatonic patients during remission. METHOD: A catatonic patient was evaluated by clinical interview, behavioral examination, and functional neuroimaging (single photon emission computed tomography) to determine diagnosis and brain perfusion. RESULTS: The patient exhibited persistent hypoperfusion of the basal ganglia even after achieving symptomatic remission. CONCLUSIONS: These findings predict a secondary cause and may predict a chronic course.- - - - - - - - - - ranking = 4.9897507993174keywords = catatonic (Clic here for more details about this article) |
8/103. lithium carbonate in prophylaxis of reappearing catatonic stupor: case report.The case of a patient with reappearing stupor, accompanied by auditory hallucinations and persecutory ideas during the periods and not with alternating excitement, is reported. After 24 years of neuroleptics medication with little effect, the lithium carbonate regimen was started, which showed a remarkable prophylactic effect. The implications of lithium carbonate treatment for recurrent psychosis are discussed.- - - - - - - - - - ranking = 3.9918006394539keywords = catatonic (Clic here for more details about this article) |
9/103. Oneiroid syndrome: a concept of use for western psychiatry.Oneiroid syndrome (OS), or dream-like fantastic delusional derangement of consciousness, is characterized by a kaleidoscopic quality of psychopathological experiences, wherein reality, illusions and hallucinations are merged into one. It is typically accompanied by motor and, in particular, catatonic disturbances. This syndrome is an uncommon psychiatric state, which is hardly mentioned in standard psychiatric textbooks. OS is a neglected entity among DSM-oriented psychiatrists because it deals with a phenomenological approach in contrast to the European attitude, which deals with detailed clinical descriptions. Here, we propose detailed clinical descriptions with a number of consecutive stages of the OS development, illustrated by two vignettes with typical variants of oneiroid syndrome, in order to raise the awareness of psychiatrists who are not familiar with this state, and to try to open a window to the inner life of those patients suffering from this syndrome. These cases may also serve as illustration of certain principles which, when understood, may be found to lead in turn to a deeper knowledge of the psychopathology of other more commonplace conditions.- - - - - - - - - - ranking = 0.99795015986348keywords = catatonic (Clic here for more details about this article) |
10/103. ECT for prolonged catatonia.OBJECTIVE AND BACKGROUND: electroconvulsive therapy (ECT) is highly effective for acute catatonia but its use in prolonged catatonia is not well established. We report three cases of prolonged catatonia with medical complications or comorbidities treated by ECT. METHOD: case reports. RESULTS: A 24 year-old woman developed fever and autonomic instability after parenteral neuroleptics. catatonia and autonomic signs persisted for 14 weeks. After minimal improvement from lorazepam, 15 bilateral ECTs led to resolution. A 26-year-old woman with a history of lupus erythematosus, complicated by lupus cerebritis with lesions in the cortex and basal ganglia and a communicating hydrocephalus, was catatonic for 9 weeks. lorazepam produced marginal improvement. A series of 14 bilateral ECTs led to improved mobility, speech, and interaction, but the response was less robust than Case 1. A 40-year-old man with mental retardation and intermittent psychosis developed severe neuroleptic malignant syndrome and remained catatonic for 4 months. After lorazepam produced minimal improvement, his catatonia resolved with 20 bilateral ECTs. CONCLUSIONS: ECT may improve prolonged catatonia with complex medical comorbidities, but may require many treatment sessions. Gross cerebral pathology may predict a less robust response. As for acute catatonia, ECT may resolve prolonged catatonia after benzodiazepines have failed.- - - - - - - - - - ranking = 1.995900319727keywords = catatonic (Clic here for more details about this article) |
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