Cases reported "Catatonia"

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1/6. catatonia and autistic spectrum disorders.

    The phenomenon of catatonic-like states in people with autistic spectrum disorders is discussed in the context of current knowledge about catatonia as it occurs in severe mental illness and, less frequently documented, in conjunction with developmental disorders. The existing literature on catatonic-like states in people with autistic spectrum disorders is summarized, and it is suggested that such states are not directly comparable with the existing concepts of catatonia. A concept of 'autistic catatonia' is outlined in terms of both its phenomenology and its possible aetiological and maintaining factors. A case study is presented that examines this phenomenon from a cognitive neuropsychological perspective, together with implications for everyday management. The implications of this work for both research and clinical practice are discussed.
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2/6. Towards a valid nosography and psychopathology of catatonia in children and adolescents.

    Paraphrasing Taylor and Fink (2003), catatonia needs "a home of its own" in child and adolescent psychiatry. Limited but expanding literature supports that catatonia in children and adolescent can be identified reliably among other childhood conditions, is sufficiently common, treatable with the same specific treatments as adult catatonia (e.g., sedative drugs and electroconvulsive therapy), and can be worsened by other treatments (e.g., antipsychotics). Other findings in child and adolescent catatonia suggest that sex ratio and associated disorders may differ, and the proposed classification of Taylor and Fink (2003) needs modification. Adopting a broader diagnostic schedule may accommodate both child, adolescent, and adult catatonia. A psychomotor automatism variant should be included as a diagnosis, as well as specifiers for associated disorders such as acute nonpsychotic anxious state and pervasive developmental disorder. Duration of illness should be specified as acute or chronic. Regardless of associated psychiatric disorders, this chapter describes a new psychopathological model. Three main modalities of movement dysfunction in catatonic subjects are listed: (1) adherence to delusional ideas leading to a psychomotor automatism (De Clerambault, 1927); (2) resistance to delusional thinking or conviction; and finally (3) hyperanxious states. Case-vignettes illustrate the model, and future research directions are identified.
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3/6. Psychological approaches to chronic catatonia-like deterioration in autism spectrum disorders.

    The psychological dysfunctions that may underlie catatonia-like deterioration in autism spectrum disorders are discussed. Clinical observation suggests that an important factor is ongoing stress. The evidence for this from research and clinical observation is considered. The lack of evidence concerning the most appropriate medical treatments is discussed. A psychological approach designed for individual needs by relevant professionals and applied by parents and/or caregivers is described. This can be helpful whether or not medical treatments are used. It involves detailed holistic assessment of the individual and their circumstances to highlight possible precipitating stress factors in view of their underlying autism and cognitive/psychological functioning. The overall aim of this approach is to restructure the individual's lifestyle, environment and resolve cognitive/psychological factors to reduce the stress. An eclectic approach is used to find individual strategies in order to provide external goals and stimulation to increase motivation and keep the person engaged and active in meaningful and enjoyable pursuits. The approach describes ways of using verbal and physical prompts as external stimuli to overcome the movement difficulties and emphasizes maintaining a predictable structure and routine for each day. The importance of educating caregivers and service providers to understand the catatonia-like behavior is emphasized. Advice is given on management of specific problems such as incontinence, freezing in postures, eating problems, and episodes of excitement.
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4/6. Consistency of symptoms in recurrent catatonia.

    This study examined the consistency of symptom profiles across episodes of catationia. A recently developed standardized examination and symptom scale systematically rates 23 motor signs of catatonia, permitting symptom analysis of recurrent illness. patients from the emergency room or inpatient unit were prospectively examined using the 23-item Bush-Francis catatonia Rating Scale (BFCRS), both on initial presentation and during a later episode of catatonia. Five cases were identified, with a variable interval (mean, 10.7 months; range 4.5 to 20) between episodes. All five met DSM-IV motor criteria for catatonia (293.89) and research criteria of more than two BFCRS signs. They showed a mean of 9.6 (range, 7 to 15) catatonic signs in the first episode, and 9.6 (range, 4 to 14) signs in the second. Of the 23 individual BFCRS motor signs, a mean of 16.6 (range, 13 to 21) showed agreement of signs (absence or presence) between the two episodes. The catatonic syndrome shows consistency of motor symptoms on recurrent episodes and the BFCRS facilitates the systematic study of catatonia.
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5/6. clozapine withdrawal catatonia and neuroleptic malignant syndrome: a case report.

    catatonia as a clozapine withdrawal syndrome has not been documented. We report a case of excited catatonia with fever, autonomic instability, and delirium--a picture of malignant catatonia (lethal catatonia) after abrupt clozapine withdrawal. The use of conventional neuroleptics transformed the excited malignant catatonia into a stuporous state resembling neuroleptic malignant syndrome (NMS). Such a transformation of excited lethal catatonia into NMS has been described in the literature, providing support for the hypothesis that NMS is a variant of catatonia. Opinions, however, have been conflicting whether lethal catatonia and NMS are indistinguishable. We argue that NMS may be regarded as a neuroleptic-induced retarded (stuporous) subtype of malignant catatonia, clinically indistinguishable from nonneuroleptic retarded malignant catatonia but different from the excited form. To differentiate between the two subtypes of malignant catatonia would help resolve the controversy. The nosological status of excited catatonia, a poorly studied condition, remains unclear. The two subtypes of catatonia may differ in pathophysiology and responses to treatment. Clinicians should be alert to catatonia as a possible clozapine withdrawal phenomenon, and excited catatonia deserves more research attention.
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6/6. catatonia in an adolescent with prader-willi syndrome.

    catatonia in children and adolescents has received little research attention. Treatment and course of catatonia in an adolescent patient with prader-willi syndrome are presented. Clinical features of a small series of published case reports of catatonia in children and adolescents are reported. The association between catatonia, prader-willi syndrome, and other neurodevelopmental disorders is discussed.
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