BACKGROUND Catatonic syndrome is a mental health issue,as well as a medical,neurological,and toxic condition.There are few published data on catatonic syndrome in African countries and none in Sudan,the third-largest ...BACKGROUND Catatonic syndrome is a mental health issue,as well as a medical,neurological,and toxic condition.There are few published data on catatonic syndrome in African countries and none in Sudan,the third-largest African country.AIM To assess the prevalence and presenting symptoms of catatonic syndrome in an acute psychiatric inpatient population in four governmental psychiatric hospitals in Sudan.METHODS A cross-sectional study was conducted in four psychiatric hospitals in the capital,Khartoum,in Sudan.The data were collected using an interviewer-administered questionnaire tool,which included sociodemographic data(age,sex,educational level,marital status,and residence).Signs and symptoms of catatonic syndrome were assessed using the Bush–Francis Catatonia Rating Scale(BFCRS)and the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)diagnostic criteria.χ^(2) tests were used to compare categorized variables.Multivariate analysis was not performed because none of the variables were found to be different between patients with and without catatonic syndrome.RESULTS Of the 384 patients,50.0%and 49.3%were males and females,respectively,and their median age was 30.0 years.One hundred and sixty-three(42.4%)patients had catatonic syndrome according to the BFCRS criteria.Of these patients,104 fulfilled the DSM-5 criteria,with a 27.1%prevalence of catatonic syndrome.Echopraxia/echolalia(84.5%),mutism(71.2%),posturing/catalepsy(67.3%),and mannerisms(66.3%)were the main manifestations among patients with catatonic syndrome.There was no significant difference in age,sex,marital status,or job between patients with and those without catatonic syndrome.Of the 163 patients with catatonic syndrome,31.3%had bipolar disorder,28.2%had schizophrenia,and 19.6%had major depressive disorder.CONCLUSION Catatonic syndrome is highly prevalent in an acute psychiatric inpatient population in Sudan regardless of age or sex.Echopraxia/echolalia(84.5%)and mutism were the main manifestations among the patients with catatonic syndrome.展开更多
Autism spectrum disorder(ASD)is an early-onset neurodevelopmental disorder marked by persistent deficits in social communication and interaction,alongside restricted,repetitive patterns of behaviors(RRB),interests,or ...Autism spectrum disorder(ASD)is an early-onset neurodevelopmental disorder marked by persistent deficits in social communication and interaction,alongside restricted,repetitive patterns of behaviors(RRB),interests,or activities.It often co-occurs with various neuropsychiatric disorders,though their frequency varies widely due to unclear boundaries between the core features of ASD and common comorbidities.Catatonia,increasingly noted in neurodevelopmental conditions like ASD,shares striking similarities with ASD in symptomatology,brain mech-anisms,and treatment responses,prompting the question of whether it is a core feature of ASD or a distinct condition.This paper delved into this overlap,ex-ploring the relationship between catatonia and ASD through a narrative review of peer-reviewed literature from 1943 to 2024,sourced from PubMed and psy-chiatric journals.Focusing on ASD diagnostic evolution,symptom overlap with catatonia,and shared neurobiological and therapeutic characteristics,we used thematic analysis to synthesize findings into key areas such as historical nosology,phenomenological overlap,neurobiological parallels,and treatment response.The evidence revealed weak support for separating catatonia from overlapping RRB features of ASD,suggesting that some RRB might align more with comorbid catatonia than intrinsic ASD traits.However,this idea needs further validation through rigorous clinical trials.Clarifying this relationship could refine diagnostic approaches and open doors to targeted treatments,potentially improving out-comes for those affected.展开更多
BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neu...BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neuropsychiatric presentations,such as catatonia.CASE SUMMARY We present a case of an adolescent male patient with first-onset SLE who presented with neuropsychiatric symptoms including epilepsy and delirium.The initial utilization of olanzapine to alleviate symptoms of agitation precipitated the emergence of catatonia,which was mitigated by discontinuing olanzapine and supplementing with lorazepam.In this case,whether the catatonia was secondary to the utilization of antipsychotics or to an organic disease is a question that warrants differential diagnosis.CONCLUSION Multidisciplinary collaborative management is the cornerstone for the successful management of severe cases of SLE.展开更多
This editorial addresses catatonia,a complex neuropsychiatric syndrome characterised by a spectrum of psychomotor disturbances.The editorial seeks to clarify the ambiguous aspects of catatonia,integrating recent resea...This editorial addresses catatonia,a complex neuropsychiatric syndrome characterised by a spectrum of psychomotor disturbances.The editorial seeks to clarify the ambiguous aspects of catatonia,integrating recent research findings,including global studies and diagnostic advancements.It discusses catatonia’s clinical manifestations,prevalence,and associated psychiatric and medical conditions,with particular emphasis on its frequent co-occurrence with schizophrenia and mood disorders.The prevalence of catatonia,which varies across psychiatric populations,is illustrated by a significant study conducted in Nelson Mandela Bay,South Africa.This study provides valuable insights into the effectiveness of the Bush-Francis Screening Instrument compared to the Diagnostic and Statistical Manual 5 criteria in diagnosing catatonia.The editorial evaluates treatment approaches,primarily focusing on benzodiazepines and electroconvulsive therapy,and discusses emerging therapeutic strategies.It underscores the importance of robust diagnostic frameworks and early intervention in managing catatonia,as recommended by the latest evidence-based consensus guideline.Furthermore,it suggests future research directions,particularly in exploring the neurobiological and genetic factors of catatonia,to enhance our understanding and improve treatment outcomes.This editorial succinctly aims to demystify catatonia and provide valuable insights for clinicians and researchers in mental health care.展开更多
Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Al...Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course,a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions.In his classification system,Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox(schizophrenia)disease entity.Because of the substantial influence of Kraepelin’s classification,catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century.However,with the advent of the psychopharmacotherapy era starting from the early 1950s,interest in catatonia in both clinical practice and research subsided until the early 2000s.The past two decades have witnessed a resurgence of interest in catatonia.The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition,marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions.The introduction of an independent diagnostic category termed“Catatonia Not Otherwise Specified”significantly stimulated research in this field.The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.展开更多
Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is c...Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is characterized by immobility, mutism, staring, rigidity, and a host of other clinical signs. Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. In many cases, the catatonia must be treated before any underlying conditions can be accurately diagnosed. Most patients with the syndrome respond rapidly to low-dose benzodiazepines, but electroconvulsive therapy is occasionally required. Patients with longstanding catatonia or a diagnosis of schizophrenia may be less likely to respond. The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors. Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome. Since 1989, we have systematically assessed patients presenting to our psychiatry service with signs of retarded catatonia. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated.展开更多
Kahlbaum was the first to propose catatonia as a separate disease following the example of general paresis of the insane,which served as a model for establishing a nosological entity.However,Kahlbaum was uncertain abo...Kahlbaum was the first to propose catatonia as a separate disease following the example of general paresis of the insane,which served as a model for establishing a nosological entity.However,Kahlbaum was uncertain about the nosological position of catatonia and considered it a syndrome,or "a temporary stage or a part of a complex picture of various disease forms".Until recently,the issue of catatonia as a separate diagnostic category was not entertained,mainly due to a misinterpretation of Kraepelin's influential views on catatonia as a subtype of schizophrenia.Kraepelin concluded that patients presenting with persistent catatonic symptoms,which he called "genuine catatonic morbid symptoms",particularly including negativism,bizarre mannerisms,and stereotypes,had a poor prognosis similar to those of paranoid and hebephrenic presentations.Accordingly,catatonia was classified as a subtype of dementia praecox/schizophrenia.Despite Kraepelin's influence on psychiatric nosology throughout the 20 th century,there have only been isolated attempts to describe and classify catatonia outside of the Kraepelinian system.For example,the Wernicke-KleistLeonhard school attempted to comprehensively elucidate the complexities of psychomotor disturbances associated with major psychoses.However,the Leonhardian categories have never been subjected to the scrutiny of modern investigations.The first three editions of the DSM included the narrow and simplified version of Kraepelin's catatonia concept.Recent developments in catatonia research are reflected in DSM-5,which includes three diagnostic categories: Catatonic Disorder due to Another Medical Condition,Catatonia Associated with another Mental Disorder(Catatonia Specifier),and Unspecified Catatonia.Additionally,the traditional category of catatonic schizophrenia has been deleted.The Unspecified Catatonia category could encourage research exploring catatonia as an independent diagnostic entity.展开更多
BACKGROUND Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated,even though its classification has evolved in recent years.Prompt and correct identification of catatonia allows for hi...BACKGROUND Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated,even though its classification has evolved in recent years.Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications.The underrecognition of catatonia in older patients is also frequent,and research in this population is scarce.AIM To conduct a systematic review of the literature on catatonia in older people to ascertain its clinical characteristics across settings.METHODS Following the PRISMA guidelines,MEDLINE,EMBASE,and PsycINFO databases were searched from inception to December 2021,with a strategy aimed at identifying all articles published on catatonia in older adults.Titles and abstracts were scanned and selected independently by two authors.Papers investigating issues related to catatonia and/or catatonic symptoms in older people,with English abstracts available,were included.References of selected articles were revised to identify other relevant studies.RESULTS In total,1355 articles were retrieved.After removing duplicates,879 remained.Of the 879 identified abstracts,669 were excluded because they did not meet the inclusion criteria.A total of 210 articles underwent full text review,and 51 were eliminated for various reasons.Fourteen more articles were selected from the references.Overall,173 articles were reviewed:108 case reports,35 case series,11 prospective cohort studies,6 case-control studies,3 retrospective cohort studies and 10 reviews.We found several particular aspects of catatonia in this population.Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology.Older patients,compared to younger patients,have a higher risk of developing catatonia with benzodiazepine(BZD)withdrawal,in bipolar disorder,and in the general hospital.Age,together with other risk factors,was significantly associated with the incidence of deep venous thrombosis,neuroleptic malignant syndrome poor outcome,other complications and mortality.Treatment with BZDs and electroconvulsive therapy is safe and effective.Prompt treatment of its cause is essential to ensure a good prognosis.CONCLUSION Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology.The risk of developing catatonia in some settings and conditions,as well as of developing complications,is high in this population.Symptomatic treatment is safe and effective,and timely etiologic treatment is fundamental.展开更多
Background: Many studies in the 20<sup>th</sup> century have reported an association between Schizophrenia and Catatonia. Structural brain abnormalities have also been found in many psychotic illnesses, in...Background: Many studies in the 20<sup>th</sup> century have reported an association between Schizophrenia and Catatonia. Structural brain abnormalities have also been found in many psychotic illnesses, including schizophrenia and there are findings of association of large ventricles with chronic and deteriorating psychosis. It is possible that a large ventricular system may increase the likelihood of catatonia with a chronic course. Cavum Septum Pellucidum (CSP) and Cavum Vergae (CV) are structural abnormalities that have been associated with Schizophrenia. This is a case report of the presence of persistent CSP and CV in a patient diagnosed with schizophrenia with catatonia. Conclusion: Although there are several reports of the findings of a persistent large CSP and CV in patients with Schizophrenia, it is questionable whether the CSP and CV are the cause of the Catatonia or their occurrence is a mere coincidence.展开更多
In the award-winning and widely-acclaimed fictional novel,The Vegetarian,the author,Han Kang,relates a compelling and dramatic story of inexorable psychotic deterioration from the perspective of a tragically affected ...In the award-winning and widely-acclaimed fictional novel,The Vegetarian,the author,Han Kang,relates a compelling and dramatic story of inexorable psychotic deterioration from the perspective of a tragically affected young woman and her close family members.Apart from a variety of interpretations of psychosis from historical,social,psychological,and feminist perspectives,the book also presents a detailed and realistic picture of objective psychotic symptoms that reveals insights into historic and nearly forgotten phenomenological concepts.In this literary case study,we analyze the symptoms remarkably described by the author and briefly review the medical literature on the phenomena of catatonia,schizophrenic autism,paragnomen and the praecox-feeling.展开更多
Catatonia is a psychomotor syndrome that can occur in a broad spectrum of brain disorders,including schizophrenia.Current findings suggest that the neurobiological process underlying catatonia symptoms in schizophreni...Catatonia is a psychomotor syndrome that can occur in a broad spectrum of brain disorders,including schizophrenia.Current findings suggest that the neurobiological process underlying catatonia symptoms in schizophrenia is poorly understood.However,emerging neuroimaging studies in catatonia patients have indicated that a disruption in anatomical connectivity of the cortico-striatal-cerebellar system is part of the neurobiology of catatonia,which could serve as a target of neurostimulation such as electroconvulsive therapy and repetitive transcranial magnetic stimulation.展开更多
Purpose: Cotard’s syndrome, Alice in Wonderland Syndrome, and Catatonia are all rare psychiatric disorders that have relatively little research regarding their treatments. The aim of this article is to highlight any ...Purpose: Cotard’s syndrome, Alice in Wonderland Syndrome, and Catatonia are all rare psychiatric disorders that have relatively little research regarding their treatments. The aim of this article is to highlight any gaps in knowledge regarding represented demographics in these treatment studies, and to discuss the current and upcoming treatment options. Background: This literature review explores under-researched psychiatric conditions: Cotard’s syndrome, Alice in Wonderland syndrome, and Catatonic Schizophrenia. Understanding psychiatric disorders requires basic knowledge of brain anatomy. These conditions are often result of or associated with neurological issues, such as migraines or tumors. The brain has eight lobes, two of four kinds: frontal, parietal, occipital, and temporal lobes, which all govern different functions and abilities. Frontal lobes control judgment, decision-making, personality traits, and fine motor movements. Parietal lobes interpret pain and temperature, occipital lobes handle visual stimuli, and temporal lobes enable hearing. The pre-frontal cortex is associated with high intelligence, psychotic traits, and psychosis. The Broca’s Area in the frontal lobes controls expressive language. These areas and divisions of the brain contribute to the complexity of the psychiatric disorders discussed in this review. Introduction: Cotard’s syndrome is a psychiatric disorder characterized by delusions of being dead or not having certain limbs or organs. It is believed that there is a disconnect between their fusiform face area and the amygdala, causing a lack of familiarity between one’s mind and body. Alice in Wonderland Syndrome (AIWS) is another psychiatric disorder which is characterized by visual hallucinations, such as distorted perceptions of color, size, distance, and speed. The most common symptoms include micropsia and macropsia. Catatonia/Catatonic Schizophrenia is an uncommon type of schizophrenia. This type of schizophrenia is characterized by motor rigidity, verbal rigidity, the flat effect, psychomotor retardation, waxy flexibility, and overall negative symptoms. Thus, these people may come off as emotionally detached, and able to stay frozen in odd positions for periods on end. Treatments and Results: Cotard’s syndrome seemed to be most effectively treated by ECT (electroconvulsive therapy). Alice in Wonderland Syndrome (AIWS) had the highest positive responses to treatment by Valproate (an anti-epileptic drug), as well as intervention to treat the associated neurological conditions they had. Catatonia/Catatonic Schizophrenia seemed to be most effectively treated with a combination of benzodiazepines and ECT. Discussion and Demographics: In all 3 disorders, the Latino and African communities were underrepresented. There also seemed to be an underrepresentation of men in Cotard’s syndrome, and of women in Alice in Wonderland Syndrome. Japan and India seemed to have the highest density of treatment studies in all 3 disorders.展开更多
Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelop-mental, physical and toxic conditions. From our system...Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelop-mental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy(ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient's medical condition. Little is known about the long-term treatment outcomes following administration of ECT for catatonia. The presence of a concomitant chronic neurologic disease or extrapyramidal deficit seems to be related to ECT non-response. On the contrary, the presence of acute, severe and psychotic mood disorder is associated with good response. Severe psychotic features in responders may be related with a prominent GABAergic mediated deficit in orbitofrontal cortex, whereas non-responders may be characterized by a prevalent dopaminergic mediated extrapyramidal deficit. These observations are consistent with the hypothesis that ECT is more effective in "top-down" variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in "bottom-up" variant, in which an extrapyramidal dysregulation may be prevalent. Future research should focus on ECT response in different subtype of catatonia and on efficacy of maintenance ECT in long-term prevention of recurrent catatonia. Further research on mechanism of action of ECT in catatonia may also contribute to the development of other brain stimulation techniques.展开更多
基金Supported by The Deanship of Graduate Studies and Scientific Research at Qassim University,No.QU-APC-2025.
文摘BACKGROUND Catatonic syndrome is a mental health issue,as well as a medical,neurological,and toxic condition.There are few published data on catatonic syndrome in African countries and none in Sudan,the third-largest African country.AIM To assess the prevalence and presenting symptoms of catatonic syndrome in an acute psychiatric inpatient population in four governmental psychiatric hospitals in Sudan.METHODS A cross-sectional study was conducted in four psychiatric hospitals in the capital,Khartoum,in Sudan.The data were collected using an interviewer-administered questionnaire tool,which included sociodemographic data(age,sex,educational level,marital status,and residence).Signs and symptoms of catatonic syndrome were assessed using the Bush–Francis Catatonia Rating Scale(BFCRS)and the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)diagnostic criteria.χ^(2) tests were used to compare categorized variables.Multivariate analysis was not performed because none of the variables were found to be different between patients with and without catatonic syndrome.RESULTS Of the 384 patients,50.0%and 49.3%were males and females,respectively,and their median age was 30.0 years.One hundred and sixty-three(42.4%)patients had catatonic syndrome according to the BFCRS criteria.Of these patients,104 fulfilled the DSM-5 criteria,with a 27.1%prevalence of catatonic syndrome.Echopraxia/echolalia(84.5%),mutism(71.2%),posturing/catalepsy(67.3%),and mannerisms(66.3%)were the main manifestations among patients with catatonic syndrome.There was no significant difference in age,sex,marital status,or job between patients with and those without catatonic syndrome.Of the 163 patients with catatonic syndrome,31.3%had bipolar disorder,28.2%had schizophrenia,and 19.6%had major depressive disorder.CONCLUSION Catatonic syndrome is highly prevalent in an acute psychiatric inpatient population in Sudan regardless of age or sex.Echopraxia/echolalia(84.5%)and mutism were the main manifestations among the patients with catatonic syndrome.
文摘Autism spectrum disorder(ASD)is an early-onset neurodevelopmental disorder marked by persistent deficits in social communication and interaction,alongside restricted,repetitive patterns of behaviors(RRB),interests,or activities.It often co-occurs with various neuropsychiatric disorders,though their frequency varies widely due to unclear boundaries between the core features of ASD and common comorbidities.Catatonia,increasingly noted in neurodevelopmental conditions like ASD,shares striking similarities with ASD in symptomatology,brain mech-anisms,and treatment responses,prompting the question of whether it is a core feature of ASD or a distinct condition.This paper delved into this overlap,ex-ploring the relationship between catatonia and ASD through a narrative review of peer-reviewed literature from 1943 to 2024,sourced from PubMed and psy-chiatric journals.Focusing on ASD diagnostic evolution,symptom overlap with catatonia,and shared neurobiological and therapeutic characteristics,we used thematic analysis to synthesize findings into key areas such as historical nosology,phenomenological overlap,neurobiological parallels,and treatment response.The evidence revealed weak support for separating catatonia from overlapping RRB features of ASD,suggesting that some RRB might align more with comorbid catatonia than intrinsic ASD traits.However,this idea needs further validation through rigorous clinical trials.Clarifying this relationship could refine diagnostic approaches and open doors to targeted treatments,potentially improving out-comes for those affected.
基金Supported by STI2030-Major Projects,No.2021ZD0202001Capital Funds for Health Improvement and Research,No.CFH 2022-2-4012.
文摘BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neuropsychiatric presentations,such as catatonia.CASE SUMMARY We present a case of an adolescent male patient with first-onset SLE who presented with neuropsychiatric symptoms including epilepsy and delirium.The initial utilization of olanzapine to alleviate symptoms of agitation precipitated the emergence of catatonia,which was mitigated by discontinuing olanzapine and supplementing with lorazepam.In this case,whether the catatonia was secondary to the utilization of antipsychotics or to an organic disease is a question that warrants differential diagnosis.CONCLUSION Multidisciplinary collaborative management is the cornerstone for the successful management of severe cases of SLE.
文摘This editorial addresses catatonia,a complex neuropsychiatric syndrome characterised by a spectrum of psychomotor disturbances.The editorial seeks to clarify the ambiguous aspects of catatonia,integrating recent research findings,including global studies and diagnostic advancements.It discusses catatonia’s clinical manifestations,prevalence,and associated psychiatric and medical conditions,with particular emphasis on its frequent co-occurrence with schizophrenia and mood disorders.The prevalence of catatonia,which varies across psychiatric populations,is illustrated by a significant study conducted in Nelson Mandela Bay,South Africa.This study provides valuable insights into the effectiveness of the Bush-Francis Screening Instrument compared to the Diagnostic and Statistical Manual 5 criteria in diagnosing catatonia.The editorial evaluates treatment approaches,primarily focusing on benzodiazepines and electroconvulsive therapy,and discusses emerging therapeutic strategies.It underscores the importance of robust diagnostic frameworks and early intervention in managing catatonia,as recommended by the latest evidence-based consensus guideline.Furthermore,it suggests future research directions,particularly in exploring the neurobiological and genetic factors of catatonia,to enhance our understanding and improve treatment outcomes.This editorial succinctly aims to demystify catatonia and provide valuable insights for clinicians and researchers in mental health care.
文摘Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course,a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions.In his classification system,Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox(schizophrenia)disease entity.Because of the substantial influence of Kraepelin’s classification,catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century.However,with the advent of the psychopharmacotherapy era starting from the early 1950s,interest in catatonia in both clinical practice and research subsided until the early 2000s.The past two decades have witnessed a resurgence of interest in catatonia.The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition,marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions.The introduction of an independent diagnostic category termed“Catatonia Not Otherwise Specified”significantly stimulated research in this field.The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.
文摘Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is characterized by immobility, mutism, staring, rigidity, and a host of other clinical signs. Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. In many cases, the catatonia must be treated before any underlying conditions can be accurately diagnosed. Most patients with the syndrome respond rapidly to low-dose benzodiazepines, but electroconvulsive therapy is occasionally required. Patients with longstanding catatonia or a diagnosis of schizophrenia may be less likely to respond. The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors. Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome. Since 1989, we have systematically assessed patients presenting to our psychiatry service with signs of retarded catatonia. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated.
文摘Kahlbaum was the first to propose catatonia as a separate disease following the example of general paresis of the insane,which served as a model for establishing a nosological entity.However,Kahlbaum was uncertain about the nosological position of catatonia and considered it a syndrome,or "a temporary stage or a part of a complex picture of various disease forms".Until recently,the issue of catatonia as a separate diagnostic category was not entertained,mainly due to a misinterpretation of Kraepelin's influential views on catatonia as a subtype of schizophrenia.Kraepelin concluded that patients presenting with persistent catatonic symptoms,which he called "genuine catatonic morbid symptoms",particularly including negativism,bizarre mannerisms,and stereotypes,had a poor prognosis similar to those of paranoid and hebephrenic presentations.Accordingly,catatonia was classified as a subtype of dementia praecox/schizophrenia.Despite Kraepelin's influence on psychiatric nosology throughout the 20 th century,there have only been isolated attempts to describe and classify catatonia outside of the Kraepelinian system.For example,the Wernicke-KleistLeonhard school attempted to comprehensively elucidate the complexities of psychomotor disturbances associated with major psychoses.However,the Leonhardian categories have never been subjected to the scrutiny of modern investigations.The first three editions of the DSM included the narrow and simplified version of Kraepelin's catatonia concept.Recent developments in catatonia research are reflected in DSM-5,which includes three diagnostic categories: Catatonic Disorder due to Another Medical Condition,Catatonia Associated with another Mental Disorder(Catatonia Specifier),and Unspecified Catatonia.Additionally,the traditional category of catatonic schizophrenia has been deleted.The Unspecified Catatonia category could encourage research exploring catatonia as an independent diagnostic entity.
文摘BACKGROUND Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated,even though its classification has evolved in recent years.Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications.The underrecognition of catatonia in older patients is also frequent,and research in this population is scarce.AIM To conduct a systematic review of the literature on catatonia in older people to ascertain its clinical characteristics across settings.METHODS Following the PRISMA guidelines,MEDLINE,EMBASE,and PsycINFO databases were searched from inception to December 2021,with a strategy aimed at identifying all articles published on catatonia in older adults.Titles and abstracts were scanned and selected independently by two authors.Papers investigating issues related to catatonia and/or catatonic symptoms in older people,with English abstracts available,were included.References of selected articles were revised to identify other relevant studies.RESULTS In total,1355 articles were retrieved.After removing duplicates,879 remained.Of the 879 identified abstracts,669 were excluded because they did not meet the inclusion criteria.A total of 210 articles underwent full text review,and 51 were eliminated for various reasons.Fourteen more articles were selected from the references.Overall,173 articles were reviewed:108 case reports,35 case series,11 prospective cohort studies,6 case-control studies,3 retrospective cohort studies and 10 reviews.We found several particular aspects of catatonia in this population.Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology.Older patients,compared to younger patients,have a higher risk of developing catatonia with benzodiazepine(BZD)withdrawal,in bipolar disorder,and in the general hospital.Age,together with other risk factors,was significantly associated with the incidence of deep venous thrombosis,neuroleptic malignant syndrome poor outcome,other complications and mortality.Treatment with BZDs and electroconvulsive therapy is safe and effective.Prompt treatment of its cause is essential to ensure a good prognosis.CONCLUSION Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology.The risk of developing catatonia in some settings and conditions,as well as of developing complications,is high in this population.Symptomatic treatment is safe and effective,and timely etiologic treatment is fundamental.
文摘Background: Many studies in the 20<sup>th</sup> century have reported an association between Schizophrenia and Catatonia. Structural brain abnormalities have also been found in many psychotic illnesses, including schizophrenia and there are findings of association of large ventricles with chronic and deteriorating psychosis. It is possible that a large ventricular system may increase the likelihood of catatonia with a chronic course. Cavum Septum Pellucidum (CSP) and Cavum Vergae (CV) are structural abnormalities that have been associated with Schizophrenia. This is a case report of the presence of persistent CSP and CV in a patient diagnosed with schizophrenia with catatonia. Conclusion: Although there are several reports of the findings of a persistent large CSP and CV in patients with Schizophrenia, it is questionable whether the CSP and CV are the cause of the Catatonia or their occurrence is a mere coincidence.
文摘In the award-winning and widely-acclaimed fictional novel,The Vegetarian,the author,Han Kang,relates a compelling and dramatic story of inexorable psychotic deterioration from the perspective of a tragically affected young woman and her close family members.Apart from a variety of interpretations of psychosis from historical,social,psychological,and feminist perspectives,the book also presents a detailed and realistic picture of objective psychotic symptoms that reveals insights into historic and nearly forgotten phenomenological concepts.In this literary case study,we analyze the symptoms remarkably described by the author and briefly review the medical literature on the phenomena of catatonia,schizophrenic autism,paragnomen and the praecox-feeling.
基金supported by the grant support of Fourth Military Medical University and National Natural Science Foundation of China (82271949)supported by Shanghai Sailing Pr ogr am (21YF1402400).
文摘Catatonia is a psychomotor syndrome that can occur in a broad spectrum of brain disorders,including schizophrenia.Current findings suggest that the neurobiological process underlying catatonia symptoms in schizophrenia is poorly understood.However,emerging neuroimaging studies in catatonia patients have indicated that a disruption in anatomical connectivity of the cortico-striatal-cerebellar system is part of the neurobiology of catatonia,which could serve as a target of neurostimulation such as electroconvulsive therapy and repetitive transcranial magnetic stimulation.
文摘Purpose: Cotard’s syndrome, Alice in Wonderland Syndrome, and Catatonia are all rare psychiatric disorders that have relatively little research regarding their treatments. The aim of this article is to highlight any gaps in knowledge regarding represented demographics in these treatment studies, and to discuss the current and upcoming treatment options. Background: This literature review explores under-researched psychiatric conditions: Cotard’s syndrome, Alice in Wonderland syndrome, and Catatonic Schizophrenia. Understanding psychiatric disorders requires basic knowledge of brain anatomy. These conditions are often result of or associated with neurological issues, such as migraines or tumors. The brain has eight lobes, two of four kinds: frontal, parietal, occipital, and temporal lobes, which all govern different functions and abilities. Frontal lobes control judgment, decision-making, personality traits, and fine motor movements. Parietal lobes interpret pain and temperature, occipital lobes handle visual stimuli, and temporal lobes enable hearing. The pre-frontal cortex is associated with high intelligence, psychotic traits, and psychosis. The Broca’s Area in the frontal lobes controls expressive language. These areas and divisions of the brain contribute to the complexity of the psychiatric disorders discussed in this review. Introduction: Cotard’s syndrome is a psychiatric disorder characterized by delusions of being dead or not having certain limbs or organs. It is believed that there is a disconnect between their fusiform face area and the amygdala, causing a lack of familiarity between one’s mind and body. Alice in Wonderland Syndrome (AIWS) is another psychiatric disorder which is characterized by visual hallucinations, such as distorted perceptions of color, size, distance, and speed. The most common symptoms include micropsia and macropsia. Catatonia/Catatonic Schizophrenia is an uncommon type of schizophrenia. This type of schizophrenia is characterized by motor rigidity, verbal rigidity, the flat effect, psychomotor retardation, waxy flexibility, and overall negative symptoms. Thus, these people may come off as emotionally detached, and able to stay frozen in odd positions for periods on end. Treatments and Results: Cotard’s syndrome seemed to be most effectively treated by ECT (electroconvulsive therapy). Alice in Wonderland Syndrome (AIWS) had the highest positive responses to treatment by Valproate (an anti-epileptic drug), as well as intervention to treat the associated neurological conditions they had. Catatonia/Catatonic Schizophrenia seemed to be most effectively treated with a combination of benzodiazepines and ECT. Discussion and Demographics: In all 3 disorders, the Latino and African communities were underrepresented. There also seemed to be an underrepresentation of men in Cotard’s syndrome, and of women in Alice in Wonderland Syndrome. Japan and India seemed to have the highest density of treatment studies in all 3 disorders.
文摘Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelop-mental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy(ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient's medical condition. Little is known about the long-term treatment outcomes following administration of ECT for catatonia. The presence of a concomitant chronic neurologic disease or extrapyramidal deficit seems to be related to ECT non-response. On the contrary, the presence of acute, severe and psychotic mood disorder is associated with good response. Severe psychotic features in responders may be related with a prominent GABAergic mediated deficit in orbitofrontal cortex, whereas non-responders may be characterized by a prevalent dopaminergic mediated extrapyramidal deficit. These observations are consistent with the hypothesis that ECT is more effective in "top-down" variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in "bottom-up" variant, in which an extrapyramidal dysregulation may be prevalent. Future research should focus on ECT response in different subtype of catatonia and on efficacy of maintenance ECT in long-term prevention of recurrent catatonia. Further research on mechanism of action of ECT in catatonia may also contribute to the development of other brain stimulation techniques.
