Catatonia

Catatonia is a condition associated with a number of serious mental and physical illnesses. It is characterized by extreme and bizarre changes in muscle tone or activity. There are two specific types of catatonia--catatonic stupor and catatonic excitement. In catatonic stupor, the motor activity (movement) of an individual drastically slows or stops and the individual"freezes," becoming rigid and/or silent. In catatonic excitement, the individual experiences the opposite, becoming extremely hyperactive and potentiallyviolent.

Symptoms of catatonia include odd ways of walking such as walking on tiptoesor pacing, and rarely, hopping and skipping. Repetitive odd movements of thefingers or hands may also indicate that catatonia is present Echopraxia (imitating the movement of others) and echolalia (parrot-like repetition of wordsspoken by others), are also common. Other signs and symptoms include selective mutism, negativism, facial grimaces, and animal-like noises.

Catatonic stupor is marked by immobility and a behavior known as cerea flexibilitas (waxy flexibility) in which the individual assumes bizarre (andsometimes painful) positions that they will maintain for extended periods oftime. The individual may refuse food and liquids and become dehydrated and malnourished as a result. In extreme situations, such individuals must be fedthrough a tube. Catatonic excitement is characterized by excessive movement and violence; the individual may harm him/herself or others. On rare occasions, isolation or restraint may be needed to ensure the individual's safety andthe safety of others.

The causes of catatonia are unknown. Medical research indicates that brain structure and function are altered in this condition. A variety of medical conditions also may lead to catatonia including head trauma, cerebrovascular disease, encephalitis, and certain metabolic disorders.

Features of catatonia may also be seen in Neuroleptic Malignant Syndrome (NMS), which is an uncommon but serious reaction to some medications used to treat major mental illnesses. NMS is considered a medical emergency since 25% ofuntreated cases result in death. Catatonia can also be present in individualssuffering from a number of other physical and emotional conditions such as drug intoxication, depression, and schizophrenia. It is most commonly associated with mood disorders.

NMS may occur as a side effect of certain neuroleptic medications (antipsychotic drugs) such as haloperidol (Haldol). It comes on suddenly and is characterized by stiffening of the muscles, fever, confusion and heavy sweating.

There are no laboratory or other tests that can be used to positively diagnose this condition, but medical and neurological tests are necessary to determine any physical causes of the symptoms observed. Catatonia usually responds quickly to medication, including benzodiazipines (the preferred treatment) and, in some cases, barbiturates. Antipsychotic drugs may be appropriate in somecases, but can make catatonia worse. Electroconvulsive therapy (ECT) may help those patients who do not respond to medication.

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