Catatonia

Catatonia Catatonia is a syndrome of motor and psychological disorder. Catatonia is not a diagnosis but a descriptive term for an event observed in a wide variety of disorders. Psychomotor manifestations of catatoniei were divided into four classes as follows: automatic, repetitive, withdrawal and resistance.
Catatonia is an apparent status aresponsivitate to external stimuli to a person who is apparently awake, it is difficult to distinguish from epileptic encephalopathy nonconvulsiv run and their status.
Syndrome occurs in children, adolescents and adults. It is associated with a heterogeneous group of comorbid conditions and is characterized by a variety of symptoms and signs of damage to the expression of thought and voluntary movement. Catatonia syndrome is typically episodic with periods of remission. Appropriate prompt diagnosis is crucial to prevent morbidity and death.
A similar catatonic syndrome occurs after exposure to antipsychotic medications. People with autism, mental retardation and other neurological or developmental disorders are especially vulnerable to catatonia.
Pathogenesis Catatonia is rather a heterogeneous group of etiologies. Some hypotheses have been proposed for the mechanism catatoniei.
Deficits in cortical development: Deficits in fetal cortical development can lead to schizophrenia and other disorders of development. These deficits cause dysfunction of cortical and subcortical glutamatergic pathways, forcing catatoniei symptoms and signs.
Dopaminergic Blockade: Administration of agents that block postsynaptic dopamine receptors is associated with the onset catatoniei in some individuals. D1 and D2 receptor agonists cause catalepsy, a sign of catatoniei.
Glutamatergic dysfunction: The effectiveness of amantadine in the treatment catatoniei suggests that at least some individuals with this disorder manifest catatonia.
Signs and symptoms Catatonia is a syndrome characterized by the presence of various behaviors and driving patterns. While individuals with catatonia can not tell a coherent history, collateral sources of information shows the relevant historical information. Family members may confirm the presence of the primary manifestations would catatoniei including immobility, stupor, position, stiffness, and withdrawal grimasele. A history of behavior towards others usually present include mutism, negativism, echopraxiei, echolaliei. A history of stereotypes and verbigeratie manerism is frequently reported by people close to patients. Priapism has been reported in some cases.
Alternative presentation is that of a status catatoniei excited with impulsivity, combativeness and autonomic instability. Although a history of status is noted by horny patient's family is frequently denied. When present, this episode is short in duration and may precipitate the collapse of extreme fatigue. A horny status of catatoniei is usually associated with bipolar disorder. Diagnostic criteria: -Motor immobility as evidence of catalepsy with flexibility and stupor wax Excessive motor activity, non-profit, uninfluenced by external stimuli -Extreme negativism (resistance to all controls unmotivated or active attempts to maintain a rigid position despite attempts to be moved) or mutism -Stereotyped voluntary movements, mannerisms or grimacing -Echolalia or ecohopraxie. Subtypes of catatoniei: Is a lethargic stupor status, lack of exercise the person does not respond to external stimuli. Motor activity is almost non-existent. People in this status does not look in the eyes of others for a long period of time and then immediately adopt a different position. Catatonic excitation is a non-profit status of constant agitation and excitement. People in this status are extremely hyperactive although the activity does not seem to have purpose.
Complications During a status of patients with catatonia excitation can cause severe damage, even fatal to herself or others. Can destroy property. Patients may refuse to eat. May die if not fed parenterally. Experience automonica instability with hyperthermia, hypertension and tachycardia. Medical intervention is indicated. Neuroleptic malignant syndrome can occur in catatonia. In these cases, medical consultation is indicated. Total pulmonary embolism is increased in catatonia. To prevent thromboembolic disease will check the D-dimer.
Treatment Prompt treatment in early stages is crucial for obtaining the status catatonic for long periods of remission of symptoms. Benzodiazepines are first line treatment, high doses are needed. Intramuscular administration of 1-2 mg lorazepam frequently cause marked improvement in half an hour.
Electroconvulsive therapy is an effective treatment for catatonia as for its possible causes (psychosis, mania, depression). antipsychotics should be used with care because they can aggravate Catatonia and neuroleptic malignant syndrome are due to a dangerous condition that can mimic Catatonia and require immediate discontinuation of antipsychotic.
A version known as catatonic deterioration occurs in 12% of young adults with autism. This form is made worse by antipsychotics. Stuporous catatonic girl, this deterioration occurs gradually. The only way to heal is to keep the patient aware of activities and activities must have an end. Stress should be reduced.
Since Catatonia is often periodic, one patient who recovered after an episode of catatonia is at risk of developing other episodes. Catatoniei appellant is an indication for hospitalization.