Catatonic schizophrenia

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F20.2 catatonic schizophrenia
ICD-10 online (WHO version 2019)
Initial description

The catatonic schizophrenia is a subtype of schizophrenia , in which psychomotor disorders, the clinical picture dominate. However, other symptoms of schizophrenia such as hearing voices , anxiety, thought disorders, and delusions are also common.

The disease was first described as Dementia catatonica by Karl Ludwig Kahlbaum in 1874 (see figure on the right). Later, the neurologist and psychiatrist Karl Leonhard (1904–1988) dealt with catatonic schizophrenia. With the introduction of the operationalized criteria catalogs ICD-10 and DSM-IV and the increasing intermingling of the subjects neurology and psychiatry , the clinical picture is diagnosed less and less.

Emergence

The origin and causation of all diseases from the schizophrenic group of forms has not yet been clarified. One assumes a multifactorial genesis with genetic, psychodynamic and environmental causes.

The psychopathological school of Wernicke-Kleist-Leonhard sees schizophrenia - including the catatonic forms - as a heterogeneous group of diseases. Karl Leonhard assumed genetic causes for the sub-form "periodic catatonia" . The detection of the susceptibility gene 15q15 established a genetic disposition for this relapsing catatonia. Leonhard attributed the chronic catatonia to maternal infections in the middle trimester of pregnancy .

Symptoms

As the disease progresses, the following symptoms can occur:

If the stupor is accompanied by a fever , it is called febrile , pernicious , or malignant catatonia . This life-threatening appearance used to offer only minimal chances of survival. Thanks to the therapy options with modern treatment methods ( intensive care unit and therapy, benzodiazepines, neuroleptics, electroconvulsive therapy ) almost all affected patients survive. The discussion as to whether "pernicious" or "malignant" catatonia is identical to the life-threatening clinical picture " Malignant Neuroleptic Syndrome " (MNS) has not yet been conclusively resolved. The course of the disease is similar: the picture of fatal catatonia was first described over 100 years ago, whereas the picture of the MNS has only existed since the introduction of neuroleptics in the 1960s.

therapy

Catatonic conditions are initially usually treated with benzodiazepines in order to break through catalepsy and to reduce the severe fear that is often present. As with the other forms of schizophrenia, treatment continues with antipsychotics . Mood stabilizers such as lithium , valproic acid , carbamazepine, and lamotrigine can be extremely helpful in long-term treatment . Catatonia can often be treated quickly and effectively using electroconvulsive therapy (ECT). Based on the GABA A - glutamate hypothesis of catatonia, if a therapy with benzodiazepines such as lorazepam fails , a therapy attempt with dopamine agonists or amantadine (an NMDA receptor antagonist) can be considered.

criticism

In a systematic review from 2010, the concept of catatonic schizophrenia was heavily criticized. Catatonia and schizophrenia are fundamentally different syndromes that can be easily distinguished by certain drug tests and that also require completely different treatment.

literature

Individual evidence

  1. ^ KL Kahlbaum: Catatonia or the insanity of tension . Hirschwald, Berlin 1874.
  2. ↑ SN Caroff, SC Mann et al. (Ed.): Catatonia: From psychopathology to neurobiology. American Psychiatric Publishing Arlington, 2004.
  3. ↑ M. Fink, E. Shorter, MA Taylor: Catatonia is not schizophrenia: Kraepelin's error and the need to recognize catatonia as an independent syndrome in medical nomenclature. In: Schizophrenia bulletin. Volume 36, Number 2, March 2010, pp. 314-320, doi: 10.1093 / schbul / sbp059 , PMID 19586994 , PMC 2833121 (free full text) (review).
  4. ^ PI Rosebush, MF Mazurek: Catatonia and its treatment. In: Schizophrenia bulletin. Volume 36, number 2, March 2010, pp. 239-242, doi: 10.1093 / schbul / sbp141 , PMID 19969591 , PMC 2833127 (free full text) (review).
  5. ↑ G. Gazdag, R. Takács, GS Ungvari: Catatonia as a putative nosological entity: A historical sketch. In: World journal of psychiatry. Volume 7, number 3, September 2017, pp. 177-183, doi: 10.5498 / wjp.v7.i3.177 , PMID 29043155 , PMC 5632602 (free full text) (review).