catatonia

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Catatonia ( ancient Greek κατά , from top to bottom 'and τόνος , (tension) tension', together so 'tension from head to toe') is a behavioral and psychomotor syndrome . It can occur as a side effect [possibly Cause / consequence] of mental illnesses (such as severe depression, manias, bipolar affective disorders and especially catatonic schizophrenia ), of metabolic disorders, after the consumption of alcohol and other drugs, but also with other neurological diseases or diseases of the immune system (for example as a neurological disorder as a result of an AIDS disease, in the context of autoimmune encephalitis or a neuroleptic malignant syndrome).

The first person to describe the disease was Karl Ludwig Kahlbaum (1828–1899), psychiatrist and owner of a private hospital for the mentally ill in Görlitz . For a long time, catatonia was diagnosed mainly as a form of schizophrenia. The catatonic schizophrenia , a sub-form of the "group of schizophrenia" ( Eugen Bleuler , 1911), goes with disorders of motor function associated that can switch between extreme excitement and passivity and forth.

The diversity of the actually possible relationships illustrates the difficulties in making a diagnosis and in choosing the right therapy. In the new ICD-11, which is due to be adopted by the World Health Organization in 2019, a separate diagnostic category - separate from the group of schizophrenias - is provided for the first time.

Symptom picture

Catatonia manifests itself in unnatural and very cramped postures or behaviors of the whole body or person. A distinction is made between hypokinetic ["hypo ..." = one less, too little of ...] and hyperkinetic ["hyper ..." = one more, too much of ...] phenomena. The following terms are relevant:

  • Stupor (rigidity of the whole body)
  • Mutism (persistent silence)
  • bizarre posture stereotypes (prolonged persistence in one posture even with external attempts at change)
  • Flexibilitas cerea (waxy resistance of the muscles during passive movement)
  • Negativism (resistance to any prompts or attempts to move - or instead, movements that do the opposite of the prompt)
  • Catalepsy (maintaining posture after passive movement)
  • very increased psychomotor arousal
  • Movement and language stereotypes (continuous and apparently meaningless repetition of movements or parts of speech without an external "role model")
  • Echopraxia / echolalia (constant and apparently meaningless imitation of movements or parts of speech)
  • Mannerisms (strange, "caricature-like" depictions of everyday gestures and facial expressions).

The disease variant can be life-threatening due to a lack of water and food intake, among other things.

treatment

  • The drug treatment with benzodiazepines [e.g. B. Lorazepam] and the use of electroconvulsive therapy. A particular and life-threatening difficulty exists with regard to the treatment of a catatonic condition if this occurs as a result of a malignant neuroleptic syndrome. In this case, the neuroleptic medication must be discontinued.
  • In psychopharmacological therapy with GABA-ergic substances, including lorazepam , caution is required, as benzodiazepine dependence can develop after one to two weeks of use, which can trigger or worsen catatonia.
  • Targeted treatment of the underlying mental disorder, e.g. B. with neuroleptics for schizophrenic or antidepressants for depressive disorders
  • Electroconvulsive therapy is indicated for the treatment of therapy-resistant catatonia as well as the first-line treatment for pernicious catatonia.

See also

literature

Wikiversity: Karl Ludwig Kahlbaum: The catatonia or the insanity of tension. Berlin 1874.  - Course materials
  • Roland Depner: Is it all a matter of nerves? How our nervous system works - or not. Schattauer, Stuttgart 2012, ISBN 978-3-7945-2887-5 .
  • Michael Franz: catatonia. A new psychopathological inventory to evaluate the severity and its use in an alternative form of therapy. Dissertation at the University of Giessen in 1994.
  • Winfried Krill: Systematic investigation into the experience of catatonic patients. Interpretations of catatonia in the mirror of subjective experience. Dissertation at the University of Frankfurt am Main 1997.
  • Daniel Nagel: Frontoparietal dysfunction in catatonia. A neuropsychological examination. Dissertation at the University of Magdeburg in 1999.
  • Georg Northoff : Catatonia. Introduction to the phenomenology, clinic and pathophysiology of a psychomotor syndrome. Enke , Stuttgart 1997, ISBN 3-432-29811-0 .
  • Georg Northoff: Neuropsychiatric phenomena and the mind-body problem. Catatonia at the junction between medicine and philosophy. Dissertation at the University of Bochum in 1992.

Web links

Wiktionary: catatonia  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ^ William Haubrich, Medical meanings, American College of Physians 2003
  2. ↑ James Wilcox, Pam Reid Duffy: The Syndrome of Catatonia . In: Behavioral Sciences . tape 5 , no. 4 , December 9, 2015, ISSN  2076-328X , p. 576-588 , doi : 10.3390 / bs5040576 , PMID 26690229 , PMC 4695780 (free full text) - ( mdpi.com [accessed May 7, 2019]).
  3. ^ A b Elisabeth Doran, John D. Sheehan: Acute catatonia on medical wards: a case series . In: Journal of Medical Case Reports . tape 12 , no. 1 , July 6, 2018, ISSN  1752-1947 , p. 1 , PMID 29976243 , PMC 6034265 (free full text) - ( biomedcentral.com [PDF; accessed May 10, 2019]).
  4. ↑ JC Huffman, GL Fricchione: Catatonia and psychosis in a patient with AIDS: treatment with lorazepam and aripiprazole. In: J Clin Psychopharmacol . [Case Reports Letter]. 2005 Oct; 25 (5), pp. 508-510.
  5. ↑ BT Carroll, TJ Anfinson, JC Kennedy, R. Yendrek, M. Boutros, A. Bilon: Catatonic disorder due to general medical conditions. In: J Neuropsychiatry Clin Neurosci. [Case Reports Review]. 1994 Spring; 6 (2), pp. 122-133.
  6. ↑ Léon Wurmser: The Mask of Shame - The Psychoanalysis of Shame Affects and Shame Conflicts . 5th unchanged edition. Klotz Verlag, Magdeburg 2013, ISBN 978-3-88074-024-2 , p. 208, 220, 324 and other positions .
  7. ^ Walter Jaimes-Albornoz, Jordi Serra-Mestres: Recognizing Catatonia in Medically Hospitalized Older Adults: Why It Matters . In: Geriatrics . tape 3 , no. 3 , 2018, p. 3 , doi : 10.3390 / geriatrics3030037 , PMID 31011075 , PMC 6319219 (free full text) - ( mdpi.com [accessed on May 10, 2019]).
  8. ↑ a b c d Lieb, Klaus, Frauenknecht, Sabine, Brunnhuber, Stefan, Wewetzer, Christoph: Intensive course in psychiatry and psychotherapy . 8th edition. Urban & Fischer in Elsevier, Munich 2016, ISBN 3-437-42528-5 , p. 23 f .; 188 .
  9. ↑ a b 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 . tape 36 , no. 2 , March 1, 2010, ISSN  0586-7614 , p. 314-320 , doi : 10.1093 / schbul / sbp059 , PMID 19586994 , PMC 2833121 (free full text) - ( oup.com [accessed May 7, 2019]).
  10. ↑ Dilling, Horst, 1933-, World Health Organization .: International Classification of Mental Disorders: ICD-10 Chapter V (F) clinical-diagnostic guidelines . 10th edition, taking into account the changes according to ICD-10-GM 2015. Hogrefe, Bern 2015, ISBN 978-3-456-85560-8 , p. 133 .
  11. ^ ICD-11. Retrieved May 10, 2019 .
  12. ↑ ICD-11 - Mortality and Morbidity Statistics. Retrieved May 10, 2019 .
  13. ↑ Erik den Boer, Frank MMA van der Heijden, Anne CM Pelzer: Systematic review of catatonia treatment. January 17, 2018, accessed May 7, 2019 .
  14. ^ PI Rosebush, MF Mazurek: Catatonia and its treatment. In: Schizophr Bull. [CommentReview]. 2010 Mar; 36 (2), pp. 239–242.
  15. ^ JJ Arnos: Lorazepam withdrawal-induced catatonia. In: Ann Clin Psychiatry. 2012 May; 24 (2), pp. 170-171.
  16. ↑ T. Sivakumar, A. Yadav, M. Sood, SK Khandelwal: Lorazepam withdrawal catatonia: a case report. In: Asian Journal of Psychiatry. 2013 Dec; 6 (6), pp. 620-621. doi: 10.1016 / j.ajp.2013.05.008
  17. ^ SG Glover, R. Escalona, ​​J. Bishop, A. Saldivia: Catatonia associated with lorazepam withdrawal. In: Psychosomatics. 1997 Mar-Apr; 38 (2), pp. 148-150.
  18. ↑ bundesaerztekammer.de ( Memento from July 1, 2007 in the Internet Archive )
  19. ^ S3 guideline for schizophrenia. Abstract, 2019. Version 1.0. In: www.awmf.org. German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) eV for the Leitlniengruppe, March 15, 2019, accessed on May 6, 2019 .