| Pathophysiology | Diagnosis | Clinical Features/subtypes | Treatment | ¯\_(ツ)_/¯ |
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What is UNCLEAR, lets explore some theories in the next few questions
Pathophysiology leading to symptoms
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What is FALSE, can also be seen in ASD, etc. Most commonly seen as a complicating syndrome as opposed to its own etiology.
Catatonia. A prospective clinical study. Abrams R, Taylor MA Arch Gen Psychiatry. 1976 May; 33(5):579-81. Catatonia. Retarded and excited types. Morrison JR Arch Gen Psychiatry. 1973 Jan; 28(1):39-41.
True or false: one must have carry a diagnosis of schizophrenia to have catatonia.
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What is retarded & excited
2 subtypes
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What is BENZOS
Tx for catatonia.
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What is 9-17%
https://pubmed.ncbi.nlm.nih.gov/2211547/ https://pubmed.ncbi.nlm.nih.gov/21099376/
Catatonia prevalence in an acute psychiatric disorder?
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What is REDUCED
this is theorized why "the main treatment option" would be so effective, hint hint
GABA A receptor activity enhanced or reduced?
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What are IMMOBILITY & MUTISM (90-97% or pts)
Catatonic syndrome in a general psychiatric inpatient population: frequency, clinical presentation, and response to lorazepam. Rosebush PI, Hildebrand AM, Furlong BG, Mazurek MF J Clin Psychiatry. 1990 Sep; 51(9):357-62. Catatonia in psychiatric classification: a home of its own. Taylor MA, Fink M Am J Psychiatry. 2003 Jul; 160(7):1233-41.
2 Most common physical signs of catatonia.
Choices: posturing, rigidity, immobility, mutism, staring, negativism, posturing, waxy flexibility/ cataplexy, stereotypy, echolalia/echopraxia, verbigeration, withdrawal and refusal to eat, negativism) - described by Karl Kahlbaum in 1874 |
What is retarded
Most common subtype?
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What is lorazapam 1-2 mg IM or sublingual (IM most common)
Most commonly used (specific) medication (and dosage) to treat catatonia.
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What is FALSE, pts can recall their catatonic state and are fully aware of the events that happened to them
T or F: Pts who were previously catatonic cannot recall their catatonic state or the events that happened to them during that state.
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What is RIGHT LATERAL ORBITOFRONTAL & RIGHT POSTERIOR PARIETAL CORTEX (which would explain the effecveness of the "most common treatment" on motor and affective symptoms but NOT behavioral symptoms. hmmmmm
Most densely packed area of brain with GABA-A receptors.
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What is RIGIDITY
3rd most common catatonic sign.
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What is excited (malignant or lethal catatonia)
severe psychomotor agitation, potentially leading to life-threatening complications such as hyperthermia, altered consciousness, and autonomic dysfunction
Which is the more dangerous subtype?
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What is 3 hours (85.7% had some response, 58% recovered completely within 3 hrs)
Benzodiazepines in the treatment of catatonic syndrome. Ungvari GS, Leung CM, Wong MK, Lau J Acta Psychiatr Scand. 1994 Apr; 89(4):285-8.
How long does it take after treatment is administered for catatonia symptoms to resolve?
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What is extrapyramidal side effects, NMS, nonconvulsive status epilepticus, akinetic mutism, locked in syndrome, vegetative state, stiff person syndrome.
Differential diagnosis for catatonia.
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What is GLUTAMATERGIC ABNORMALITIES (hyperactivity)
abnormalities in the basil ganglia would lead to _____
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What is 4 (100% specificity) - still a few cases were left out which led to the refining into the DSM-V formulation
how many of the original catatonic signs did you need to be diagnosed?
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What is retarded
Subtype associated with staring, mutism, rigidity, withdrawal and refusal to eat, along with more bizarre features such as posturing, grimacing, negativism, waxy flexibility, echolalia or echopraxia, stereotypy, verbigeration, and automatic obedience
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What is schizophrenia (59% responding to treatment)
bipolar = 97% responsding unipolar depression = 93% responding "other psychosis" = 92% responding
Only other underlying diagnoses that would lead to less response to treatment.
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What is:
affective disorders increasing age postpartum disorders abrupt cessation of clozapine thrombotic thrombocytopenic purpura hx of severe infxns in childhood prior brain injury physical illness at onset of psychosis
Risk factors for catatonia
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What is FREEZING (the physical manifestation of anxiety and fear)
Evolutionary fear response (think the third F in fight, flight, ____)
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What is THREE
DSM-V defines catatonia as the presence of _____ or more of the following: Catalepsy, waxy flexibility, stupor, agitation, mutism, negativism, posturing, mannerisms, stereotypies, grimacing, echolalia, and echopraxia
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What is NMS (mortality rate of 10%) (hard to clinically distinguish from excited catatonia)
(retarded catatonia can also lead to pathophysiology - DVT, dehydration, etc.)
Most common lethal syndrome associated with the excited subtype?
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What is ECT (requires clear consent though which can be tricky in catatonic pts)
(also, zolpidem, amantadine, memantine but these are a backup for pts who fail ECT and benzos)
Other treatment option ________.
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What is NORMAL BRAIN ACTIVITY
EEG is catatonia would show _____.
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