The psychopathological syndrome of catatonia (from the Greek "pull, strain") was first described at the end of the nineteenth century. the German psychiatrist Karl Ludwig Kalbaum. He singled it out and studied it as an independent psychosis, but the followers of Kalbaum began to regard catatonia as a subtype of schizophrenia.
What is catatonia?
Clinical manifestations of the disease are motor disorders - stupor, impulsive behavior or agitation. Stresses in the muscle tone can be associated with brain damage (due to stroke, tumor, Tourette's syndrome, somatic diseases and conditions, taking certain medications, drugs, etc.). Psychosis also appears as a symptom of various mental disorders. In some patients it is impossible to identify the causes of the syndrome.
Catatonia is a disease that causes disputes among specialists from all over the world. The exact cause of its origin is still not known, and there are only hypotheses. So, the appearance of the syndrome is due to:
- a deficiency in the cerebral cortex of gamma-aminobutyric acid;
- a sudden blockade in the brain of the dopamine hormone;
- increased activity of serotonergic and cholinergic systems (after a sudden discontinuation of clozapine);
- the emergence of an evolutionary reaction of fear;
- bilateral metabolic disturbances in the frontal lobes and thalamus.
Catatonic syndrome
The state of catatonia includes motor disorders, sometimes combined with delirium, hallucinations, confusion of consciousness and other psychopathological disorders. The diagnosis of the disease is established taking into account the history, clinical symptoms, neurological examination and research results. The psychiatrist should determine the underlying pathology that triggered the development of the syndrome. This condition can be diagnosed if at least 2 of its signs are regularly repeated for 2 weeks.
Catatonic symptoms
Catatonic syndrome affects people of any age - children and adults (mostly up to 50 years). In the first case, the disorder takes the form of regressive behavior and motor stereotypes: impulsive or monotonous actions, stupor, mutism, etc. In those aged 16 to 30, catatonic manifestations reach the greatest intensity. Symptoms of illness in women 40-55 years may be mistaken for hysteria: expressive facial expressions and speech, theatrical behavior, etc. In most cases, the symptomatology of the syndrome is as follows:
- stereotype - patients repeatedly reproduce postures, movements;
- echosymptoms - repetition of other phrases and words;
- passive or active negativism - failure to fulfill requests or reverse actions);
- stupor and catalepsy - fading in an unnatural position.
On the development of the disease may indicate such signs as constant excitement, duality of feelings towards a person or the same subject, closedness, complete silence (mutism) or speech incontinence, muscle resistance, a symptom of an "air pillow" (a person lies in an uncomfortable position with his head raised), wide-open eyes, a grasping reflex.
Catatonic disorders
The basic state of catatonia is a stupor characterized by muscle hypertension and silence. There are three types of this condition: cataleptic stupor, negativistic and with numbness. Patients can maintain a certain position of the body or facial expression from a couple of hours to several months. Less extreme catatonic behavior is delayed motor activity, in which the position of the body is often unusual or inappropriate. Reverse reaction for the same disease - agitation and aimless movements, not related to the environment.
Catatonic agitation
If the patient is mobile, active and performs purposeful and non-purposeful actions, there is a catatonic agitation, the symptoms of which can be divided into two types. Pathetic form of excitation is characterized by gradual development, and it is not very pronounced: it begins with a change of mood, inappropriate behavior, pathetic speech. The second type of stimulation is impulsive, for which the acute development of symptoms is characteristic. The patient acts harshly, actively, persistently, at the peak of severity, can harm himself and others; his actions are a threat.
Catatonic Schizophrenia
A rare, severe and, as a rule, incurable mental illness is a catatonic form of schizophrenia. It occurs in a small percentage (1-3) of schizophrenics. The syndrome affects all the functions of the body, and severe violations of the motor system are observed. Catatonic patients can stay in one position for a long time, even if it is inconvenient from the point of view of a normal person (standing on one leg or extending the arm vertically upwards). The exact symptoms of catatonic schizophrenia are the alternation of stupor and excitement.
Catatonic shock
First of all, catatonic schizophrenia is characterized by impaired motor function. But with it there are other symptoms: paranoid nonsense, hallucinations, etc. In a later period of the disease, severe social degradation develops. Catatonic delirium, as a rule, occurs with a cataleptic stupor, when the patient freezes for a long time, does not respond to a loud appeal to him and becomes available for communication in silence.
Catatonia without a cloud of consciousness is called lucid. Almost always it develops in schizophrenia. The oneroid form of the disease carries with it a violation of the reflection of the real world, incoherence of thinking, disorientation, amnesia (full or partial). Some doctors consider oneiroid catatonia to be the most acute form of any schizoaffective attack. Catatonic syndrome of this type arises spontaneously.
Catatonic state
The Oyneroid syndrome characterizes the obscuration of the patient's consciousness with dreamlike experiences, a sharp change of emotions and a pronounced confusion. Catatonic dream is filled with unfolded fantastic and pseudo-hallucinatory experiences. They can intertwine with reality. The patient is a participant in the fictional situation, there is disorientation in space in particular in his own "I". There is a rapid transition of excitement to stupor.
Catatonic Depression
Catatonic syndrome develops both independently and together with other mood disorders. Often the disease is accompanied by depression, which aggravates the signs of catatonia. For example, a patient in a stupor can very long leave it, experiencing pain even from moving a finger - both physical and emotional. Depressive state becomes the cause of the full estate of the patient.
Deadly Catatonia
There is an atypical form of schizophrenia, which is characterized by acute onset, rapid development, strong catatonic arousal, increased body temperature, subcutaneous hemorrhages and pathological changes in the hematopoietic system, the development of exhaustion and coma. Another name for this disease is hypertoxic schizophrenia. The prognosis of the syndrome is unfavorable, although lethal catatonia is treatable.
Catatonia - treatment
A person diagnosed with catatonia can not be referred to treatment before the mental disorders that contribute to the development of the disease are identified. Special studies should be conducted to exclude other neurological causes and to find concomitant catatonia disorders. If catatonia develops on the basis of schizophrenia and any psychosomatic abnormalities, treatment should begin with relieving the patient of the symptoms of these diseases. The patient is continuously observed at the doctor, is placed in a hospital.
A suffering catatonic stupor needs to undergo several stages of treatment. At the first stage, the patient is given insignificant doses of caffeine and 10% solution of barbamyl. When the motor processes are resumed, the administration of the drugs ceases. The most effective treatment is stupor with the help of ECT - electroconvulsive therapy and benzodiazepine preparations. At the same time by means of ultrasound diagnosis the patient is regularly examined to determine the stages of his recovery.
There are many causes of catatonic syndrome, which determine its further treatment. At the current level of development of medicine, this state of psychopathological nature is not a verdict. Conditionally curable can be called 40% of patients. In most cases, specialists manage to achieve complete remission or persistent improvement in the patient's condition.