1. CATATONIA
Dr.Muhammed Musthafa

2. Definition of Catatonia
Catatonia is a neuropsychiatric syndrome with a unique combination of mental, motor, vegetative and behavioral signs.

3. Kahlbaum (1874).
Coined the term ‘Catatonia or Tension Insanity’

4. Catatonia is a Disturbance of motor behavior that can have either a psychological or neurological cause
a state of apparent unresponsiveness to external stimuli in a person who is apparently awake
difficult to differentiate from diffuse encephalopathy and nonconvulsive status epilepticus

5. Diagnostic criteria DSM-IV
motor immobility as evidenced by catalepsy (including waxy flexibility) or stupor
excessive motor activity (purposeless, not influenced by external stimuli)
extreme negativism (motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
echolalia or echopraxia

6. "With catatonic features" specifier can be applied if the clinical picture is dominated by at least two
Two of the items are required to diagnose catatonia in schizophrenia and mood disorder.
Only one item is required to diagnose catatonia in general medical conditions.

7. Causes of catatonia Primary Psychiatric Acute psychosis
Affective disorder
Schizophrenia
Dissociative disorders
Obsessive compulsive disorder
Personality disorders

8. Neurologic conditions
Organic/secondary
Medical conditions
Neurologic conditions
Metabolic disturbances
Endocrinopathies
Viral Infections (H.I.V.)
Typhoid fever
Heart stroke
Autoimmune diseases
Post-encephalitic states
Parkinsonism
Bilateral globus pallidus lesions
Thalamic lesions
Parietal lobe lesions
Frontal lobe
Seizure disorder in children

9. Causes of catatonia Drugs- Organic/secondary neuroleptics (NMS)
dopamine withdrawal
alcohol
stimulants
hallucinogens
anticonvulsants (carbamazapine)
steroids

10. LETHAL CATATONIA (MALIGNANT)
Hyperpyreia,extreme rigidity, autonomic dysfunction leading to death but without exposure to any neuroleptic
Can occur when levodopa or amantidine is abruptly discontinued in patients with Parkinsons disease who have no previous history of psychiatric dysfunction

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