Catatonia is a syndrome characterized by disturbances in volitional movement and language in the absence of weakness or dysphasia. There is a wide range of nonspecific signs and symptoms that may be elicited:
- Catatonic stuper--mutism, immobility, nonresponsiveness to pain (with normal alertness)
- Catatonic excitement--purposeless, agitated, disorganized overactivity
- Mannerisms--odd or exaggerated actions
- Echolalia, echopraxia--repetition or imitation of the utterances and/or actions of others
- Stereotypy--repetitive movement without a goal, e.g. rocking back and forth, tapping hands or feet, verbigeration (repeating the same phrase/sentence like a broken record)
- Gegenhalten--resistance to passive motion that is proportional to the magnitude of the external force but increases with the speed of the external force (also called waxy flexibility)
- Mitgehen aka passive obedience (passive motion in any direction brought on by very little external force, test: ask patient to extend the arm, apply pressure to the palm with one finger while instructing "Don’t raise your arm"), automatic obedience (cooperation with illogical requests, test: examiner extends hand while saying "Don’t shake my hand")
- Negativism (resistance to following simple commands OR doing the opposite of what is asked OR not responding to commands)
- Ambitendency (alternating between opposing movements, e.g. walking toward and then withdrawing from the door as if unable to decide whether to leave the room or stay)
- Malignant catatonia is a syndrome very similar to NMS but which was first described in 1832 (some consider NMS to be a form of drug-induced catatonia) featuring: acute onset, fever, abnormal blood pressures, tachycardia, and tachypnea
- There are multiple rating scales that may help in the diagnosis of catatonia, including the Bush-Francis Catatonia Rating Scale which takes about 5 minutes and may be sensitive to changes in symptom severity after treatment. However, such rating scales may generate overdiagnosis of catatonia if the threshold for case diagnosis (i.e. the number of symptoms required for diagnosis) is set too low.
- The classification of catatonia has been a point of contention since its original formulation in 1870s. In DSM-V it is recognized as a separate clinical entity (catatonia due to a specific medical or neurological disorder) as well as as a specifier for severe mood disorders (Major Depressive Disorder, Bipolar Disorder) and Schizophrenia.
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