![]() The signs and symptoms of malignant catatonia overlap significantly with neuroleptic malignant syndrome (NMS) and so a careful history, review of medications, and physical exam are critical to properly differentiate these conditions. These lab findings include: leukocytosis, elevated creatine kinase, low serum iron. Certain lab findings are common with this presentation however, they are nonspecific, which means that they are also present in other conditions and do not diagnose catatonia. It is characterized by fever, abnormalities in blood pressure, heart rate, respiratory rate, diaphoresis (sweating), and delirium. Malignant Catatonia: Malignant catatonia is a life-threatening condition that may progress rapidly within a few days. Catatonic excitement is commonly cited as one of the most dangerous mental states in psychiatry. People in this state are extremely hyperactive and may have delusions and hallucinations. Speech and actions may be repetitive or mimic another person's. Įxcited Catatonia: Excited catatonia is characterized by odd mannerisms/gestures, performing purposeless or inappropriate actions, excessive motor activity, restlessness, stereotypy, impulsivity, agitation, and combativeness. Patients may sit or stand in the same position for hours, may hold odd positions, and may resist movement of their extremities. Withdrawn Catatonia: This form of catatonia is characterized by decreased response to external stimuli, immobility or inhibited movement, mutism, staring, posturing, and negativism. ![]() Although catatonia can be divided into various subtypes, the natural history of catatonia is often fluctuant and different states can exist within the same individual. There are several subtypes of catatonia and they are characterized by the specific movement disturbance and associated features. ![]() It should not be assumed that patients presenting with catatonia are unaware of their surroundings as some patients can recall in detail their catatonic state and their actions. The most common signs of catatonia are immobility, mutism, withdrawal and refusal to eat, staring, negativism, posturing (rigidity), rigidity, waxy flexibility/ catalepsy, stereotypy (purposeless, repetitive movements), echolalia or echopraxia, verbigeration (repeat meaningless phrases). Movements and mannerisms may be repetitive, or purposeless. These patients may be unable to start an action or stop one. ![]() Catatonia presents as a motor disturbance in which patients will display marked reduction in movement, marked agitation, or a mixture of both despite having the physical capacity to move normally. īecause most patients with catatonia have an underlying psychiatric illness, the majority will present with worsening depression, mania, or psychosis followed by catatonia symptoms. The presentation of a patient with catatonia varies greatly depending on the subtype, underlying cause and it can be acute or subtle. Antipsychotics are sometimes employed, but they can worsen symptoms and have serious adverse effects. There is growing evidence of the effectiveness of the NMDA receptor antagonists amantadine and memantine for benzodiazepine-resistant catatonia. Treatment with benzodiazepines or ECT can lead to remission of catatonia. Recognizing and treating catatonia is very important as failure to do so can lead to poor outcomes and can be potentially fatal. There are several subtypes of catatonia: akinetic catatonia, excited catatonia, malignant catatonia, delirious mania, and self-injurious behaviors in autism. Catatonia is not a stand-alone diagnosis (although some experts disagree), and the term is used to describe a feature of the underlying disorder. It is now known that catatonic symptoms are nonspecific and may be observed in other mental, neurological, and medical conditions. It has historically been related to schizophrenia (catatonic schizophrenia), catatonia is most often seen in mood disorders. The onset of catatonia can be acute or subtle and symptoms can wax, wane, or change during episodes. Underlying illness (psychiatric, neurologic, or medical), brain injury/damage, certain drugs/medicationsīenzodiazepines (lorazepam challenge), ECTĬatatonia is a complex neuropsychiatric behavioral syndrome that is characterized by abnormal movements, immobility, abnormal behaviors, and withdrawal. Physical trauma, malignant catatonia (autonomic instability, life-threatening), dehydration, pneumonia, pressure ulcers due to immobility, muscle contractions, DVT, PE Immobility, mutism, staring, posturing, rigidity, low consciousness, etc.
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