General psychopathology  © Tushnik Ghosh


A- Different types of katatonia



Catatonic syndrome was written in 1863 as a separate nosological unite, but presently is considered as a symptom-complex, which is mostly observed in schizophrenia. Catatonic syndrome consists of different types of hypokinesias (stupors), hyperkinesias, and parakinesias. <' BR>

Hypokinesias can be seen as stupor and substupor. It is characterized by complex, unoriginal uncomforting poses of the patient. Most often, the pose is intrauterine pose, where the ' patient sits by adducting his limbs towards the body with the head bending on the knees. Another symptom is symptom of air pillow, where the patient, while lying on the bed raises his head, as if ' there is a pillow under his head. In Symptom of blanket, the patient covers his head with any clothes.
Patient with catatonic stupor generally lies on the bed, but he is able to sit and stand. In case of substupor the same patient can walk a little bit but very slowly. In case of stupor there is high tonus of the skeletal muscles. The high tonus allows him to keep the position which the ' doctor gave him. This phenomenon is called catalepsy. Eg. Tell your patient to raise his hand, or you raise his hand while talking with him, and observe that his keeps his hand in that pose for a long time.
Negativism in this case is frequently observed. Negativism is not passivity. In case of ' negativism, patient does the work when he is given extreme options. Eg. Patient will start eating only when sanitary personal will pretend to take away his food.
Frequently stupor is demonstrated by primitive reflexes i.e. sucking, snatching ect. The facial expression is hypomimical. Often there is complete absence of speech i.e. mutism. Sometimes the patient reacts to question if asked loudly, but his answer is just a sound (Pavlov s symptom). Negativism can be combined with passivity. It means that the patient is able to do work but only under orders. In this case if the caretaker tells him to sit and go away, the patient sits in the same place for hours in the same pose.

Hyperkinesias: in catatonic syndrome it is expressed as attacks of excitements. It is characterized by senseless, chaotic, aimless movements. Eg. Patient can put forward his hand for several times without doing anything without being tired. Motor stereotype and speech stereotype (verbegeration) are often observed. Another important sign is impulsive movement where the patient can suddenly get up from bed, jump at neighbors or unpredictably run away.

Parakinesias: it is presented by strange, unreal movements like pretentious, mannerism and pantomimic. Patient can walk with wide spread steps or very cautiously like walking on the ice. Mimic of the patient cannot be read. There can be wrinkles on the forehead as if the patient is very anxious but he may have simultaneously smiling lips. In catatonia, there is a row of echo symptoms. Echolalia- repeating the word of questioner. Echopraxia- repeating others movements. Echomimia- copying mimics of surrounding people.

Patient with catatonic syndrome is needed to be hospitalized. Sometimes he cannot get up from bed to go to toilet. Patient in stupor doesn t react to cold, pain, and are not able to run in critical condition. He is fed with nasogastric tube. Nowadays with the developments of new neuroleptic drugs, catatonia is seldom seen.
Catatonia is mostly seen in schizophrenia. But sometimes it is observed in organic disorder of brain (epidemic encephalitis).
Catatonia can be divided in two groups: lucid catatonia, which occurs with consciousness, and oneiroid catatonia, which occurs in obscured consciousness and twilight state. The later one is acute psychosis and can be treated. Lucid catatonia on the contrary has malignant prognosis and is a malignant variant of schizophrenia.

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