What is Catatonia?
Catatonia or catatonic is not a psychiatric illness, although it is often referred to as such. It is a cluster of several symptoms, with bizarre motor phenomena occur, including mutism, flexibilitas cerea (waxy flexibility) and stupor.
This image can be caused by various diseases. In more than half of the cases there is a bipolar disorder as the underlying cause, but other mental illnesses such as schizophrenia or somatic (physical) disorders as intoxication, drugs, side effect of some medications, infections of the brains (encephalitis, meningitis) some metabolic disorders, epilepsy can cause this. It is important that catatonia may occur as a symptom of a neuroleptic malignant syndrome, a rare side effect of medication, especially antipsychotics. In the past, catatonia been observed within the context of schizophrenia, which is why one sometimes thinks that it only occurs in psychiatric disorders. Nowadays, it is clear that this is not the case.
Catatonia comes in gradations, from mild symptoms that patients themselves still eat and drink, and there is some communication is possible to completely immobility without any self-care. Catatonia can if untreated or inadequately treated themselves (relatively quickly) develop into lethal catatonia and it is also the case of fluctuating blood pressure, high heart rate varying, extreme rigidity, muscle breakdown, fever. The likelihood that patients with it will die if it is not recognized and treated is greatly increased. The muscle breakdown leads to an increase in creatine kinase, which gives damage to the kidneys, causing kidney failure may occur. The image of catatonia in a patient may vary considerably over the day, but also a longer time remain the same.
Types
Catatonic stupor is an immobile and apathetic state, without any response to external stimuli. Motor activity is virtually absent. Patients remain constant in almost the same position. Patients sometimes lie with the head a few centimeters above the pad instead of on it. Sometimes the picture is so severe that patients keep their eyes open and not even blink the eyelids, which dehydration of the cornea and can cause damage to it. Patients often do not eat more self, and thereby run the risk of dehydration which, in extreme cases, may even lead to death. It can continuously stay in the same position lead to bedsores. There is little or not to get contact with the patient in this condition. There is no or hardly any more verbal communication.
Catatonic excitement is a state of excitement, with stereotype (and the same movements or gestures), bizarre behavior, shouting or emit sounds and physical restlessness. There is little purpose in the act, including the aggression that can show you some patients in this condition for themselves or others. These arousal state may suddenly arise in a patient who was previously in a catatonic stupor, and is, as such, can not be predicted. Also in this state, there is no gain or little contact with the patient.
Catatonia Treatment
As a catatonic state at risk of having dehydration, injury and / or malnutrition and possibly death, treatment is necessary. First choice is thereby the administration of high doses of benzodiazepine, which is usually chosen as the first choice for lorazepam. This is administered by injection or infusion, if necessary if patients can not swallow. If this is unsatisfactory, or at lethal catatonia where mortal danger threatens, given ECT (electroconvulsive therapy). If the image improves, the underlying cause, if known, should be adequately treated in order to avoid a repetition. If necessary moisture and nutrition intravenously administered through a tube, and treated other physical problems.