1/33. Case series: catatonic syndrome in young people.This article reviews all recent (1977-1997) reports on catatonic adolescents and summarizes the 9 consecutive cases seen at the authors' institution during the past 6 years. catatonia occurs infrequently in adolescents (0.6% of the inpatient population), but it appears to be a severe syndrome in adolescents of both sexes. Diagnoses associated with catatonia are diverse, including in this series: schizophrenia (n = 6), psychotic depression (n = 1), mania (n = 1), and schizophreniform disorder (n = 1). Two patients had a previous history of pervasive developmental disorder. In the literature, catatonia was also reported in children with organic condition (e.g., epilepsy, encephalitis). Therapeutic management depends on the specific causes, but several points need to be stressed: (1) the frequency of neuroleptic-induced adverse effects; (2) the potential efficacy of sedative drugs on motor signs; (3) the possible use of electroconvulsive therapy; and (4) the necessity to manage family reactions and fears, which are frequent causes of noncooperation. It is concluded that catatonia is an infrequent but severe condition in young people. While symptomatology, etiologies, complications, and treatment are similar to those reported in the adult literature, findings differ with regard to the female-male ratio and the relative frequencies of associated mental disorders.- - - - - - - - - - ranking = 1keywords = depression (Clic here for more details about this article) |
2/33. Malignant catatonia-induced respiratory failure with response to ECT.A 47-year-old acutely psychotic schizophrenic man was diagnosed with malignant catatonia. Because of a history of neuroleptic malignant syndrome (NMS), traditional neuroleptics were avoided, and the patient had been treated with reserpine for a period of 10 years. Symptomatically, severe agitation alternated with severe retardation. The syndrome progressed, despite early termination of any neuroleptic medications, to marked catatonic rigidity and dehydration. Worsening was associated with transfer to a medical intensive care unit, intubation, and subsequently a tracheostomy. dantrolene and bromocriptine were unhelpful. lorazepam produced muscular relaxation and resulting decreases in creatine phosphokinase levels but elicited no other improvement. Eleven bilateral electroconvulsive treatments, however, resolved the respiratory impairment and catatonia and improved the psychosis. This report highlights the efficacy of ECT in lethal catatonia despite respiratory impairment and tracheostomy.- - - - - - - - - - ranking = 10.781284476249keywords = psychosis (Clic here for more details about this article) |
3/33. catatonia, autism, and ECT.We describe the clinical presentation, course, and treatment response of a 14-year-old boy with catatonic stupor. This patient, with a preexisting diagnosis of autism, displayed mutism, akinesia, and an extreme level of rigidity, waxy flexibility, posturing, including the psychological pillow, facial grimacing, and other involuntary movements of his upper extremities. In addition he had symptoms suggestive of a depressive disorder as well as some non-specific psychotic symptoms. Intravenous injection of sodium amytal failed to resolve any motor symptoms, although he showed a good response to the zolpidem test. A course of electroconvulsive therapy (ECT) caused dramatic and sustained relief of catatonic stupor without a change in the symptoms of autism. The presentation of catatonia in autism and the use of ECT in children are discussed, and the available literature reviewed. This is the first description of the use of ECT in the treatment of catatonia coinciding with autism and we confirm its efficacy.- - - - - - - - - - ranking = 151.80520649045keywords = depressive disorder (Clic here for more details about this article) |
4/33. multiple sclerosis presenting as catatonia.OBJECTIVE: Catatonic disorder due to general medical condition must be excluded in psychiatric patients presenting with this movement disorder. This report emphasizes the association of catatonia with multiple sclerosis. METHOD: A patient with catatonia, psychotic depression, and the subsequent diagnosis of multiple sclerosis is described and the literature reviewed. RESULTS: mutism, immobility, cataplexy, waxy flexibility, and other aspects of catatonia occur in multiple sclerosis, usually as a consequence of a severe mood disorder and extensive cerebral demyelination. These symptoms may be the presenting manifestations of multiple sclerosis. CONCLUSIONS: A high index of suspicion for neurological disease is indicated in patients with new-onset catatonia. neuroimaging and other studies may reveal underlying demyelination requiring specific therapy.- - - - - - - - - - ranking = 1keywords = depression (Clic here for more details about this article) |
5/33. lithium carbonate in prophylaxis of reappearing catatonic stupor: case report.The case of a patient with reappearing stupor, accompanied by auditory hallucinations and persecutory ideas during the periods and not with alternating excitement, is reported. After 24 years of neuroleptics medication with little effect, the lithium carbonate regimen was started, which showed a remarkable prophylactic effect. The implications of lithium carbonate treatment for recurrent psychosis are discussed.- - - - - - - - - - ranking = 10.781284476249keywords = psychosis (Clic here for more details about this article) |
6/33. Adverse outcome with delay in identification of catatonia in elderly patients.All three patients to show catatonia at a teaching veterans' hospital over a 1-year period were over 60 years old. Each experienced delays of 2-5 months in identification of catatonia and adverse events attributable to the delay (e.g., pulmonary embolus, physical restraint, pneumonia, mislabeling as "advanced dementia," Do Not Resuscitate orders, and death). These outcomes suggest that geriatric patients with unrecognized catatonia are at high risk for major adverse events.- - - - - - - - - - ranking = 0.0083025149624805keywords = major (Clic here for more details about this article) |
7/33. ECT for prolonged catatonia.OBJECTIVE AND BACKGROUND: electroconvulsive therapy (ECT) is highly effective for acute catatonia but its use in prolonged catatonia is not well established. We report three cases of prolonged catatonia with medical complications or comorbidities treated by ECT. METHOD: case reports. RESULTS: A 24 year-old woman developed fever and autonomic instability after parenteral neuroleptics. catatonia and autonomic signs persisted for 14 weeks. After minimal improvement from lorazepam, 15 bilateral ECTs led to resolution. A 26-year-old woman with a history of lupus erythematosus, complicated by lupus cerebritis with lesions in the cortex and basal ganglia and a communicating hydrocephalus, was catatonic for 9 weeks. lorazepam produced marginal improvement. A series of 14 bilateral ECTs led to improved mobility, speech, and interaction, but the response was less robust than Case 1. A 40-year-old man with mental retardation and intermittent psychosis developed severe neuroleptic malignant syndrome and remained catatonic for 4 months. After lorazepam produced minimal improvement, his catatonia resolved with 20 bilateral ECTs. CONCLUSIONS: ECT may improve prolonged catatonia with complex medical comorbidities, but may require many treatment sessions. Gross cerebral pathology may predict a less robust response. As for acute catatonia, ECT may resolve prolonged catatonia after benzodiazepines have failed.- - - - - - - - - - ranking = 10.781284476249keywords = psychosis (Clic here for more details about this article) |
8/33. The first-line use of electroconvulsive therapy in major affective disorders.Although electroconvulsive therapy (ECT) has generally been reserved for patients refractory to other forms of treatment, its use as a first-line treatment, prior to the use of other biologic approaches, has occasionally been mentioned in the literature on the treatment of affective disorders and, when indicated, can prove rapidly effective and even life saving. The present study retrospectively reviewed 27 cases treated over the span of a decade in which ECT was chosen as the first treatment of an affective episode. In none of these cases was antidepressant medication or other biologic approaches used for the current episode. A clinical global rating scale was employed to measure improvement. Although the majority of such patients were treated with ECT first based upon the severity of their depressive illness, 13 received ECT because of their obtunded condition and these patients, initially diagnosed as catatonic on admission, were suspected of having a bipolar condition, as revealed on their discharge diagnosis. In addition, ECT was recommended preferentially in 4 patients because they were pregnant and in another 4 because it had worked well in the past; an additional patient received ECT first because of his fragile medical condition. Almost all patients recovered and none suffered serious adverse effects. Sample case histories are provided along with tentative guidelines for the consideration of first-line use of ECT in clinically difficult cases.- - - - - - - - - - ranking = 0.041512574812403keywords = major (Clic here for more details about this article) |
9/33. catatonia induced by levetiracetam.Levetiracetam (Keppra) is a novel antiepileptic drug approved as adjunctive treatment for adults with partial onset seizures. Although the drug is generally well tolerated, behavioral side effects have been reported in variable frequency. Most behavioral problems are mild in nature (agitation, hostility, anxiety, emotional lability, apathy, depression) and quickly resolve with discontinuation of medication. However, serious psychiatric adverse events may also occur with rare cases of psychosis and suicidal behavior. We report here the case of a 43-year-old woman who developed symptoms compatible with catatonia after being exposed to levetiracetam for the treatment of epilepsy. To our knowledge, it is the first reported case of catatonia induced by levetiracetam. We review the difficulties that may be encountered in the differential diagnosis of medical catatonia.- - - - - - - - - - ranking = 11.781284476249keywords = psychosis, depression (Clic here for more details about this article) |
10/33. catatonia in autistic spectrum disorders: a medical treatment algorithm.Autism is a developmental syndrome with an unknown biology and inadequate therapeutics. Assessing the elements of the syndrome for the presence of depression, psychosis, mania, or catatonia, offers opportunities for systematic intervention. Since almost all descriptions of autism highlight the presence of motor symptoms that characterize catatonia, an assessment for this eminently treatable syndrome is recommended for all patients considered to be autistic. A minimum examination includes a catatonia rating scale and for those patients with defined catatonia, a lorazepam test. For those whose catatonia responds to lorazepam, high dose lorazepam therapy is recommended. If this fails, electroconvulsive therapy is recommended. The assessment and treatment of catatonia offers positive medical therapy for the victims of autism and their families.- - - - - - - - - - ranking = 11.781284476249keywords = psychosis, depression (Clic here for more details about this article) |
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