1/10. 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 = 1keywords = physical (Clic here for more details about this article) |
2/10. Psychological approaches to chronic catatonia-like deterioration in autism spectrum disorders.The psychological dysfunctions that may underlie catatonia-like deterioration in autism spectrum disorders are discussed. Clinical observation suggests that an important factor is ongoing stress. The evidence for this from research and clinical observation is considered. The lack of evidence concerning the most appropriate medical treatments is discussed. A psychological approach designed for individual needs by relevant professionals and applied by parents and/or caregivers is described. This can be helpful whether or not medical treatments are used. It involves detailed holistic assessment of the individual and their circumstances to highlight possible precipitating stress factors in view of their underlying autism and cognitive/psychological functioning. The overall aim of this approach is to restructure the individual's lifestyle, environment and resolve cognitive/psychological factors to reduce the stress. An eclectic approach is used to find individual strategies in order to provide external goals and stimulation to increase motivation and keep the person engaged and active in meaningful and enjoyable pursuits. The approach describes ways of using verbal and physical prompts as external stimuli to overcome the movement difficulties and emphasizes maintaining a predictable structure and routine for each day. The importance of educating caregivers and service providers to understand the catatonia-like behavior is emphasized. Advice is given on management of specific problems such as incontinence, freezing in postures, eating problems, and episodes of excitement.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. electroconvulsive therapy complicated by life-threatening hyperkalemia in a catatonic patient.electroconvulsive therapy (ECT) requires brief general anesthesia, and succinylcholine is a depolarizing neuromuscular blocking agent that is frequently used for this procedure. Its use leads to intracellular potassium release into the extracellular space, usually increasing the serum potassium level by 0.5-1 mEq/L, with little clinical significance. However, long-term immobilization has been associated with changes at the neuromuscular junction (up-regulation of nicotinic cholinergic receptors) and subsequent serious hyperkalemia following succinylcholine administration. We report the case of a severely obese patient, immobilized due to her catatonic state, who developed life-threatening ventricular tachycardia after succinylcholine administration for ECT. Resumption of normal physical activity reverses these neuromuscular junctional changes, allowing subsequent safe succinylcholine administration. Current drug development may eliminate the need for succinylcholine use during ECT.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. neuroleptic malignant syndrome following amoxapine overdose.The case of a patient who developed the neuroleptic malignant syndrome following an overdose of amoxapine is presented. It is suggested that amoxapine, an antidepressant structurally related to the neuroleptic loxapine, be added to the list of medications that can cause this potentially lethal syndrome. This case illustrates the need for careful evaluation and attention to differential diagnosis when psychiatric patients develop physical signs and symptoms.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. catatonia in the emergency department.The catatonic syndrome has a wide differential diagnosis that includes both psychiatric and organic disorders. We present the cases of two patients with catatonia seen acutely in the emergency department. In these cases, the striking clinical picture proved to be secondary to psychiatric disturbances, and were accompanied by dementia in the second patient. The examining physicians were confused by the presentations, and the correct diagnosis and disposition were delayed. The clinical presentation of the catatonic complex, its differential diagnosis, and the pertinent physical signs are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Anticholinergic toxicity masquerading as neuroleptic malignant syndrome: a case report and review.patients who present with acute neuropsychiatric syndromes pose difficult diagnostic and treatment challenges. A history of psychiatric illness and treatment with psychotropic medication may be valuable clues to diagnosis and management of such patients. However, this information may also tempt a clinician to focus on a premature diagnosis, excluding other important possibilities. A case of a 42-year-old male with recurrent psychotic illness who developed an abrupt deterioration in mental and physical status is presented. Despite an initial good response to physostigmine, he was diagnosed with neuroleptic malignant syndrome and did not receive subsequent treatment with cholinesterase inhibitors. The patient expired within hours of arriving in the emergency room. The postmortem benztropine level was elevated, leading to the attribution of death to anticholinergic toxicity. This case serves to illustrate the difficulties in distinguishing features of anticholinergic toxicity and neuroleptic malignant syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. catatonia mimicking nonconvulsive status epilepticus.Nonconvulsive status epilepticus (NCSE) and catatonia share many clinical features and distinguishing between them on the basis of the physical examination may be difficult and even impossible. Although several reports have been made of NCSE simulating catatonia, there are no published cases of catatonia mimicking NCSE. We report a 24-year-old woman whose initial examination was notable for a fixed stare, no response to voice or command, gaze preference, tonic head posturing, constant stereotypic chewing movements, profuse foamy salivation, and dramatic response to the parenteral administration of benzodiazepines (BZDs). She was initially misdiagnosed as having NCSE. EEG, however, was normal. We believe this is the first published report of catatonia simulating NCSE. The EEg may be more useful than the clinical examination in distinguishing NCSE from catatonia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. Fatal pulmonary embolism in the catatonic syndrome: two case reports and a literature review.BACKGROUND: catatonia is associated with excess early mortality when it is unrecognized or inadequately treated. The characteristics of the lethal catatonia subtype are now well described, but the excess mortality of the remaining patients with catatonic syndrome, particularly from pulmonary embolism, appears to be inadequately recognized. The fatal risk of the catatonic syndrome is reviewed. METHOD: Two new case reports of sudden death from pulmonary embolism in catatonic syndrome are presented. The world literature on morbidity, mortality, and pulmonary embolism in catatonia was reviewed by a search of medline and PsychInfo from 1966 to the present. Additional older references were discovered by screening bibliographies from articles produced by the searches. RESULTS: Twenty cases of autopsy-confirmed pulmonary embolism were found in patients with catatonic syndrome. Catatonic patients were more likely to die of pulmonary embolism and die earlier than patients with other types of schizophrenia. death from pulmonary embolism did not occur until after the second week of catatonic symptoms and often occurred without warning. CONCLUSION: risk of a fatal pulmonary embolism is inherent in persistent catatonic symptoms and may explain the observed excess early mortality. Prompt resolution of the catatonic syndrome with benzodiazepines, barbiturates, or electroconvulsive therapy is the best way to reduce risk of pulmonary embolism. The prophylactic value of physical therapy or anticoagulation merits further investigation. Despite the absence of controlled trials of treatment effectiveness, the catastrophic outcome of acute pulmonary embolism warrants early and vigorous intervention in catatonic patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Case study: ECT treatment of a young girl with catatonia.This article reports a case of major depression with catatonic symptoms which occurred in an 8 1/2-year-old girl. While taking oral antidepressants, her symptoms worsened markedly, and significant physical morbidity appeared imminent. electroconvulsive therapy was successful in treating the patient's catatonic and mood symptoms, with no observable deleterious effects. review of the English-language literature reveals no younger patients ever reported to have presented with such severe catatonia or to have been treated with electroconvulsive therapy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Deep venous thrombosis of the leg due to psychiatric stupor.We report the cases of two patients with psychiatric stupor who developed venous thrombosis. A 29-year-old schizophrenic woman had been hospitalized in psychiatric institutions three times because of stupor associated with auditory hallucinations and thought blocking. These symptoms recurred and she was admitted to our hospital with deep venous thrombosis of her left leg. The other patient was a 67-year-old woman with depression. She had also suffered from insomnia. Following admission to our hospital, she developed a depressive stupor complicated by deep venous thrombosis of her left leg. Both cases were treated with sodium heparin and urokinase, and completely resolved. It is well known that dehydration, infection and decubitus ulcers are important physical complications of psychiatric stupor, but there have been few reports of deep venous thrombosis as a physical complication of stupor.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
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