This post will focus on likely causes for catatonia secondary to underlying medical conditions. DSM-5 defines this as Catatonic Disorder Due to Another Medical Condition: 293.89 (F06.1).
(A) DSM-5 DIAGNOSIS OF CATATONIA:
Catatonia is defined as the presence of three or more of the following
- Catalepsy: passive induction of a posture held against gravity.
- Waxy flexibility: slight and even resistance to positioning by examiner.
- Stupor: no psychomotor activity; not actively relating to environment.
- Agitation, not influenced by external stimuli.
- Mutism: no, or very little, verbal response. (Note: not applicable if there is an established aphasia)
- Negativism :opposing or not responding to instructions or external stimuli.
- Posturing: (spontaneous and active maintenance of a posture against gravity.
- Mannerisms: odd caricature of normal actions.
- Stereotypies: repetitive, abnormally frequent, non-goal directed movements.
- Echolalia: mimicking another’s speech.
- Echopraxia: mimicking another’s movements.
(B) RULE OUT FOLLOWING MEDICAL CAUSES OF CATATONIA:
(1) METABOLIC DISORDERS:
- Diabetic keto-acidosis
- Acute intermittent porphyria
- Hereditary coproporphyria
(2) SYSTEMIC DISORDERS:
- Renal failure
- Hepatic failure
(3) NEUROLOGICAL INFECTIONS:
- herpes encephalitis
- encephalitis lethargica
- post immunisation encephalopathy
- subacute sclerosing panencephalitis
(4) NEUROLOGICAL DISORDERS:
- Cerebral tumors
- Trauma: subdural heamtoma
- Cerebrovascular Disease: subarachnoid haemorrhage; cerebral infarct; cortical venous thrombosis; thrombotic thrombocytopenic purpura.
- Book: CATATONIA. From Psychopathology to Neurobiology. (HIGHLY RECOMMENDED)
- Lancet. 1976 Jun 19;1(7973):1339-41.
- J Neurol Neurosurg Psychiatry 49:991–996, 1986.
- Schizophrenia Research 150 (2013) 26–30.
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Dr. Harvinder Singh, M.D. (Admin)
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