Catatonia (#2): Catatonic Disorder Due to Another Medical Condition: 293.89 (F06.1)

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

  1. Catalepsy: passive induction of a posture held against gravity.
  2. Waxy flexibility: slight and even resistance to positioning by examiner.
  3. Stupor: no psychomotor activity; not actively relating to environment.
  4. Agitation, not influenced by external stimuli.
  5. Mutism: no, or very little, verbal response. (Note: not applicable if there is an established aphasia)
  6. Negativism :opposing or not responding to instructions or external stimuli.
  7. Posturing: (spontaneous and active maintenance of a posture against gravity.
  8. Mannerisms: odd caricature of normal actions.
  9. Stereotypies: repetitive, abnormally frequent, non-goal directed movements.
  10. Grimacing
  11. Echolalia: mimicking another’s speech.
  12. Echopraxia: mimicking another’s movements.

(B) RULE OUT FOLLOWING MEDICAL CAUSES OF CATATONIA: 

(1) METABOLIC DISORDERS:

  • Diabetic keto-acidosis
  • Hypercalcaemia
  • Homocystinuria
  • Acute intermittent porphyria
  • Hereditary coproporphyria

(2) SYSTEMIC DISORDERS:

  • Renal failure
  • Hepatic failure

(3) NEUROLOGICAL INFECTIONS:

  • herpes encephalitis
  • syphilis
  • encephalitis lethargica
  • post immunisation encephalopathy
  • subacute sclerosing panencephalitis
  • tuberculosis

(4) NEUROLOGICAL DISORDERS:

  • Epilepsy
  • Cerebral tumors
  • Trauma: subdural heamtoma
  • Cerebrovascular Disease: subarachnoid haemorrhage; cerebral infarct; cortical venous thrombosis; thrombotic thrombocytopenic purpura.

REFERENCES:

  1. Book: CATATONIA. From Psychopathology to Neurobiology. (HIGHLY RECOMMENDED)
  2. Lancet. 1976 Jun 19;1(7973):1339-41.
  3. J Neurol Neurosurg Psychiatry 49:991–996, 1986.
  4. Schizophrenia Research 150 (2013) 26–30.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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