Catatonia (#1): History of Catatonia: Kahlbaum & Kraepelin.

Kahlbaum is well known for his monograph “Catatonia or Tension Insanity“, where he described catatonic symptoms as having behavioral and motor components. He described this term tension insanity due to presence of dystonic, stiff, and rigid symptoms in catatonia. The most common locations of these symptoms included neck, lips, peri-oral areas, eye muscles and proximal limbs. Note that this localization is similar to antipsychotic induced acute dystonia.

Kraepelin (well known for his work on dementia praecox) also described catatonia but differed from Kahlbaum’s catatonia concept in following ways:

(1) CYCLICAL STAGES

Kahlbaum: described catatonia with several cyclical stages: prodrome stage, initial stage, stage with most severe symptoms and remission after (unitary psychosis concept).

Kraepelin: described catatonia as not following this cyclical course.

(2) COURSE

Kahlbaum: described catatonia with cyclical and remitting course.

Kraepelin: described catatonia with chronic course.

(3) BEHAVIORAL VS MOTOR COMPONENT

Kahlbaum: described catatonic symptoms as having behavioral and motor components.

Kraepelin: behavioral components were more highlighted than motor components.

(4) CATATONIA & HEBEPHRENIA (DISORGANIZED SCHIZOPHRENIA)

Kahlbaum: described both of them as separate disease categories.

Kraepelin: described them as subtype of same disease process, which was later described as dementia praecox. He described catatonia as subtype and not diagnostic criteria for dementia praecox.

(5) PROGNOSIS

Kahlbaum: described catatonia with mostly as good prognosis. He described catatonia into three subtypes (a) Catatonia mitis– milder form (b) Catatonia gravis– severe form, and (c) catatonia protracta– chronic catatonia.

Kraepelin: described catatonia with poor prognosis. This was also supported by Hecker in 1871.

(6) CHRONIC CATATONIA:

Kraepelin: removed following from chronic catatonia subtype classification: (a) Melancholia attonita, (b) catatonic mania and (c) catatonic mixed states.


REFERENCES:

  1. Book: CATATONIA. From Psychopathology to Neurobiology. (HIGHLY RECOMMENDED) (amazon)
  2. Kahlbaum KL: Klinische Abhandlungen über psychische Krankheiten. 1. Heft: Die Katatonie oder das Spannungsirresein. Berlin, Hirschwald, 1874.
  3. British Journal of Psychiatry (1993), 162, 733-738.
  4. World J Psychiatry. 2017 Sep 22; 7(3): 177–183.

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Dr. Harvinder Singh, M.D. (Admin)


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