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Catatonia

  • Sundararajan Rajagopal
Abstract

Catatonia is an important phenomenon in both psychiatry and general medicine. This article provides an overview of the key aspects of catatonia, including clinical features, differential diagnoses, management and prognosis. The different types of catatonia, the position of catatonia in the psychiatric classificatory systems, use of catatonia rating scales and the association between catatonia and neuroleptic malignant syndrome are also covered. Abnormalities that have been hypothesised as being possible underlying mechanisms in catatonia are highlighted. The article aims to provide clinicians with a comprehensive update on the subject, with information derived from an extensive range of relevant references.

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References
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Catatonia

  • Sundararajan Rajagopal
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eLetters

Catatonia in Present Day Society

Sally A Morgan, Specialist Registrar in General Adult Psychiatry
23 July 2008

Rajagopal (2007) suggests that catatonia is a unique syndrome that requires treatment in its own right, independent of any underlying disorder.

We conducted a postal survey of psychiatrists working in the South West of England and Wales, looking at their understanding of catatonia. Wealso enquired about the number of catatonic cases encountered in a 2 year period, the presence of underlying/comorbid disorders, treatment type and response to treatment.

There are a large number of varied signs associated with the syndrome(Bush 1996) and they may be subtle and unrecognised. No specific diagnostic criteria for catatonia have been established, although most authors define the syndrome by the presence of motor signs. There is a growing evidence base for effective treatment and recognition of catatoniais important to prevent significant morbidity (Rosebush 1999).

In our survey, 96% of respondents understood catatonia as a syndrome in its own right and as a subtype of schizophrenia. For the majority of signs, 90% of respondents felt confident to give a definition but there was no consensus regarding which signs needed to be present to diagnose catatonia. Only 28% of respondents reported seeing a case/s of catatonia and a range of different treatments were used.

Catatonia continues to be recognised, but the understanding of the condition differs which could result in under diagnosis and suboptimal treatment. The use of rating scales may ensure more cases are identified. There is a need to raise awareness amongst clinicians of this often forgotten entity.

Declaration of Interst: None

Bush, G., Fink, M., Petrides, G., et al (1996) Catatonia. I. Rating scale and standardized examination. Acta Psychiatrica Scandinavica, 93, 129 -136

Rajagopal,S. (2007) Catatonia. Advances in Psychiatric Treatment, 13,51-59

Rosebush, P. I., Mazarek, M. F. (1999) Catatonia: Re-awakening to a Forgotten Disorder. Movement Disorders, 14, 395-397
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Conflict of interest: None Declared

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