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Catatonic depression, now known in the DSM-5 as major depressive disorder with catatonic features, is diagnosed when someone who is suffering major depression develops physical symptoms, such as being unable to move, speak or respond to external stimuli.
Catatonia is a not a stand-alone disorder. Rather, it is a psychomotor disorder that may be triggered by a number of things, including infection, certain medications, neurologic disorders, autoimmune disorders, overly abrupt alcohol or benzodiazepine withdrawal, and other psychiatric disorders, notably schizophrenia and other major mood disorders.
There are many different presentations for catatonia.
Stupor is a state where there is no evidence of outward connection to the environment, with little or no psychomotor activity at all. Those suffering from stupor make little or no eye contact, and the patient might remain in one position for a long time, and then abruptly "freeze" into a second position.
Catalepsy causes the body and limbs to go rigid, with non-responsiveness, loss of muscle control and slowed bodily functions, including breathing.
Waxy Flexibility causes slight, even resistance to a change in position initiated by a clinician; allows a patient who is exhibiting catalepsy to maintain a position after it has been changed by the clinician.
Mutism results in little to no verbal response.
Negativism is exhibiting opposition or no response to external instructions or stimuli..
Posturing causes a patient to maintain an extreme body position for an indefinite period, regardless of gravity.
Echolalia is the unconscious repetition or mimicking of another's speech.
Echopraxia is the mimicking of another's movements.
Grimacing is involuntarily "making faces".
Stereotypy are repetitive, abnormally frequent, random movements.
Agitation (not influenced by external stimuli) Individuals experiencing this form or catatonia are extremely hyperactive, with apparently purposeless movements. The patient may also experience delusions and hallucinations.
The added diagnosis of catatonia is made when at least two of the above manifestations are present.
Electroconvulsive therapy (ECT) is considered to be the most effective form of treatment for catatonia, with a success rate of 85%. It is a safe and effective therapy for a variety of mood disorders and illnesses. However, because of the negative connotation to what was once known as "electroshock therapy", ECT is generally not the first line treatment for catatonic symptoms.
Catatonia is believed to be the result of dysregulation of the gabba-aminobutyric acid (GABA) and glutamate neurotransmitter systems. Benzodiazepines are a class of psychoactive drugs that enhances the actions of GABA. These drugs generally provide quick relief for catatonic symptoms.
Lorazepam is the benzodiazepine that is most commonly prescribed to catatonic patients, with a 70% success rate. It is also sometimes prescribed in conjunction with ECT.
Other promising treatments include N-Methyl-D-aspartate (NMDA), an amino acid that acts in the same manner as GABA, which has shown some success at ameliorating symptoms. So have repetitive Transcranial Magnetic Stimulation (rTMS) and several atypical antipsychotics. For all of these, however, more research will have to be done to determine side effects and effectiveness.
Image courtesy Emery Way
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