Prevalence and clinical significance of catatonic symptoms in mania
Westfälisches Zentrum fur Psychiatric, University of Bochum, Bochum, Germany Comprehensive Psychiatry
(Impact Factor: 2.25).
01/1999; 39(1):35-46. DOI: 10.1016/S0010-440X(98)90030-X
The study investigates the prevalence, clinical characteristics, and implications of catatonic symptoms in mania. Sixty-one inpatients with DSM-111-R bipolar disorder (BD), manic or mixed episode, established by the Structured Clinical Interview for DSM-III-R (SCID) were assessed for the presence of catatonic by a 21-item rating scale. Nineteen patients fulfilled criteria for catatonic mania, exhibiting between five and 16 catatonic symptoms. Catatonic manics had more mixed episodes, more severe manic symptoms, more general psychopathology, a higher prevalence of comorbidity, a longer hospitalization, and lower Global Assessment of Functioning (GAF) scores than the noncatatonics. The results indicate that catatonic symptoms are a marker of a more severe course and outcome in mania.
Available from: Nina Lindberg
- "Studies on adult patients with schizophrenia-related and mood disorders have reported incidences of catatonia that varied between10–38% [4,7,8]. However, despite that catatonia also occurs among children and adolescents , it has been sparsely studied among this age group. "
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Catatonia has been associated with both schizophrenia and pervasive developmental disorders. The aim of this study was to evaluate catatonic features among adolescents suffering from schizophrenia. Further, we compared these features between adolescents with a comorbid pervasive developmental disorder and those without one. Finally, we wanted to compare the profile of catatonia-like features of our schizophrenia patients to that described earlier among persons with autism spectrum disorders.
The study comprised a consecutive sample of 18 adolescents with schizophrenia (mean age 15.6 years, SD 1.4) and their families. Diagnosis of schizophrenia was assessed with the Schedule for Affective Disorders and Schizophrenia for School-Aged Children – Present and Life-Time (K-SADS-PL) for the DSM-IV. The Diagnostic Interview for Social and Communication Disorders version 11 was used to assess catatonic features.
All adolescents with schizophrenia had showed some lifetime catatonic features. Approximately 78% of them had already expressed these features before the age of 10. The number of catatonic features before the age of 10 was significantly higher among the adolescents with a comorbid pervasive developmental disorder compared to those without one. The numbers of catatonic features after the age of 10 did not significantly differ between the two groups. Over three-quarters of schizophrenia patients shared four lifetime catatonic features: “lacks facial expression”, “odd intonation”, “poor eye contact” and “lack of cooperation”.
Adolescent schizophrenia patients with a comorbid pervasive developmental disorder show many catatonic features in childhood whereas those without one seem to develop these features first in adolescence. Catatonic features exhibited by adolescents with schizophrenia resemble those described among persons with pervasive developmental disorders without schizophrenia.
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ABSTRACT: Es wird die Symptomatik einer Patientin mit katatoner Schizophrenie im Krankheitslängsschnitt vorgestellt. Anhand videografischer
Aufzeichnungen werden Stabilität und Variabilität katatoner Symptome im zeitlichen Verlauf untersucht. Durch die Videodokumentation
kann belegt werden, daß die katatonen Symptome längsschnittstabil auftreten, aber bedingt durch Veränderungen der Erregungslage
bezüglich ihres Schweregrades deutlich variieren. Dadurch lassen sich wechselnde, das klinische Bild jeweils bestimmende Symptomkonstellationen
erkennen: Ein hyperkinetisches katatones Syndrom mit im Vordergrund stehender Unruhe oder Erregung, mit abnormen unwillkürlichen
Bewegungsstörungen, Stereotypien und parakinetischen (eckig-unrunden) Bewegungen sowie ein hypokinetisches katatones Syndrom
mit unterschiedlichen Hemmungsphänomenen bis zu Mutismus und Stupor. Zu verschiedenen Zeitpunkten stehen jeweils bestimmte
katatone Symptomkonstellationen im Vordergrund, während andere katatone Symptome durch die Abnahme ihres Ausprägungsgrades
in den Hintergrund treten und dadurch übersehen werden können. In diesem Zusammenhang wird die Frage des „diagnostischen Schwellenwertes”
diskutiert. Die Videografie ist aus Sicht der Autoren für die Dokumentation katatoner Bewegungsstörungen besonders geeignet
und kann auch zur Differenzierung morbogener und pharmakogener Störungen beitragen.
The symptomatology of a female patient with catatonic schizophrenia is presented with respect to its longitudinal course.
The stability and variability of catatonic symptoms are investigated using videotape technique. It is demonstrated that catatonic
symptoms are stable in the longitudinal course but due to unsteady arousal they severity of the catatonic symptoms varies
markedly. There are fluctuating symptom patterns that dominate the clinical picture: a hyperkinetic form with prevailing
restlessness or excitement, with abnormal involuntary movements, stereotypies, and parakinetic movements, and a hypokinetic
form with various inhibition phenomena, mutism and stupor. The clinical impression of the catatonic syndrome changes according
to the dominating symptom patterns at different times, whereas the less severe symptoms recede into the background and thus,
may be overlooked. Considering this finding the problem of a ’diagnostic threshold’ is discussed. The authors intend to emphasize
videotape documentation of catatonic motor disturbances as most useful. This technique may contribute to differentiating illness
related from neuroleptic induced movement disorders.
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