Electroconvulsive Therapy in a Patient With Chronic Catatonia: Clinical Outcomes and Cerebral 18[F]Fludeoxyglucose Positron Emission Tomography Findings.

Catatonia is a psychomotor syndrome that can be associated with both psychiatric diseases (mainly mood disorders, but also psychotic disorders) and medical conditions. Lorazepam (6-21 mg/day, occasionally up to 30 md/day) is the first choice treatment and electroconvulsive therapy (ECT) is the second line, regardless of the underlying clinical condition. There are some evidences also for effectiveness of other medications. Patients treated acutely usually show rapid and full therapeutic response but even longstanding catatonia can improve. However, some authors suggested that chronic catatonia in the context of schizophrenia is phenomenologically different and less responsive to lorazepam and ECT, especially if associated with echophenomena. We present here the case of a patient with longstanding catatonic schizophrenia treated with antipsychotics who significantly improved after ECT. Improvement regarded mainly catatonia, but also negative symptoms, cognition and psychosocial functioning. A slight amelioration in prefrontal metabolism (Brain[F]FDG PET) one month following the ECT course was also noted.

Catatonic psychosis related to forced normalization in a girl with Dravet's syndrome.

It has been reported that the clinical presentation of forced normalization can vary from paranoid hallucinatory states to anxiety and conversion phenomena, and that it may occur in both generalised and focal epilepsies. On the basis of the evaluation of a video recording, we found that forced normalization was concomitant with catatonic psychosis in a patient with epilepsy, intellectual disability and pervasive developmental disorder. Catatonic psychosis accompanying forced normalization has not been previously reported. As the psychotic symptoms and quality of life worsen seizure control improves, we believe it may be better for the patient to tolerate some seizures, thus preserving their capacity to interact socially.

Seasonality of schizophrenic births in the United States.

The birth months of persons later diagnosed as schizophrenic were studied. Data were collected from 19 states on 53,584 schizophrenics born between 1920 and 1955. The controls were the general births in the same states for the same years. A highly significant peak in schizophrenic births was found from December to May, most marked in March and April. The seasonality was stronger in New England and the Midwest than in the South. Previous studies of schizophrenic births are also reviewed. The cumulative evidence would appear to establish more firmly a winter and spring seasonality of schizophrenic births in northern Europe and the eastern United States. Selection of patients, nutritional factors, environmental factors, genetic factors, and infectious agents are discussed as possible etiological explanations.

Catatonia in thrombotic thrombocytopenic purpura: case report.

A young woman with thrombotic thrombocytopenic purpura (TTP) and a history of "catatonic schizophrenia" proved to have had a prolonged previous episode of TTP with catatonic features. TTP may present with a variety of "mental" phenomena; its pathophysiology may prove to be relevant to psychiatry. As a treatable but potentially fatal disease, its recognition is important.

Biomathematical models of schizophrenia.

This paper summarizes the work of developing and analyzing a mathematical model of schizophrenia. First the psychological and physiological studies of patients with periodic catatonia made by R. R. Gjessing are briefly described. Then a mathematical model, which is based on Gjessing's work and consists of a set of nonlinear ordinary differential equations, is derived. Gjessing showed that there was a periodic change in the basal metabolic rate associated with a periodic change in the symptoms of catatonia. This suggests a study of the thyroid control system, and since the thyroid control system is a negative feedback system, previous engineering studies are followed and a system of ordinary differential equations is used as a model. The first such model was due to Danziger and Elmergreen, and their model and improvements of their model are described. Then the models are analyzed qualitatively and the mathematical results are interpreted medically. Solutions of the system of differential equations corresponding to a stable set of symptoms in the schizophrenic patients, solutions corresponding to periodic patterns of symptoms (periodic catatonia), and solutions corresponding to random or unpredictable patterns of symptoms are obtained. The model suggests that since certain parameters are varied, various types of solutions and hence various patterns of symptoms are obtained. There are a number of unresolved questions in this study, and these problems are discussed in detail as they arise.

Catatonic schizophrenia: a cohort prospective study.

BACKGROUND: In the 20th century, catatonia was usually deemed a subtype of schizophrenia. Recently, the nature and classification of catatonia are being reconsidered. This study is the first to describe catatonia using prospectively collected data and to examine how catatonic schizophrenia differs from, or resembles, other types of schizophrenia. METHODS: Data were analyzed in a cohort of 90,079 offspring followed from birth till ages 29-41 years. Proportional hazards models were used, calculating time to first psychiatric hospital admission, to compare risk factors for catatonic schizophrenia vs "other schizophrenia." RESULTS: Of 568 cases of schizophrenia, 43 (7.6%) had catatonic schizophrenia. The sexes were equally at risk for catatonic schizophrenia in contrast to other schizophrenia, for which the incidence was higher in males (1.70, 1.42-2.03, P < .0001). Advancing paternal age had no influence on the risk of catatonic schizophrenia in contrast to other schizophrenia, in which the risk to offspring of fathers age 35+ was 1.27 (1.03-1.57, P = .03) compared with those of younger fathers. Those with catatonic schizophrenia were somewhat more likely to have older mothers (aged 35+) (relative risk = 2.14, 0.85-5.54) while maternal age was not related to other schizophrenia. Both were equally affected by parental history of schizophrenia. Patients with catatonia were significantly more likely to attempt suicide (P = .006). CONCLUSION: Patients with catatonic schizophrenia show a somewhat different profile of risk factors from those with other types of schizophrenia in this cohort and are more likely to attempt suicide. This lends some support to the hypothesis that catatonic schizophrenia may have a distinct etiology.

Unusual neuropsychiatric manifestations of enteric fever.

Enteric fever, a common problem in the tropics, may present with unusual neuropsychiatric complications. Three patients presenting as catatonic schizophrenia, encephalomyelitis and pseudo-bulbar palsy are reported. Early recognition and management of the cause of such presentations can reduce morbidity and mortality.

Genetic predisposition and environmental causes in periodic and systematic catatonia.

The nosological heterogeneity of catatonic schizophrenia was the focus of a family study involving 139 catatonic patients. The clinical dichotomization of catatonia into periodic catatonia and systematic catatonia revealed good inter-rater reliability and stability of the diagnoses at follow-up. Analysis of the cumulative morbidity risk among first-degree relatives gave an excessive familial aggregation of homogenous psychoses in periodic catatonia with a risk of 26.9%. The mode of inheritance was consistent with an autosomal dominant model. In contrast, first-degree relatives of probands with systematic catatonia had a morbidity risk of 4.6%. Subsequent investigations pointed to a potential association of systematic catatonia to exposure to midgestational infections in the index cases and linked these sporadic disorders to disturbances of fetal neurodevelopment. The periodic catatonia, an unequivocally genetically transmitted illness, is at present under investigation in a genome-wide linkage analysis.

Kahlbaum's catatonia revisited.

Modern psychiatric nosologies separate catatonia along the lines of presumed etiology: bipolar, major depression, schizophrenia and due to a general medical condition. The presence of catatonia has always held diagnostic and prognostic value. Kahlbaum's description of catatonia includes careful documentation of phenomenology and the course of the illness. Since there were no effective treatments in his time, Kahlbaum was documenting the natural history of the illness. A review of classic studies of the natural history of catatonia demonstrates that the syndrome is episodic, may have few other psychotic signs, may have periods of remission and may, in some cases, be associated with the disorganized subtype of schizophrenia. The literature of the past 100 years supports the validity of Kahlbaum's description for a subset of patients with catatonia.