Catatonia in Affective Disorders

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Abstract

Catatonia was described by Kahlbaum in 1874 as a putative disease entity and was subsumed under dementia praecox by Kraepelin in 1896. Although a number of studies attested to the occurrence of catatonia in several other clinical conditions (major psychiatric disorders and organic brain disturbances), its place in modern classifications is still debated. While the traditional clinical stereotype have equated catatonia with schizophrenic psychosis, modern studies in the last three decades observed catatonia in approximately 10% of acute psychiatric admissions, most frequently in association with mood disorders. Catatonic signs (such as mutism, stereotypy, posturing, catalepsy, automatic obedience, negativism, echolalia/echopraxia, or stupor) occur in 13-31% of patients with affective disorders. Recent studies confirmed that catatonic signs are present in 28-66% in different phases of Bipolar Affective Disorder and Schizoaffective Disorder, bipolar subtype. In these cases, manic symptoms are more prominent and mixed states are more frequent. Catatonic signs occur most frequently (approx 61%) in mixed affective states and 46% of these patients require admission to an emergency psychiatric unit.

Catatonic symptoms are found in 31-62% of patients with mania. Presence of catatonia is associated with more severe manic phases. Depression is associated with catatonic signs in 20-53%. Catatonia usually indicates the severity of depressive state but its presence is also a predictor of favorable treatment response.

The prompt recognition of catatonic signs is important since catatonia in patients with affective disorders responds rapidly to benzodiazepines or electroconvulsive therapy which could be a lifesaving intervention. Appropriate prophylactic treatment of affective disorders is of crucial importance in this respect.

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