How common is catatonia
|Classification according to ICD-10|
|ICD-10 online (WHO version 2006)|
The catatonic schizophrenia corresponds to a sub-form of schizophrenia in which psychomotor disorders dominate the clinical picture. However, other symptoms of schizophrenia are common: hearing voices, fear, thought disorders, paranoid experiences. The clinical picture was first described by the German psychiatrist Kahlbaum in 1874 (Kahlbaum, KL: catatonia or tension insanity, Hirschwald, Berlin, 1874). Later, the neurologist and psychiatrist Karl Leonhard (1904-1988) dealt with this topic in depth. With the introduction of the operationalized criteria catalogs ICD-10 and DSM-IV and the diffusion of the subjects neurology and psychiatry, the clinical picture is diagnosed less and less.
The genesis of all schizophrenic forms has not yet been clarified. Today, as with the other forms of schizophrenia, the catatonic sub-forms are assumed to have a multifactorial genesis with genetic, psychodynamic and environmental factors. In one of the most differentiated schools of psychopathology, the Wernicke-Kleist-Leonhard direction, it is assumed that schizophrenias - including the catatonic forms - represent a heterogeneous group of diseases, with the sub-form "periodic catatonia" (classification according to Karl Leonhard) having genetic causes could, while the chronic catatonia may be due to maternal infections in the middle trimester. With the detection of the susceptibility gene 15q15, a genetic predisposition of this relapsing subtype was proven.
The following symptoms can occur as the disease progresses:
If the stupor is accompanied by a fever, one speaks of one pernicious or malignant catatonia. This vitally threatening appearance used to offer only minimal chances of survival. Thanks to the therapy options with modern treatment methods (intensive care unit and therapy, benzodiazepines, neuroleptics, electroconvulsion therapy), almost all affected patients are now surviving. The discussion as to whether "pernicious" or "malignant" catatonia is identical to the life-threatening clinical picture of "neuroleptic malignant syndrome" (NMS) has not yet been conclusively resolved. The course of the disease is similar, the picture of fatal catatonia was first described over 100 years ago In contrast, the picture of the NMS has only existed since the introduction of neuroleptics in the 1960s.
The treatment of symptoms from the catatonic spectrum is usually initially carried out with benzodiazepines in order to break through catalepsy and to alleviate the most severe fear that is often present. The treatment of catatonic schizophrenia takes place, as with the other schizophrenic forms, with neuroleptics. So-called mood stabilizers such as lithium, valproic acid, carbamazepine, lamotrigine and olanzapine can be extremely helpful for long-term stabilization. Catatonia can often be treated quickly and efficiently with electroconvulsive therapy (ECT). On the basis of the GABA-A-glutamate hypothesis of catatonia, if a therapy with benzodiazepines such as lorazepam fails, a therapy attempt with dopamine agonists or amantadine (an NMDA receptor agonist) can be considered.
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