Catatonie — Wikipedia

The catatonie is a psychiatric syndrome expressed both in the psychic and motor sphere. It is in particular a form of expression of many pathologies as neurological as psychiatric. It was once considered as an exclusive form of schizophrenia ( Hebephrenocatatonic schizophrenia ), characterized by periods of passivity and negativism alternating with sudden excitations ^{[ first ]} . Nowadays, it is recognized that a catatonic syndrome can appear during the evolution of mood disorders (depression or bipolar disorders) or as a symptom of organic diseases, with a main prevalence of organic causes on psychiatric causes. This recognition brought the Diagnostic and statistical manual of mental disorders (DSM- IV -TR) published by the American Association of Psychiatry (AAP) not to recognize it as a disorder apart or as a schizophrenia subformer, but as a syndrome associated with other disorders.

The following signs are generally associated with it:

• Negativism, that is to say opposition to any proposal. This was defined by Henri Ey as the “refusal of all contact with others and with reality”. This can understand a refusal of the gaze, a silence, anorexia or total apragmatism;
• Passivity: paradoxically, the subject can also occasionally have attitudes of passive acceptance, by suggestibility;
• Motor syndrome: Loss of the motor initiative, generalized stiffness, frozen attitude, active resistance to attempted mobilization. Sometimes we observe the catalepsy syndrome, known as Swell flexibility , the patient keeping the attitudes imposed by others even when they are uncomfortable (this is for example the sign of the pillow: the head remains raised when the pillow is removed). Parakinetic phenomena (mannerism, stereotypia, pathetism, impulses), echolalia, echopraxis and other forms of perseveration are observed. Sometimes the evolution is punctuated by sudden psychomotor agitation access or by clatical crises.

Associated somatic symptoms include signs of dysautonomy, tension disorders, edema of the lower limbs, profuse sweats, ends of the extremities, hypersalivation.

The DSM- IV Defined it as a syndrome, without prejudging its etiology: schizophrenia, mood disorders (mainly melancholy), neurological conditions. Its evolution without treatment can lead to death by anorexia or dehydration.

• schizophrenia (catatonic type),
• bipolar disorder,
• post-traumatic stress syndrome,
• depression,
• Parkinsonian syndrome ^{[ 2 ]} ,
• abuse of substances or during a overdose ,
• alcohol wean ^{[ 3 ]} ,
• wean on benzodiazepines ^{[ 4 ] , [ 5 ] , [ 6 ]} ,
• stroke,
• encephalitis, autoimmune disorders,
• Metabolic disorder (hyponatremia) ^{[ 7 ]} ,
• Hypnosis (State ” Esdaile ») ^{[ 8 ]} .

• Benzodiazepines are the first treatments and high doses are often required.
• Electro-convulsive therapy is sometimes used ^{[ 9 ]} .
• Antagonists with NMDA receptors are sometimes used in case of benzodiazepines resistant catatonia ^{[ ten ]} .

His description was established by Karl Ludwig Kahlbaum in 1874 ^{[ 11 ]} .

Emil Kraepelin defines it as one of the forms of early dementia, which is, moreover, the theoretical ancestor of schizophrenia.

Eugen Bleuler includes it among the forms of schizophrenia. The latter defines the nature of extreme symptoms of the Psychomotor dissociation and identifies the combined expression of negativism and autism in the blue sense.

Nosological controversy [ modifier | Modifier and code ]

The observations of doctors and certain studies now lead to consider that catatonia is not particularly linked to schizophrenia but more to mood disorders and states of intoxication, contrary to what Kraepelin thought. Reactions to neuroleptic agents, as well as the clever neuroleptic syndrome, would have led to confusion with malignant catatonia ^{[ twelfth ]} .

Lorna Wing, who highlighted the notion of spectrum of autism, and Amitta Shah considered the specificity of the catatonic phenomenon in autistic people, and examined the exacerbated nature of symptoms among this population ^{[ 13 ]} .

There is a behavioral concordance between conventional catatonic manifestations and the symptoms present in many autistic people. The concept of developmental handicap makes it possible to understand these two clinical descriptions as having a common etiology at the neurological level. The common features include self-aggression, stereotypia, silence, negativism, stereotypical discourse, echolalia, postural pathologies, grimaces, maniérisms, rigidity and agitation aimlessly ^{[ 14 ]} .

Lorna Wing and Amitta Shah suggest a difference between catatonic stupor and deterioration resembling catatonia , in autism. In order to avoid the chronicization of these symptoms, it is important to use the combination of a clinical assessment, an individual neurodevelopmental history, as well as a psychological estimate of the strengths and weaknesses of the person. The use of the diagnostic interview for social and communication disorders ( Diagnostic interview for social and communication disorders or disco) is recommended ^{[ 15 ]} .

The recommended treatments to prevent the worsening of such symptoms are listed by Wing and Shah:

• The adoption of a program to reduce stress factors in life, by providing stimulation objectives and factors. The principles of the approach Text are mentioned, as models of the structuring of the daily environment ^{[ 15 ]} ;
• An education in symptoms of this type intended for the environment close to the person. It is particularly advisable not to assimilate a Excitation resembling catatonia to problematic or opposition behavior, and not to confuse passive symptoms with laziness ^{[ 15 ]} ;
• the use of prompts In order to allow people with catatonia to regain control of the central nervous system and to manage the frustrations generated by the growing impossibility of moving, as well as the difficulties to stop once a repetitive process initiated ^{[ 15 ]} .

Classic treatments of catatonic stupor, namely electroconvulsive therapy and lorazepam, do not show much efficiency, faced with this particular phenomenon of autistic catatonia ^{[ 15 ]} .