Catatonia

Question 1

Most patients with catatonia have. . .

Answer 1

. . . a mood disorder (depression or bipolar)

NOT schizophrenia

Question 2

Non-psychiatric causes of catatonia

Answer 2

Autoimmune disease

Malignancy/paramalignancy

Nutritional deficiencies

Question 3

Definition of retarded catatonia

Answer 3

• At least 3 of:
  
  • Stupor
  • Catalepsy
  • Waxy flexibility
  • Rigidity/Negativism
  • Mutism

Question 4

Definition of excited catatonia

Answer 4

• At least 3 of:
  
  • Repetitive stereotyped behaviors
  • Agitation and/or Grimace
  • Echolalia
  • Echopraxia

Question 5

Diagnosis of catatonia

Answer 5

Lorazepam trial with improvement on Bush-Francis scale

Question 6

Treatment of catatonia

Answer 6

• Lorazepam for the catatonia itself
• For associated problems:
  
  • Serum Albumin to screen for malnutrition
  • Serum CK to screen for rhabdomyolysis
  • LMWH for DVT prophylaxis

Question 7

Malignant catatonia

Answer 7

Catatonia with significant rigidity and autonomic nervous system dysfunction

Precipitated by some psychiatric disease (mood disorder or psychosis). No precipitant medication.

Very similar to NMS, malignant hyperthermia, serotonin syndrome

Question 8

DDx for malignant catatonia

Answer 8

Note: Serotonin syndrome does not have lead pipe rigidity, but rather hypertonia/hyperreflexia

Question 9

Antidote for serotonin syndrome

Answer 9

Cyproheptadine

A serotonin receptor antagonist

Should be given to those who do not respond to discontinuing the offending serotinergic drugs.