OnlineMedEd: Psychiatry - Catatonia

Question 1

What big change occurred from the DSM-4 to the DSM-5 regarding catatonia?

Answer 1

It was considered a disease in the DSM-4. In the DSM-5, however, it is a symptom, subtype, or modification of other disorders.

Question 2

Catatonia most often occurs in ______________.

Answer 2

mood disorders (e.g., bipolar, MDD)

Question 3

What medical disorders cause catatonia?

Answer 3

• Autoimmune disorders

* Paraneoplastic syndromes

Question 4

To diagnose catatonia, the patient has to have three or more symptoms. List the symptoms by excited and retarded catatonia.

Answer 4

Retarded:

• Stupor
• Waxy flexibility
• Mutism
• Negativism
• Catalepsy (not cataPLEXY!)

Excited:

• Echolalia
• Echopraxia
• Stereotypy
• Agitation or grimace

Question 5

If the symptoms respond to ____________, then the diagnosis was catatonia.

Answer 5

lorazepam

Question 6

All of the dangerous kinds of catatonia have the same symptoms: ________________.

Answer 6

rigidity (lead-pipe, increased CK) and autonomic dysfunction (increased BP, HR, and temperature)

Note: serotonin syndrome doesn’t have lead-pipe rigidity; instead, it has hyperreflexia and myoclonus.

Question 7

Give the four dangerous kinds of catatonia and their causes.

Answer 7

• Malignant catatonia: caused by psychiatric conditions (no meds needed)
• Neuroleptic malignant syndrome: caused by D2 blockade
• Serotonin syndrome: caused by serotonin-enhancing drugs
• Malignant hyperthermia: caused by halogenated anesthetics