Edit concept Question Editor Create issue ticket

Malignant Catatonia

Catatonia Lethal


Presentation

  • Three case reports are presented to illustrate the diagnostic conundrum of delirious mania and several different presentations of malignant catatonia.[ncbi.nlm.nih.gov]
Hyperthermia
  • He presented with hyperthermia, tachycardia, hypertension, excessive sweating, and an elevated serum creatine phosphokinase (CPK) level. On the basis of these features, he was suspected to have NMS.[ncbi.nlm.nih.gov]
  • Differential Diagnosis of catatonia Locked-in syndrome Seizures Malignant hyperthermia Parkinsonism Deception syndromes: What is Malignant hyperthermia occurs post-operatively reaction to inhalation anesthetics communicate via vertical eye movements and[quizlet.com]
  • Our review also supports the proposed conceptualization of catatonia as a continuum, with milder forms at one end (termed simple or nonmalignant catatonia) and more severe forms involving hyperthermia and autonomic dysfunction (termed malignant catatonia[eurekaselect.com]
  • Main symptoms of malignant catatonia are hyperthermia and autonomic symptoms such as tachycardia, tachypnea and hyperhidrosis. It is important to make the diagnosis as early as possible for an appropriate medical treatment.[scopemed.org]
Anemia
  • The case of a 17-year-old adolescent with sickle cell anemia is presented. The patient developed malignant catatonia and responded dramatically to electroconvulsive therapy.[ncbi.nlm.nih.gov]
Anorexia
  • High fever, altered consciousness, autonomic instability, anorexia, electrolyte imbalance, cyanosis, and associated catatonic signs (e.g., posturing, stereotypies, and mutism) were present from the early stages; stupor typically followed, but it was the[clinicalgate.com]
Acute Intermittent Porphyria
  • intermittent porphyria Addison’s disease Cushing’s disease Diabetic ketoacidosis Glomerulonephritis Hepatic dysfunction Hereditary coproporphyria Homocystinuria Hyperparathyroidism Idiopathic hyperadrenergic state Multiple sclerosis Pellagra Idiopathic[clinicalgate.com]
Cyanosis
  • High fever, altered consciousness, autonomic instability, anorexia, electrolyte imbalance, cyanosis, and associated catatonic signs (e.g., posturing, stereotypies, and mutism) were present from the early stages; stupor typically followed, but it was the[clinicalgate.com]
Flushing
  • […] impairment, but was otherwise in good health until age 15 years, when he developed rigidity, posturing, stupor, unresponsiveness, repetitive self-injurious behaviors, and negativism, as well as autonomic abnormalities including profuse diaphoresis and flushing[ncbi.nlm.nih.gov]
  • Severe prolonged catatonia with associated flushing reaction responsive to lithium carbonate. J Am Acad Child Psychiatry (1985) 24 (2):235–7. doi:10.1016/S0002-7138(09)60454-4 CrossRef Full Text Google Scholar 123. Gjessing LR.[frontiersin.org]
Purpura
  • Diabetic ketoacidosis Glomerulonephritis Hepatic dysfunction Hereditary coproporphyria Homocystinuria Hyperparathyroidism Idiopathic hyperadrenergic state Multiple sclerosis Pellagra Idiopathic Peripuerperal Systemic lupus erythematosus Thrombocytopenic purpura[clinicalgate.com]
Negativism
  • […] patient experienced significant motor and communication delays with mild cognitive impairment, but was otherwise in good health until age 15 years, when he developed rigidity, posturing, stupor, unresponsiveness, repetitive self-injurious behaviors, and negativism[ncbi.nlm.nih.gov]
  • 115 ページ - The presence of catatonia as manifested by motoric immobility, excessive motor activity (that is apparently purposeless and not influenced by external stimuli), extreme negativism or mutism, peculiarities of voluntary movement, or echolalia[books.google.com]
  • Abstract Catatonia is a syndrome characterized by mutism, immobility, negativism, stereotypy, mannerisms, echophenomena, perseveration and passive obedience.[scopemed.org]
  • Ind Psychiatry J 2014;23:163-5 Catatonia is a syndrome, comprised of symptoms such as motor immobility, excessive motor activity, extreme negativism, and stereotyped movements.[industrialpsychiatry.org]
  • The essence of catatonia symptoms are: movement disorders, mutism, negativism, waxy flexibility, stereotypical movement, impulsive actions, duality, and paramimics. It is a psychosis that affects movement and speech.[llmd.lt]
Psychiatric Symptoms
  • The symptoms of NMS/MC include severe agitation, behavior disregulation, motor and speech changes, self-injury and aggression, autonomic instability, and a range of psychiatric symptoms (affective, anxiety, or psychotic symptoms).[ncbi.nlm.nih.gov]
  • She exhibited recent onset psychiatric symptoms which were later followed by a rapid deterioration in her physical health.[cambridge.org]
Indecisiveness
  • The appearance of being “stuck” in indecisive, hesitant movement. Per neurologic examination. Repeatedly returns to the same topic or persistence with movement.[clinicalgate.com]
Onset in Adolescence
  • Kraepelin identified a “periodic” catatonia (with an onset in adolescence) characterized by intermittent excited states, followed by catatonic stupor and a remitting and relapsing course. 8 In the 1930s this disorder was further described as lethal catatonia[clinicalgate.com]
Uremia
  • […] ketoacidosis Glomerulonephritis Hepatic dysfunction Hereditary coproporphyria Homocystinuria Hyperparathyroidism Idiopathic hyperadrenergic state Multiple sclerosis Pellagra Idiopathic Peripuerperal Systemic lupus erythematosus Thrombocytopenic purpura Uremia[clinicalgate.com]
Stupor
  • The patient experienced significant motor and communication delays with mild cognitive impairment, but was otherwise in good health until age 15 years, when he developed rigidity, posturing, stupor, unresponsiveness, repetitive self-injurious behaviors[ncbi.nlm.nih.gov]
  • This stage would be followed by exhaustion, characterized by stupor and by high temperatures.[clinicalgate.com]
  • […] with rates in unipolar depression and in normal controls. ‎ 115 ページ - A type of schizophrenia in which the clinical picture is dominated by at least two of the following: (1 ) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor[books.google.com]
  • Sam; An undiagnosed stupor in the acute medical unit: a case of malignant catatonia, QJM: An International Journal of Medicine, Volume 108, Issue 4, 1 April 2015, Pages 335–336, Download citation file: Ris (Zotero) EndNote BibTex Medlars ProCite RefWorks[academic.oup.com]
  • Aarti 23 years female admitted to female medical ward Tata Main Hospital (TMH) with acute onset mutism, complete refusal of food, stupor and generalized rigidity of the body.[industrialpsychiatry.org]
Insomnia
  • A 53-year-old man with schizophrenia was admitted to the psychiatric hospital because of excitement, monologue, muscle rigidity, and insomnia.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION A 53-year-old man with schizophrenia was admitted to the psychiatric hospital because of excitement, monologue, muscle rigidity, and insomnia.[unboundmedicine.com]
Paresis
  • Langerhans’ carcinoma Paraneoplastic encephalopathy Periventricular diffuse pinealoma Poisoning Coal gas Organic fluorides Tetraethyl lead poisoning Infections Acquired immunodeficiency syndrome Bacterial meningoencephalitis Bacterial sepsis General paresis[clinicalgate.com]
Screaming
  • ., running down a hallway, screaming, or taking off clothes) without provocation. Afterward, gives no or only facile explanations. Exaggerated cooperation with the examiner’s request or spontaneous continuation of the movement requested.[clinicalgate.com]

Workup

  • […] a) EEG b) lumbar puncture c) MRI d) CT In approximately 25% of cases, catatonia is caused by a general medical condition 2 ; as such, a comprehensive medical workup is vital for assessment and management of catatonic patients. In Ms.[mdedge.com]
  • On Day 5, as part of our workup for non-convulsive epilepsy, a trial of intravenous diazepam (5 mg) was given.[academic.oup.com]

Treatment

  • In children with this syndrome, electroconvulsive treatment should be considered.[ncbi.nlm.nih.gov]

Prognosis

  • Its short-term prognosis is of paramount importance. Without effective treatment, it is associated with high mortality.[em-consulte.com]
  • It is crucial to diagnose and begin an appropriate treatment quickly to improve the patient's prognosis. Plasma exchange appears to be an efficient treatment option in SLE and catatonia, and it avoids the use of ECT [ 17, 18 ].[ncbi.nlm.nih.gov]
  • Classical catatonic signs, such as mutism, stupor, negativism, and excitement, do not by themselves indicate the etiology or determine the prognosis. The prognosis is better for catatonia occurring in a mood disorder than in schizophrenia.[primarypsychiatry.com]
  • Prognosis Prognosis of catatonia is good, especially with early and aggressive treatment. In mood disorders, prognosis is probably better than in psychotic disorders.[frontiersin.org]
  • Prognosis and Patient Counseling. The majority of patients recover within 2 weeks, however, NMS can be life-threatening. Mortality rates when initially reported before 1970 were as high as 76%.[clinicaladvisor.com]

Etiology

  • Familiarity with the clinical features and varied etiologies is essential for effective management of this catastrophic reaction.[ncbi.nlm.nih.gov]
  • Kraepelin and Bleuler both believed that catatonic symptoms could emerge as part of a mood disorder (either mania or depression) or could result from neurologic, toxic-metabolic, and infectious etiologies.[clinicalgate.com]
  • It is a rare condition that presents subtle signs and symptoms and different etiologies, and is therefore underdiagnosed.[scielo.br]
  • Although many of them are conceptualized as biopsychosocial disorders, recent data indicate that the biological component appears more and more as a major etiologic factor.[books.google.ro]
  • Conventional treatment, benzodiazepine- and/or ECT-based, can solve the catatonic episode in a few days, irrespective of its etiology and its severity.[em-consulte.com]

Epidemiology

  • Epidemiologic investigations show a high prevalence of functional psychoses and organic mental disorders.[books.google.ro]
  • Adityanjee, Aderibigbe, YA, Mathews, T: Epidemiology of Neuroleptic malignant syndrome. Clinical Neuropharmacology, 1999; 2:151-158. Gurrera RJ: Sympathoadrenal hyperactivity and the etiology of neuroleptic malignant syndrome.[mhaus.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology is still unclear but most reports suggest a hypodopaminergic state. Its reported mortality has declined from 75-100% in the preneuroleptic era to 31% during the review period (1986-1992).[ncbi.nlm.nih.gov]
  • Its purported pathophysiology—frontal-striatal depletion of dopamine and GABA—overlaps considerably with that of NMS.[oxfordmedicine.com]
  • Although the findings in the present study cannot entirely explain the pathophysiology of malignant catatonia, they do indicate that hyperactivity of the sympathetic nervous system may be involved in the pathology of this condition.[dovepress.com]
  • In addition, findings from our review suggest that simple catatonia, MC and NMS share a common pathophysiology involving reduced dopaminergic functioning in the basal ganglia-thalamocortical circuits, consistent with their identity as variants of the[eurekaselect.com]

Prevention

  • As a result, every psychiatrist, physician, and mental health care professional needs to understand and identify these disorders in time to prevent a fatal outcome.[books.google.com]
  • Frequently two to three ECT treatments will suffice, although four to six treatments are usually given to prevent relapse.[quizlet.com]
  • Nonetheless, early intervention with lorazepam prevented the evolution of this patient to a fatal complication.[scielo.br]
  • Springer, 13 ian. 2014 - 468 pagini In spite of progress in biomedical research, we know little about the causes, prevention, and treatment of the numerous mental and neurological disorders that afflict up to 15% of all individuals.[books.google.ro]
  • Preventing Catatonia Because the exact cause of catatonia is often unknown, prevention is not possible. However, patients should avoid taking excess neuroleptic medications, such as Thorazine.[healthline.com]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!