Catatonic disorder with organic pathology is relatively rare and is registered in about 1 / 10 patients suffering from encephalitis.
What provokes catatonic disorder of organic nature
Clinic catatonia is most common in stem encephalitis, also in Kreutzfeldt disease. The emergence of catatonia is always an indicative of increasing severity of the process.
Symptoms of catatonic disorders of organic nature:
In the foreground there are the main symptoms of pathology, which are usually detected neurologically. Catatonia has typical symptoms of stupor: catalepsy, absence of arbitrary reactions to normal stimuli in response to the paradoxical slight irritant (a symptom of Pavlov), immobility, mutism, a symptom of a gear wheel, air bag, as well as excitation random, undirected psychomotor agitation, which is suddenly interrupted by stupor. However, there is atypia associated with an organic background, frequent atonic stupor, in which muscle tone is reduced, catalepsy may be accompanied by tremor, is noticeable tremor of the eyelids, but a symptom of an air cushion can be confused with symptoms of meningitis. Temperature is often increased to 40 degrees, which is due to underlying disease. Catatonia or delirium may precede disorders of consciousness followed by the disappearance of this clinic syndrome.
Clinical Example: Patient G., aged 34, examined in an infectious hospital, was diagnosed with encephalitis. Located within the bed, he did not answer the question. He had floating eye movement, a symptom of a gear on the right, but the catalepsy was observed in all limbs. He had tremor of the fingers, makes a stereotypical chewing action. In a state of excitement he left home and was found in the woods, sitting on the grass.
Diagnosis of catatonic disorders of organic nature:
Diagnosis is based on identifying the symptoms and pathology of primary atypical catatonia.
[Febrile catatonia, which often differentiate organic catatonia, is not included in the DSM, no ICD, it is because careful studies have shown that such cases actually represent or organic catatonia or neuroleptic malignant (hyperthermia) syndrome. ]
The state must be distinguished from neuroleptic malignant syndrome, catatonic schizophrenia, dissociative and depressive stupor, catatonic disorders in the postpartum period.
Currently, catatonic schizophrenia occurs in the form of microcatatonia, accompanied by negative emotional-volitional disorders. Catatonic disorder in schizophrenia is accompanied by emotional and volitional negative manifestations characteristic of schizophrenia.
Dissociative stupor follows immediately after the stress is manifested more clearly in the presence of strangers, alone, he often disappears.
Depressive stupor is characterized by facial expressions of depression, the answers in a quiet voice at the background of periodic mutism, dilated pupils, tachycardia. It also follows from the stress or at the height of depression, which can be detected in history.
Treatment of catatonic disorders of organic nature:
Treatment must take into account the treatment of the underlying disease, as well as the use of tranquilizers, intravenous (Relanium, sibazon). It is recommended frenolon, small doses of teralena. The use of neuroleptics should be extremely cautious and in small doses.