Catatonia: what are we talking about exactly?
According to DSM-IV, the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (APA), catatonia is defined as " neuropsychiatric disorder characterized by one or more of the following essential signs: immobility, mutism, negativism (active or passive refusal to follow orders), mannerisms, stereotypies, posturing, grimaces, echolalia, echopraxia, muscular rigidity and stupor; sometimes punctuated suddenly by fits of violence, panic or hallucinations ".
" From the outside, catatonia (also called "catatonic syndrome") can make one think of a coma, but with sudden fits of agitation "clarifies Dr. Julien Smadja, psychiatrist." It is a very spectacular psychiatric disorder which is fortunately rare and which one rather observes in hospitalized patients. "
To know. Catatonia is a psychiatric disorder that can be managed by a psychiatric doctor or a neurologist.
Catatonia: what are the signs of catatonic syndrome?
A catatonic syndrome is characterized by several signs (psychic and motor) which can be really spectacular:
- Immobility: the person does not move,
- Silence: the person does not speak,
- A global attitude of opposition: the person does the opposite of what is asked of him (he clenched his teeth or eyelids when asked to open his mouth or eyes, for example),
- Imitation phenomena: echolalia (the person repeats the words or the end of sentences of his interlocutor) and / or echopraxia (the person imitates the gestures of his interlocutor),
- A catalepsy: the person seems "frozen" like a statue, she has motor rigidity and resistance. " People in a situation of catatonia can sometimes take a very long time in postures that would tire even a high level athlete: we speak of serous flexibility. "says Dr. Smadja,
- Phases of agitation with violence, aggression, panic and / or hallucinations.
To know. " Patients who experience catatonic syndrome may not remember it after the fact, but they may also feel like they have been temporarily "walled" in their own body. "explains the psychiatrist.
What are the causes of catatonia? Contrary to what one might think, catatonic syndrome is not always of psychiatric origin: " one can indeed observe the appearance of catatonia in the event of mood disorders, severe depression (melancholy), from schizophrenia or even bipolar disorders poorly (or not) taken care of, admits Dr. Smadja. However, it is important to emphasize that a third of catatonia cases have an organic cause: they develop after a cerebrovascular accident (stroke), in connection with a encephalitis, with alcohol withdrawal … "
Catatonia: what treatment for catatonic syndrome?
Catatonia: is it serious, doctor? " Catatonic syndrome is indeed quite serious: in the absence of care, it is a priori irreversible and can lead to death by dehydration or by undernutrition "explains Dr. Julien Smadja.
The medical treatment of catatonia is mainly symptomatic. The doctor will be able to prescribe drugs, which will be administered by intravenous or nasogastric route if the oral route is not possible:
- benzodiazepines. These anxiolytics are usually prescribed against anxiety: against catatonia, lorazepam (Temesta®) is used primarily to reduce motor symptoms – stiffness, catalepsy …
- of Stilnox®. Paradoxically, this sleeping drug prescribed against insomnia can cause a "waking up" of the patient suffering from catatonia. The active substance in Stillnox® is zolpidem, a hypnotic of the imidazopyridine family.
And also… " Against catatonia, emergency treatment can also be used: electroconvulsive therapy (ECT). This consists of delivering an electric current to the brain to simulate a short epileptic crisis, allowing the release of many neurotransmitters, explains Dr. Smadja. It is a painless treatment, performed under general anesthesia, and very well controlled today. "
Thanks to Dr. Julien Smadja, psychiatrist at the clinic of the Château de Garches (92).
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