Catatonic syndrome (psychiatry): treatment, symptoms

This concept in medical practice implies a set of symptoms manifested by psychomotor disorders. This pathology was first described in 1874 by Kahlbaum, who considered this disease as a separate nosological unit. Almost immediately it was recognized that catatonia is a symptom of schizophrenia. At the moment, experts do not adhere to such a clear position, highlighting several options for the causes of the pathology.

The disease can occur at any age. Including children. The peak of cases is in the age group of 17-30 years. The list of main symptoms includes:

• impulsive behavior;
• stupor;
• excitation.

Psychiatrists treat pathology. The combination of electroconvulsive and drug therapy makes it possible to successfully defeat the disease or transfer it to a stage of stable remission.

Catatonic syndrome: schizophrenia

The catatonic form is one of the manifestations of schizophrenia. It occurs in approximately 2.5% of all diagnosed cases of confirmation of this complex psychological illness. Many doctors believe that catatonic syndrome is unique to schizophrenia. In other situations, we can only talk about catatonic disorders.

The pathology is characterized by active and passive negativism, in which the patient resists when trying to change his posture. Patients suffering from active negativism refuse to carry out tasks received from the doctor. For example, when asked to sit down, the patient may defiantly remain standing and turn his back. In the passive form, the patient resists due to muscle tension.

Historical data

Living dead syndrome was first described in 1880 by French psychiatrist and neurologist Jules Cotard.
He called this syndrome delusion of denial. His first patient was a woman who was sure that she had long since died. She convinced those around her that her veins were empty, her heart had long been gone. At the same time, the patient experienced severe depression. Jules Cotard considered that in this case there is a complete denial of one’s own existence and the life of all humanity.

The disease is now named after him. It is believed that with this syndrome there is a violation of temporal perception - patients cannot adequately assess the past and future. They believe that they are dead people, their body organs are missing. Some consider themselves aliens from other worlds.

Symptoms of catatonic syndrome

The presence of pathology can be determined by the symptoms of catatonic syndrome. It is necessary to contact for consultation at the first manifestations of the diagnosis. Timely initiation of treatment speeds up recovery.

The list of the most common symptoms includes:

• persistent repetition of facial expressions and movements surrounding stereotypy;
• counteracting attitude negativism;

• echo symptoms, in which the patient involuntarily repeats phrases and words;
• isolation;
• mutism, characterized by the patient’s inability to speak with full health of the speech apparatus;
• a strange body position with the head elevated, called “air cushion syndrome”;
• the grasping reflex, which manifests itself in the unreasonable grasping of surrounding objects;
• the presence of pathological flexibility;
• excessive facial expressions, grimaces;
• hypertrophied wide eyes.

The number of symptoms accompanying catatonic disorders is varied. Only a doctor can make an accurate determination. Some of them are particularly common. For example, the proboscis symptom noted in catatonic syndrome.

Proboscis symptom (In catatonic syndrome)

The position of the lips, in which, due to muscle contraction, they are constantly extended forward and form a “tube,” is a natural stage in the development of the facial muscles and facial expressions of a child in the first year of life. When pathology appears in an adult, it indicates the possible onset of catatonia.

Often proboscis syndrome is not accompanied by other manifestations of stupor or increased excitability. To eliminate the pathology, you need to contact a psychiatrist.

Existing treatments

Unfortunately, it is very rare to completely get rid of Cotard's syndrome. This is due to patients seeking medical help late. In order to correct disorders of brain function, medications of various groups are used:

1. The basis of treatment is antipsychotic drugs such as Aminazin and Rispolept. They help fight anxiety, reduce the risk of injury, and also help normalize the functioning of the nervous system.
2. Antidepressants are widely used in the treatment of walking dead syndrome. Drugs such as Amitriptyline are used.
3. Anxiolytics are indicated for severe anxiety in the patient. This group of medications includes Grandaxin. These drugs are successfully combined with antidepressants.
4. In severe cases, the use of tranquilizers is indicated. They are used when there is a high risk of injury and suicide. Drugs such as Phenazepam are prescribed.

In some cases, in addition to medications, electroconvulsive therapy is used. Some doctors and medical institutions refuse this method because they consider it outdated and cruel. However, despite this, with the help of this technique it is possible to achieve visible results. This is possible due to the effect of low current on the brain, which leads to a change in the pathological functioning of neurons. A combination of this technique with drug treatment is also indicated.

Communication with a psychiatrist is also important. Such sessions are conducted both individually and in small groups. Through a conversation with the patient, it is possible to enhance the therapeutic effect of the pharmacological drugs taken, as well as evaluate the effectiveness of treatment.

In many cases, the diagnosis of Cotard's syndrome requires hospitalization of the patient in specialized institutions. This is associated with a high risk of suicide and trauma, as well as the need for constant monitoring. Once the person’s condition has stabilized, therapy can be carried out on an outpatient basis. Even in the absence of clinical manifestations of the disorder, patients are registered at a psychiatric clinic. This is important for controlling the disease and preventing relapses.

Treatment of catatonic syndrome

Treatment of this pathology can only be carried out in a specialized psychiatric hospital. After a thorough examination, an individual course of therapy is developed for each patient. Medications play a major role in this:

• mood stabilizers;
• benzodiazepines;
• antiglutamantics;
• muscle relaxants;
• neuroleptics.

Additionally, electroconvulsive therapy is prescribed. In the case of malignant forms of pathology, such therapy is prescribed primarily to relieve the acute stage. The therapy involves passing electrical impulses through the brain tissue. The procedure is performed only in a hospital under the supervision of a doctor. If necessary, call an ambulance. After completion of the course, drug therapy continues.

When is Cotard's syndrome observed?

Cotard's syndrome can be observed in mental disorders: psychotic endogenous depression, schizoaffective disorder, as well as the depressive-paranoid variant of schizophrenia. Much more often, this syndrome is diagnosed in involutional and senile depression, as well as psychotic conditions.

Cotard's syndrome can also be observed with organic damage to the central nervous system (progressive paralysis, encephalitis, trauma, brain tumors, etc.).

If Cotard's syndrome is observed in people of a younger age than in involution, who, of course, cannot have senile psychosis, then this may indicate a pronounced degree of severity of a depressive state with a high degree of anxiety, as well as a high risk of suicide.

In each individual case, the patient requires an individual approach and assistance from a psychiatrist, and possibly also from a neurologist.

Types of catatonic syndrome

Manifestations of pathology differ depending on the type. Only a doctor can make an accurate diagnosis.

Affective syndromes

They are accompanied by frequent changes in behavior from a high level of disinhibition to states of catatonic sleep and complete refusal to interact with the outside world.

Delusional syndromes

Obsessive movements are accompanied by delirium. Delusional states can also occur with passive negativism. This further aggravates the patient’s retreat into his inner world and refusal to communicate.

Hallucinatory syndromes

Patients in both the active and passive stages may experience hallucinations. In a state of stupor and lack of reaction to the outside world, this further worsens the patient’s condition. With active negativity of the patient, they can become socially dangerous.

Oneiric catatonic syndrome

It begins immediately with the acute phase, characterized by a noticeable increase in psychomotor agitation. In this state, the patient can be dangerous to others, and manic thoughts may arise. Moreover, in this state the patient seems to be in a waking dream. In perception, real and fictitious circumstances alternate.

Regressive catatonic syndrome

This variant of pathology turns an adult into a child in terms of behavioral style. Moreover, often in an infant. The sounds produced may resemble meowing.

Lucid catatonic syndrome

Characterized by the absence of delirium, stupor, or hallucinations. An increased level of excitement manifests itself, movements become abrupt and fussy. Stupor with numbness and negativistic stupor will occur.

History of discovery

In 1788, Swiss naturalist Charles Bonnet described one of the earliest cases of Cotard's syndrome.
Then the elderly woman was preparing food in her house, and when a draft blew, she felt like half of her body was paralyzed. After the unpleasant sensations passed, the woman persistently asked her relatives to arrange a funeral for her, dressing her in a shroud and placing her in a coffin. This situation continued for several days, during which she demanded that her maids, friends, and family members treat her as nothing less than dead. This bore fruit: the elderly woman’s relatives organized a wake for her, at which she did not stop fiddling with her shroud, relying on its “inappropriate” color. When she finally fell asleep, the family members undressed her and put her to bed. The strange psychological phenomenon passed, but returned every few months. Later, almost 100 years later, the French neurologist Jules Cotard will describe a case in which a patient (Mademoiselle X) came to him with a non-trivial complaint: she claimed that she had no stomach, brain, nerves, chest and intestines. At the same time, she was convinced that she was immortal, since in the absence of such vital organs only a chosen one could survive:

"I am immortal and will live forever."

For this reason, she stopped eating, not seeing the need for it. She died soon after, and this interesting incident was widely reported in the press. The mental disorder later received the name Jules Cotard.

Diagnostics

There are no diagnostic laboratory tests to diagnose PFAPA syndrome. Diagnosis is primarily made based on medical history and examination findings.

Throat culture (bacteriological examination) may reveal group A beta-hemolytic streptococcus (GABHS), but these patients do not respond to penicillin treatment. This allows us to conclude that they are carriers of GABHS, that is, the existing symptoms are not a manifestation of GABHS tonsillopharyngitis.

In the acute period, blood tests reveal moderate leukocytosis (13.6 ± 4.5 x 109 /l), increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and neutropenia. All indicators are normalized during the interictal period.

PFAPA syndrome is a diagnosis of exclusion. First of all, other causes of recurrent fever are excluded: infection, inflammatory bowel disease, fever with Hodgkin lymphoma, cyclic neutropenia and others.

The following criteria are important for diagnosis:

• More than three documented stereotyped episodes of fever occurring at regular intervals. For individual patients, the intervals between attacks are almost identical, ranging from two to eight weeks. Each episode usually lasts from 2 to 7 days. It is important that the symptoms of each episode are almost identical.
• During an exacerbation, patients often experience pharyngitis, cervical lymphadenopathy, or aphthous stomatitis.
• Normal parameters of growth and development in children.
• Resolution of symptoms within a few hours of treatment with prednisolone given as a single dose or two doses 12 to 48 hours apart.

Clinical picture

Periodic fever is a hallmark of Marshall syndrome. It begins suddenly and is often accompanied by chills. The temperature ranges from 38.5 to 41 ºC for 2-7 days, and then drops sharply to normal. Before the fever, the child may experience irritability, mood swings, complain of malaise, sore throat, and aphthous ulcers appear in the mouth.

Aphthous stomatitis - ulcers usually located on the inside of the lips or buccal mucosa, occur in approximately 40-80% of patients.

Pharyngitis (sometimes with exudate - liquid contents in the tonsils, less often with ulcers on the tonsils) occurs in 65-100% of patients.

Cervical lymphadenopathy (enlarged lymph nodes) accompanies fever in 60–100% of patients. Cervical lymph nodes may be painful to palpation.

Other symptoms: abdominal pain (40-65%), joint pain (11-42%), vomiting (18-41%) and headache (18-65%). Less common are diarrhea, cough, runny nose and rash.

In adulthood, episodes rarely have a uniform interval between attacks, and the attack itself is rarely diagnosed as pharyngitis, with chest pain, headache, arthralgia (joint pain), myalgia (muscle pain), eye symptoms and rash more common.