Organic Catatonic Disorder

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Organic Catatonic Disorder

The Organic Catatonic Disorder:

Organic Catatonic Disorder:

Definition:

Organic catatonic disorder is a disorder of diminished (stupor) or increased (excitement) psychomotor activity associated with catatonic symptoms. Additionally; The extremes of psychomotor disturbance may alternate. [2]

Overview

Overview of Organic Catatonic Disorders

According to the ICD-10 (F06.1) disorder of either diminished (stupor) or increased (excitement) psycho-motor activity associated with catatonic symptoms.

Generally; The extremes of psycho-motor disturbance may alternate. [2] In detail; The presence of other catatonic symptoms and signs increases the conﬁdence in the diagnosis. [1]

Sign & Symptoms

Sign & Symptoms of Organic Catatonic Disorder

1. Mutism i.e.:

In brief; Complete absence of speech.

2. Rigidity i.e.:

Maintenance of a rigid posture against efforts to be moved.

3. Negativism i.e.:

An apparently motiveless resistance to all commands and attempts either to be moved, or doing just the opposite.

4. Posturing i.e.:

Voluntary assumption of an inappropriate also often bizarre posture for long periods of time.

5. Stupor i.e.:

Akinesis (no movement) with mutism but with evidence of relative preservation of conscious awareness.

6. Echolalia i.e.:

Repetition, echo or mimic king of either phrases or words heard.

7. Echopraxia i.e.:

Repetition, echo or mimic king of actions observed.

8. Waxy ﬂexibility i.e.:

In detail; Parts of body can be placed in positions that will be maintained for long periods of time, even if very uncomfortable; ﬂexible like wax.

9. Ambitendency i.e.:

Due to ambivalence, conﬂicting impulses and tentative actions are made, but no goal directed action occurs, e.g. on asking to take out tongue, tongue is slightly protruded but taken back again

10. Other signs i.e.:

Such as mannerisms, stereotypies (verbal also behavioural), automatic obedience (commands are followed automatically, irrespective of their nature) and verbigeration (incomprehensible speech). [1]

Causes

Causes of Organic Catatonic Disorder

1. Neurological Disorders i.e.:

Post-encephalitic parkinsonism
Limbic encephalitis
Surgical procedures on basal ganglia
Neoplasms in diencephalon, frontal lobe and limbic system
Subacute sclerosing pan encephalitis (in other words; SSPE)
General paresis of incomprehensible(GPI)
Petit Mal status
Post-ictal phase of epilepsy
Subdural haematoma
Cerebral malaria
Cortical venous thrombosis

2. Systemic and Metabolic Disorders i.e.:

Diabetic ketoacidosis
Acute intermittent porphyria
Hyperparathyroidism causing hypercalcaemia
Pellagra
Hepatic encephalopathy
Systemic lupus erythematosus
Homocystinuria
Membranous glomerulonephritis

3. Drugs and Poisoning i.e.:

Organic alkaloids
Antipsychotics
ACTH (therapeutic doses)
Aspirin
Illuminating gas
Ethyl alcohol (especially large doses)
Levodopa
Disulﬁram
CO poisoning
Lithium toxicity
Methylphenidate
Phencyclidine (specifically large doses)
Mescaline

4. Psychiatric Disorders i.e.:

Catatonic schizophrenia
Depressive stupor wild stupor
Periodic catatonia
Conversion also dissociative disorder
Reactive psychosis
During hypnosis. [1]

Diagnosis

Diagnosis of Organic Catatonic Disorder

According to the ICD-10(F06.1), the following features are required for the diagnosis of organic catatonic disorder, additionally to the general guidelines for the diagnosis of other organic mental disorders, described earlier:

1. Stupor (diminution or complete absence of spontaneous movement with partial or complete mutism, negativism, also rigid posturing).
2. Excitement (gross hyper-motility either with or without a tendency to assaultiveness).
3. Mixed (shifting rapidly also unpredictably from hypo- to hyperactivity). [1]

Treatment

Treatment of Organic Catatonic Disorder

1. Treatment of the underlying cause, if amenable to treatment.
2. Symptomatic treatment with low dose of a short acting benzodiazepine (e.g. Lorazepam), or electroconvulsive therapy (if needed).

Anti-psychotics should usually be avoided as they can make catatonic features worse; however small doses of atypical anti-psychotics such as Risperidone, Olanzapine, Aripiprazole or Quetiapine can be used with care. [1]