Organic Catatonic Disorder

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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 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 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 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 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 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]

Frequently Asked Questions

What is Organic Catatonic Disorder?

It is a disorder of diminished (stupor) or increased (excitement) psychomotor activity associated with catatonic symptoms.

What causes Organic Catatonic Disorder?

  • Neurological Disorders
  • Systemic and Metabolic Disorders
  • Drugs and Poisoning
  • Psychiatric Disorders

What are the symptoms of Organic Catatonic Disorder?

  • Mutism
  • Rigidity
  • Negativism
  • Posturing
  • Stupor
  • Echolalia
  • Echopraxia
  • Waxy flexibility
  1. A Short Textbook of Psychiatry by Niraj Ahuja / Ch 3/ Ch 5/ Ch 19.
  2. http://apps.who.int/classifications/icd10/browse/2016/en#/F00-F09
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