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Ask the Mental Health Expert Archives 2001-2004

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Catatonia

Q. I am a mental health counselor who needs more information on the condition known as catatonia. As a counselor, I own a DSM-IV book, but it only describes schizophrenia-related catatonia. I need information about trauma-induced catatonia. Can you direct me to references on this subject?

A. You've raised an important question on a much-misunderstood topic. The term catatonia is properly regarded as a symptom, rather than a specific condition, much less a disorder. Saying that a patient has catatonia is a bit like saying that your balky car has automobile trouble--it could mean virtually anything!

As you may know, catatonia is usually described as a motor disturbance; e.g., of increased or decreased psychomotor activity, often accompanied by unusual muscle tone, posture, gestures, mutism, negativism, etc. All this is purely descriptive, and does not tell us anything about etiology. Catatonia may occur as a manifestation of brain injury (e.g., subdural hematoma); neuroleptic use; schizophrenia; or, more commonly, mood disorder (see Peralta et al, Compr Psychiatry 1997 Jan-Feb;38(1):61-7).

Catatonia as a symptom of post-traumatic stress appears to be uncommon--I found only a couple of references to this presentation. Jensen describes a case of "conversion catatonia" successfully treated with hypnosis (Am J Psychother 1984 Oct;38(4):566-70). Shiloh et al (Psychopathology 1995;28(6):285-90) describe an unusual case of a patient with posttraumatic stress disorder (PTSD) and several episodes of catatonia in the past 44 years. These episodes were characterized by a sudden onset of intense excitement, mild pyrexia, often moderate elevation of serum creatinine phosphokinase and the development of a full catatonic state.

The authors concluded that the catatonic states "...represented an overwhelming psychic response to associated traumatic recollections, bringing to extreme the avoidance, numbness and motor responses usually encountered in PTSD." I think the take-home message is that catatonia is "a symptom in search of a diagnosis", and that a careful medical, neurological, and psychiatric work-up is essential.

August 2002

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