CATATONIC SYNDROME (grech, katateino to pull together, strain; synonym catatonia) — the mental disorder with dominance of disturbances in the motive sphere which is expressed block (stupor) or excitement.
The clinical picture
the Catatonic stupor is shown by an obezdvizhennost, increase in a muscle tone and a mutism (failure from the speech). Distinguish a stupor with the phenomena of wax flexibility, a negativistichesky stupor and a stupor with catalepsy.
A stupor with the phenomena of wax flexibility (see. Katalepsy ) — a state, at Krom of a part of a body of the patient keep the situation given them more or less long time. The phenomena of wax flexibility arise consistently in muscles of a neck, upper and, at last, the lower extremities. Disappearance of the phenomena of wax flexibility happens upside-down.
The Negativistichesky stupor is shown by a full obezdvizhennost of the patient, and any attempt to change a pose causes a sharp muscle tension with counteraction.
A stupor with catalepsy — a condition of the most intensive muscular tension, at Krom patients constantly stay in the same pose (a thicket pre-natal), and the symptom of a proboscis (the lips extended forward is quite often observed at densely compressed jaws).
Struporous states can replace each other. So, the stupor with wax flexibility can pass into a stupor with negativism; the last can precede a stupor with catalepsy.
Except the listed types of a stupor, allocate substruporous states with an incomplete obezdvizhennost, unsharply expressed phenomena of wax flexibility, a partial mutism.
In conditions of a stupor and a substupor the symptom of an air (mental) pillow can be observed — the head during nek-ry time remains raised over a pillow.
Catatonic excitement can be ecstatic, impulsive, hebephrenic and mute.
Ecstatic (confused and pathetic) excitement it is shown by enthusiasm, mystical feeling: patients accept theatrical poses, sing, recite verses; their speech of a vysprenn, is inconsistent. Excitement can be interrupted by episodes of a stupor or a substupor.
Impulsive excitement it is expressed in unexpected, sudden acts. Patients promptly jump, try to run, aim to strike people around, fall into a condition of violent rage, stiffen for short time, again become excited, repeat the movements of people around (ekhopraksiya). In the speech repetition of the heard words quite often prevails (echolalia), verbigeration (repetition of the same words).
Hebephrenic excitement (a gebefrenokatatonichesky syndrome) it is shown by silliness, grimacing, a ridiculous, senseless laughter, patients jump, wriggle, is inappropriate plainly joke (clownism); the wrong answers to the asked questions, including and the simplest are possible (mimorech).
Mute (silent) excitement — this chaotic, senseless, not purposeful excitement with aggression, furious resistance, drawing to and people around of heavy damages.
Ecstatic excitement quite often precedes impulsive; the last can be replaced hebephrenic and sometimes by mute.
To. pages depending on whether it is followed by stupefaction or not, subdivide on To. page with oneiroid and lyutsidny (not accompanied with stupefaction) a catatonia.
Ecstatic impulsive and hebephrenic excitement, and also a stupor with the phenomena of wax flexibility and substruporous states develop at oneiric stupefaction.
A stupor with negativism and catalepsy, as a rule, svoystven a lyutsidny catatonia.
Therapy by psychotropic drugs caused almost total disappearance of severe forms of struporous states (a stupor with negativism) and the expressed forms of catatonic (mute) excitement (a so-called medicinal pathomorphism).
An etiology and a pathogeny
To. the page can arise at various diseases. At schizophrenia To. the page develops both within a recurrent and pristupoobrazno-progreduated current, and at continuously current (malignant, youthful) schizophrenia. At the same time it can be shown in the form of the symptoms entering into structure of a difficult polymorphic syndrome (hebephrenic and early the begun paranoid schizophrenia), or in the form of the syndrome defining a picture of a disease in general.
To. the page can develop at symptomatic (somatogenic infectious and intoksikatsionny) psychoses, both acute, and protragirovanny, against the background of a delirium, an amentia, depressive and paranoid and hallucinatory paranoid states (see. Intoksikatsionny psychoses , Infectious psychoses ), and also at organic and vascular diseases of a brain.
There are various points of view on a pathogeny To. page. Consider that its development is connected with impact on an organism of substance of the proteinaceous nature — a tarakseina. An opportunity is not excluded that this substance is not only primary, but also afterproduct of exchange and has toxic properties.
The research of periodically arising catatonia which is shown a stupor or excitement allows to draw a conclusion on the known role in a pathogeny of a catatonia of disturbances of a nitrogen metabolism: believe that development To. the page is connected with the increased accumulation or the increased release of nitrogen.
The reasons of development of a catatonic stupor are explained also with counterinhibition of deep departments of a brain, and consider that emergence of the total guarding braking capturing analyzers of the environment leads to development of a oneiric catatonia while the guarding braking extending on a motor analyzer leads to emergence of a lyutsidny catatonia.
To. the page is diagnosed in cases of development in the sick described motive frustration in the form of various manifestations of excitement or a stupor. Quite often separate catatonic symptoms arise in structure difficult psikhopatol. syndromes that does not allow to diagnose in general a state as catatonic.
To. the page in the form of struporous and substruporous states should be differentiated with the depression proceeding with block — a depressive stupor, with a condition of the apathy which is followed by an obezdvizhennost — an apathetic stupor (see. Struporous states ). Absence in these cases of changes of a muscle tone, the phenomena of wax flexibility, negativism and other catatonic frustration allows to exclude a possibility of assessment of a state as catatonic. To. the page in the form of a stupor needs to be differentiated also with the psychogenic stupor most often arising at hysterical psychoses. In these cases differential and diagnostic value have change of behavior of the patient at a talk on the psychoinjuring subjects, existence of separate hysterical physical symptoms (a tremor, squint), psevdodementno-puerile lines in a mimicry.
To. the page with a picture of excitement should be delimited from other types of excitement: amental, epileptiform, delirious, maniacal, melancholic, crazy, psychopathic (see. Excitement psychomotor ).
Treatment is defined by a basic disease.
the Forecast is various depending on; diseases, within to-rogo To. the page develops. At schizophrenia development To. page, followed by rise in temperature, it is necessary to regard as a state, life-threatening the patient (a febrile catatonia). Predictively adverse for life of the patient it is necessary to consider also development of catatonic frustration at height of syndromes of stupefaction (a delirium, an amentia) or after depressive and paranoid and hallucinatory paranoid frustration at symptomatic psychoses.
The forecast concerning recovery and working capacity depends on at what nozol, a form develops To. page; at schizophrenia, e.g., development To. page, followed by oneiroid, it is necessary to consider predictively favorable; the forecast of a lyutsidny catatonia, especially is adverse if it develops at the current schizophrenia juvenile zlokachestvenno.
Bibliography: V. archpriests P; Chosen works, page 369, Kiev, 1961; A. S's Tygans. About febrile schizophrenia, Zhurn, a neuropath, and psikhiat., t. 60, Hi 4, page 461, 1960; Favorina V. N. To clinic and psychopathology of a oneiric catatonia, in the same place, t. 56, JsTs 12, page 942, 1956; Yudin T. I. Deadly forms of schizophrenia, Owls. psikhonevrol., JsTs 4-5, page 3, 1939; Gjessing R. Beitrage zur So-matologie der periodischen Katatonie, Arch. Psychiat. Nervenkr., Bd 191, S. 247, 297, 1953.
A. C. Tiganov.