The first signs of impending catatonia create the impression of an anomalous increase in features characteristic of the individual. In the prodromal period, the patient more than usually closed, almost all the time spent alone, annoyed at trying to involve him in any general actions. He often complains about difficulties with falling asleep, headaches, weakness, impossibility of any purposeful actions.
Later, the mood changes significantly, anxiety arises, various delusions and visions, numbness of limbs and the whole body, the perception of reality is transformed, negativity grows, the patient can completely refuse to move and take food.
Many symptoms of catatonic syndrome are described, some of them are characteristic of different mental disorders, a complete complex of symptoms in one patient is not absolutely necessary. The features of clinical signs depend on the type of syndrome and age of the patient.
During the period of catatonic state, the following can be observed:
- stupor - a combination of full real estate and the absence of any kind of contact with the patient (mutism), while in principle the patient's ability to speak is preserved, sometimes there is one of the symptoms - real estate or mutism;
- negativism - the patient resists attempts to give his body a different position, while muscular resistance in force is equal to extraneous efforts;
- aversion to others, medical personnel (aversia) - the patient does not respond to treatment, turns away, all the way showing a reluctance to contact;
- catalepsy (wax flexibility) is an abnormally long retention of a pretentious, extremely inconvenient posture that a doctor can give to a sick person; in addition, the patient often takes strange uncomfortable positions himself and remains in them for a long time;
- submission, brought to automatism - the patient performs absolutely everything with extraordinary accuracy, the body submissively accepts any most uncomfortable pose without resistance, but again returns to the starting position when it is not touched (in contrast to catalepsy);
- the sign of the "air cushion" - the patient lies with his head elevated above the surface of the bed, as on an invisible cushion, long enough - a typical pose for catatonia;
- ambition - a demonstration of peculiar ambitions, the patient, agreeing, still does not want to obey, for example, hands the doctor out, but at the last moment pulls it away;
- verbigeration - the repetition of the same speech stereotypes: phrases or sentences, words (palalalia), individual syllables (logoclonia);
- logoreia - monotonous, continuous, incoherent muttering;
- echolalia - the patient echoes all the sounds pronounced by the doctor;
- echopraxia - repetition of someone's movements;
- blocking of thoughts and movements - sudden stopping of speech or movement;
- stereotypies and motor perseverations - a constant repetition of identical senseless movements.
The patients have wide open eyes, they grab the doctor's hand during the examination, the nurse or relatives, not allowing to touch. A characteristic feature is an instantaneous transition from a stuporous state to an excitable state and vice versa, while movements are impulsive, ridiculous and meaningless (jumping, rolling, attacking). Speech excitement is manifested by cursing, singing, indistinct mumbling. To excite both the motor and the speech are endless repetitions of grimaces, jumps, cries. Some patients are mannered - all the while greeting, bowing. Sometimes the transition from an excited state to a hindered one and vice versa occurs gradually.
In most cases, patients are satisfactorily oriented in time and space, but there is confusion, speech, hallucinations, very diverse, instantaneous or with gradual development.
Severe stages are characterized by such symptoms as mutism and real estate, sharp negativism, pretentious postures, unwillingness to eat, prolonged muscle rigidity, increasing speech disorders.
Often behind an excited state with delirium and hallucinations follows a brief normalization of the state, occasionally - so long that it borders on recovery.
Nevertheless, even more often catatonic stupor of different depth and duration develops. He can have a chronic course with frequent and sudden emotional outbursts, accompanied by meaningless escapades.
Sometimes the syndrome occurs in the form of catatonic seizures, expressed in the periodicity of stupor change and excitation.
The symptoms of a violation of the innervation of the vessels are striking: the pale face of the patient can instantly turn red, sometimes any part of the body blushes - the forehead, one cheek, ear, neck. Patients lose weight, they have persistent disturbances in sleep. Other somatic symptoms accompanying catatonia are arrhythmias, excessive sweating and salivation, eruptions resembling urticaria, fluctuations in body temperature (in the morning and in the evening), narrowing-the pupil increase and the variability of their reaction, shallow breathing.
Chronic catatonia in diseases of the psyche, in particular, in schizophrenics in general, leads to the progress of mental retardation. At the same time, with the catatonic form of schizophrenia, long-term remissions after the syndrome in 15% of patients are almost identical to their recovery.
Catatonia in a child often has the symptoms of rhythmic motor stereotypes - grimacing, running around in circles, the same type of movements with hands, legs, trunk, running or walking on tiptoes, on the outer or inner side of the foot, etc. Movements and actions are characterized by impulsivity, often there is mutism, echopraxia, echolalia and other speech disorders. Often a child may experience regressive catatonia - he begins to completely copy the behavior of animals (licking themselves and objects, eating without the help of cutlery, etc.).
It should be taken into account that the catatonic syndrome does not always go through all the stages of development described, and their arbitrary order is observed in different cases.
Psychomotor disorders in the catatonic syndrome are classified as agitation and stupor.
The excited state is characterized by psychomotor activity and is divided into such forms:
- pathetic excitation (with the preservation of consciousness) - is gradually increasing, in the highest phase - moderate manifestations; patients are mannered, pathos, an upbeat mood is observed, in the form of exaltation, and not hypertension; noteful poses and gestures are noted, perhaps echolalia; then the excitement grows, and the patient begins to frankly fool around, there are impulse actions reminiscent of gebefrenia;
- impulsive stimulation has an acute onset, develops suddenly and rapidly, in most cases the patient's actions are of a hard and destructive antisocial nature; verbal disturbances (verbigeration) are observed;
- the peak of the previous form, reaching the degree of frenzy, is singled out by some experts as a third option - mute excitement, when the patient, without uttering a sound, crushes everything around, splashing out aggression on others and even on himself.
With a stupor, almost always the muscles of the patient are tense and enslave, sometimes even passive movements are impossible. The patient, who is in the sub-stuporosis state, is inactive and slow, in the stuporous state, lies, sits or stands without movement. The patient is silent, the face is like a frozen mask, the facial expression is often absent, sometimes the movements of the muscles of the face correspond to the affective state - the patient wrinkles his forehead, squeezes his eyelids, strains the muscles of his jaws and neck, and extends his lips with a "pipe." In the catatonic stupor, patients can stay for a long time, which is calculated in weeks and months. Disorders of all functions, even instinctive ones, are observed, as well as symptomatic of disorders of the somatic sphere and the autonomic nervous system: cyanosis and edema of the extremities, hypersalivation, hyperhidrosis, seborrhea, hypotension. There are three stupor forms of catatonia:
- cataleptic - the individual holds a pose for a long period of time, often unnatural, which he took himself or gave to others (waxy flexibility), for example, lies on the "air cushion", covered with a blanket; normal and loud speech does not cause a reaction, but can respond to a whisper; under the influence of darkness and silence, the stupor sometimes weakens and contact for a while becomes possible (for this form there is the presence of delirium and hallucinations);
- negativistic - motor retardation is combined with opposition to any attempts to change the posture of the patient, resistance can be active and passive;
- numbness - the peak of inhibition and enslavement of the muscles, often in the embryo position or on the "air cushion", the lips are stretched out into the tube.
There were interconversion of one form of catatonic stupor or excitation into another, although such cases are rare. Most often there are transformations of the excited state to the stupor and vice versa, usually the corresponding type, for example, pathetic excitation → cataleptic stupor, impulsive → negativistic or stupor with a stupor.
By the presence or absence of a consciousness disorder, catatonia is classified into the following species: empty, lucid and onyroid.
Empty is characterized by symptoms typical of the syndrome without delirium and hallucinations, as well as affects: monotonous iterations of movements, postures, phrases and words, catalepsy, echosymptoms, negativism - inert (the patient sabotages requests), active (the patient commits actions, but not those that it is necessary), paradoxical (it performs the actions inverse to the required one). This type of syndrome is sometimes noted with organic lesions of brain tissue (neoplasms, the consequences of craniocerebral trauma, infections and intoxications).
Lucid (pure) catatonia is characterized by the presence of productive symptoms (delirium, hallucinations) without a consciousness disorder. The individual does not violate self-identification, he remembers and can reproduce the real events that occurred during the stupor period.
Onyroid catatonia - the course of this syndrome with delusional and manic episodes, hallucinations, moreover accompanied by confusion of consciousness. It begins suddenly with a marked increase in psychokinetic excitement. The individual quickly changes behavior, facial expressions and appear maniacal traits. Movements are active, natural, plastic, there is delirium, speech activity and lack of need for an interlocutor (schizophasia). The patient experiences bright and colorful events in an individual world, absolutely not corresponding to reality - a catatonic dream characterized by the presence of a plot and completion. The individual himself feels himself the main hero of the stories that occurred exclusively in his mind. They are accompanied by fantastic excitement, with intense emotional coloring, instantaneous changes from chaotic excitation to a stupor. The facial expression of the patient, reflecting the disturbances experienced by him in the catatonic sleep, is usually very expressive. Coming out of the syndrome, the patient does not remember any real events, but can describe his "dreams". Catatonic sleep lasts from several days to several weeks.
It is believed that lucid catatonia is characteristic only for schizophrenia, and onyroid - is more common in neoplasms of the basal parts of the brain, posttraumatic or acute epileptic psychoses, the consequences of severe infections and intoxications, progressive paralysis.
Febrile catatonia is an acute mental disorder and is observed in schizophrenics and persons with affective disorders. External manifestations resemble a oneiroid appearance, accompanied by a rapid development of not only psychopathological, but also somatic disorders. It can take a malignant course if therapeutic measures do not start immediately in the first hours of the development of the syndrome.
A specific symptom is a high body temperature, manifested as a fever, there may be temperature jumps. In addition, the patient's pulse and breathing quicken, an earthy-gray hue of the skin appears, facial features are sharpened, eye sockets fall, the forehead becomes covered with droplets of sweat, the eyes are not concentrated, the lips are dry, the tongue is white or brownish.
The cause of death of the patient is the development of cerebral edema.
Regressive catatonia is most often observed in children. It appears as a copying of behavioral stereotypes of animals.
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