Mgh Handbook Catatonia, Nms, Serotonin Syndrome

Front 1

catatonia definition

Back 1

- two or more:
- motoric immobility e.g. catalepsy or stupor
- excessive motor activity not influenced by external stimuli
- excessive mutism or negativism e.g. resistance to al instructions or maintenance of rigid posture
- peculiarities of voluntary movement e.g. inappropriate or bizarre postures, mannerisms, grimacing
- echolalia or echopraxia

Front 2

when is catatonia commonly seen?

Back 2

- neuromedical "organic" etiologies
- in mania
- personality disorders or conversion d/o

Front 3

what are the subtypes of catatonia?

Back 3

- catatonic withdrawal: psychomotor psychoactivity
- catatonic excitement: psychomotor hyperactivity

Front 4

excitement

Back 4

- extreme hyperactivity, constant motor unrest, nonpurposeful, not goal-directed agitation

Front 5

immobility or stupor

Back 5

- extreme hypoactivity, immobility, minimal response to stimuli

Front 6

mutism

Back 6

- verbal unresponsiveness or minimal responsiveness

Front 7

staring

Back 7

- fixed gaze, little or no visual scanning of environment, decreased blinking

Front 8

posturing or catalepsy

Back 8

- spontaneous maintenance of postures(s), including mundane (sitting/standing for long periods without reacting)

Front 9

grimacing

Back 9

- maintenance of odd facial expressions

Front 10

echopraxia or echolalia

Back 10

- mimicking of an examiner's movements/speech

Front 11

stereotypy

Back 11

- repetitive, non-goal-directed motor activity (finger-play, or repeatedly touching, patting, or rubbing oneself)
- act is not inherently abnormal but is repeated frequently

Front 12

mannerisms

Back 12

- odd, purposeful moevments (e.g. hopping or walking on tiptoe, saluting those passing by, or exaggerating caricatures or mundane movements)
- act itself is inherently abnormal

Front 13

verbigeration

Back 13

- repetition of phrases (like a scratched record)

Front 14

rigidity

Back 14

- maintenance of a rigid position despite efforts to be moved; exlue if cogwheeling or tremor present

Front 15

negativism

Back 15

- apparently motiveless resistance to instructions or attempts to move/examine the patient; contrary behavior; doing the exact opposite of the instruction

Front 16

waxy flexibility

Back 16

- during reposturing of the patient, the patient offers initial resistance before allowing repositioning, similar to that of a bending candle

Front 17

withdrawal

Back 17

- refusal to eat, drink or make eye contact

Front 18

impulsivity

Back 18

- sudden inappropriate behaviors (e.g. running down a hallway, screaming, or taking off clothes) without provocation; afterward, gives no or only facile explanations

Front 19

automatic obedience

Back 19

- exaggerated cooperation with the examiner's request or spontaneous continuation of the movement requested

Front 20

mitgehen

Back 20

- "anglepoise lamp": arm raising in response to light pressur of finger, despite instruction to the contrary

Front 21

gegnhalten

Back 21

- resistance to passive movement that is proportional to the strength of the stimulus; appears automatic rather than willful

Front 22

ambitendency

Back 22

- the appearance of being "stuck" in indecisive, hesitant movement

Front 23

perseveration

Back 23

- repeatedly returns to the same topic, or persistence with movement

Front 24

gegen halten

Back 24

- resistance to passive movement that is proportional to the strength of the stimulus; appears automatic rather than willful

Front 25

ambitendency

Back 25

the appearance of being stuck in indecisive, hesitant movement

Front 26

combativeness

Back 26

- usually aggressive in an undirected manner, with no, or only facile, explanation afterward

Front 27

autonomic abnormality

Back 27

- abnormal temperature, blood pressure, pulse, or respiratory rate, and diaphoresis

Front 28

when to think of limbic encephalitis

Back 28

- catatonia with stuporous state in delirium
- sx: confusion, cognitive impairment (short-term memory dysfunction), seizures, and at times catatonia

Front 29

limbic encephalitis etiology

Back 29

- infectious, autoimmune, paraneoplastic, idiopathic
- ovarian teratomas
- think of gonadal tumors and do abdominal and pelvic imaging

Front 30

physical exam for catatonia

Back 30

- thorough neuro exam

Front 31

tx of catatonia

Back 31

- benzos are first line
- will resolve primary and seconday catatonia

Front 32

standard exam for catatonia

Back 32

- observe while trying to engage in convo
- scratch head in an exaggerated manner
- examine for cogwheeling, attempt to reposture, instruct to keep arm loose, move with alternating lighter and heavier force
- ask pt to extend arm, place one finger beneath hand and try to raise it slowly stating "do not let me raise your arm"
- extend hand and state: "do not shake my hand"
- reach hand into pocket and state "stick out your tongue. I want to stick a pin in it"
- grasp reflex
- look for dx criteria stuff