4. 2 ORGANIC CATATONIC DISORDER
Gelenberg (1976) conceptualized
catatonia as a syndrome occurring in a host of medical, neurological and
psychiatric conditions. The only DSM-IV condition in which it appears in a
manner other than subtype, feature, or syndrome is catatonic disorder due
to a general medical condition, or organic catatonia. Unfortunately, the
DSM-IV description of organic catatonia is not specific, and it fits
conditions that are outside catatonia, like dementias from multiple
strokes or from alcoholism, in which patients remain in a state of passive
hypoactivity and general muteness (Swartz et al., 2003). Likewise,
distinctions between delirium and organic catatonia are not specified by
DSM-IV, and the symptoms listed for catatonia and delirium overlap
entirely (Swartz, 2002).
Catatonia has been reported to occur
in patients with diverse toxic, neurologic and infectious conditions.
Encephalitis and carbon monoxide poisoning are presumed to be the most
common causes of the syndrome (World Health Organization, 1992). Other reported etiologies of
organic catatonia include ecstasy intoxication (Masi et al., 2002),
cerebral lupus and hydrocephalus (Malur et al., 2001), hereditary
cerebellar ataxia (Folkerts et al., 1998), multiple sclerosis (Barnes et
al., 1986) and vitamin B12 deficiency (Berry et al., 2003). Waxy
flexibility has been reported in contralateral parietal lesions (Ghika et
al., 1988). In a case series, Swartz et al. (2003) reported that catatonia
due to chronic neurologic conditions does not respond as reliably to
electroconvulsive therapy (ECT) and lorazepam as functional catatonia
does. |
