Book contents
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- Chronology of catatonia concepts
- 1 Catatonia: A history
- 2 Signs of catatonia are identifiable
- 3 The many faces of catatonia
- 4 The differential diagnosis of catatonia
- 5 Catatonia is measurable and common
- 6 Past treatments for catatonia
- 7 Management of catatonia today
- 8 The neurology of catatonia
- 9 Back to the future
- Appendices
- References
- Index
4 - The differential diagnosis of catatonia
Published online by Cambridge University Press: 31 July 2009
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- Chronology of catatonia concepts
- 1 Catatonia: A history
- 2 Signs of catatonia are identifiable
- 3 The many faces of catatonia
- 4 The differential diagnosis of catatonia
- 5 Catatonia is measurable and common
- 6 Past treatments for catatonia
- 7 Management of catatonia today
- 8 The neurology of catatonia
- 9 Back to the future
- Appendices
- References
- Index
Summary
According to an old story, there are three different types of baseball umpires. The first says: “I call them [balls and strikes] as they are”; the second says: “I call them as I see them”; and the third says: “What I call them is what they become.”
Frederick Grinnell, 1992Catatonic features are observed in many psychiatric conditions. Primary catatonia, in which a person has the syndrome and no evidence of another disorder, is a hypothesized condition, but is not established. The clinical challenge is to recognize catatonia and the condition that causes it. In this chapter, we describe the differential diagnosis of disorders that underlie the expression of catatonia, and syndromes that simulate and may be mistaken for it.
“The duck principle” is a fundamental tenet of diagnosis: if it looks, walks, and quacks like a duck, it is a duck. The tenet is applicable to the diagnosis of catatonia. If a patient exhibits catatonic features, it is best to consider the patient as having catatonia. If features seem isolated from a clear underlying cause or are inconclusive, catatonic features can be temporarily relieved with an intravenous sedative, such as lorazepam or amobarbital. An intravenous injection of 1–2 mg lorazepam (0.5 mg/ml) or up to 500 mg amobarbital (50 mg/ml) over two minutes should relieve mutism, posturing, and rigidity. (At this rate of injection, laryngospasm is not a problem.) During the injection, talk to the patient, even if he is mute.
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- Information
- CatatoniaA Clinician's Guide to Diagnosis and Treatment, pp. 71 - 113Publisher: Cambridge University PressPrint publication year: 2003