The term "catatonic arousal" refers to a condition characterized by the occurrence of bouts of psychomotor anxiety. A person's behavior becomes inadequate, he commits a number of unmotivated and senseless actions. Some time ago, doctors considered the state of catatonic arousal to be one of the clinical manifestations of schizophrenia. In modern medicine, it is singled out as a separate pathology with a number of specific symptoms. According to statistics, catatonic symptoms are detected in 15% of people registered with a psychiatrist about their autism.
Etiology
A seizure always comes unexpectedly. Even a person with a disorder cannot predict when it will start.
Triggering factors for the development of disorders are the following diseases and conditions:
- Schizophrenia.
- Oligophrenia.
- Hysteria.
- Psychoses.
- Autism.
- Epilepsy.
- Stroke.
- Tourette syndrome.
- Tranio-cerebral injuries.
- Postencephalic syndrome.
- Presence of neoplasms in the brain.
- Endocrinopathy.
- Wilson's disease (pathology of a genetic nature).
- Vasculitis.
- Drug addiction.
- Exposure of the body to harmful chemical compounds (such as carbon monoxide poisoning).
- Taking certain medications, including antibiotics, hormonal drugs, and antipsychotics.
- Bipolar depression.
- PTSD.
- Behavioral disorders in women in the postpartum period.
- Werlhof disease.
- Pathologies of an infectious nature.
- Acute intestinal diseases.
There is also a hypothesis that catatonic behavior is characteristic of persons in whose body there is a lack of gamma-aminobutyric acid. Some doctors are of the opinion that the "culprit" is a lack of dopamine. Often, the state of catatonic excitement is a kind of reaction of the body to a long stay in fear.
Clinical manifestations
Catonic disorder includes two conditions. This excitement and stupor. Their change also happens suddenly.
Catatonic manifestations are a whole symptom complex. It is quite complex and includes more than two dozen clinical manifestations.
Main symptoms of catatonic arousal:
- Aversion. This term refers to intention alturning the whole body away from the interlocutor.
- Full subordination. The patient automatically follows all the orders that the doctor gives him.
- Ambition. This is a state in which a person simultaneously tries to follow all the instructions, and violently resists them.
- Block. At some point, a person suddenly stops moving or doing something.
- Verbigeration. The patient intermittently utters words, phrases, or syllables that make no sense.
- Excitement. In other words, it is excessive psychomotor activity.
- Air cushion syndrome. The patient, who lies on the bed, raises his head and stays in this position for quite a long time.
- Wax flexibility. This phenomenon, the essence of which is as follows: the doctor consciously puts the patient in an uncomfortable position, while the latter does not make any attempts to change the position.
- Grimace. It is characterized by the presence of elaborate facial expressions that do not correspond to the circumstances and the internal state of the patient.
- Closedness. The person does not want to make contact with other people.
- Catalepsy. The patient's body stops responding to external stimuli.
- Logorrhea. A person's speech becomes continuous, monotonous and incoherent.
- Manner. The patient repeats the same monotonous movements several times, which make no sense.
- Mutism. Sometimes patients completely refuse to communicate through speech.
- Instead of wax flexibility, sometimes there is negativism. In other words,the patient resists the doctor's actions and returns to the starting position.
- Stillness. This is the complete absence of any motor activity.
- Perseveration. The patient stubbornly repeats any movements that are meaningless.
- Rigidity. It is characterized by a sharp increase in the tone of anatomical structures.
- Stupor. The patient does not make any movements, does not react to external stimuli, does not make contact.
- Grab reflex.
- Protruding eyes.
- Echolalia. The patient repeats the words spoken by another person.
- Echopraxia. The patient imitates other people.
In addition, the catatonic state is accompanied by an increase in body temperature.
Shapes
In patients, pathology can manifest itself in different ways. There are the following forms of catatonic arousal:
- Pathetic. It is characterized by the slow formation of psychomotor disorders. They get stronger over time. A person's speech becomes pathetic, he begins to repeat words and sentences after other people. The patient's mood is usually good. There is occasional laughter for no reason. All actions are impulsive. Foolishness and childishness are clearly visible in the behavior.
- Impulsive. Symptoms of catatonic excitation in this case develop rapidly. The patient is a danger to the people around him. His speech consists of a series of meaningless phrases. Human movements are chaoticcharacter.
- Silent. Dangerous form of the disease. In this case, catatonic arousal is characterized by the presence of a senseless and chaotic activity in a person. He shows aggression towards other people, gives them all kinds of resistance. It is not uncommon for the patient to cause physical harm to themselves.
As mentioned above, the violation includes the state of stupor. When it occurs, motor activity stops. In addition, a person does not perceive the world around him and does not enter into conversations with other people. The state of catatonic stupor can last for several months.
Views
Pathology can be pure, lucid or oneiroid. In the first case, a person is diagnosed with either stupor or arousal. The lucid type of the disease is characterized by the fact that a person, against the background of the existing symptoms, retains a clear consciousness.
Oneiroid catatonic excitation is a condition in which the patient has incoherent thinking, he is disoriented not only in time, but also in space. The patient may lose memory, consciousness. Often he experiences emotional outbursts.
Stages
A catatonic disorder goes through several stages as it develops:
- Confused state. The patient is eloquent. His statements have an unnatural pathos. Incoherent not only speech, but also thinking.
- Hebephrenic excitement. At this stage, there is a pronouncedfoolishness. The patient arranges clowning, grimaces and mimics other people.
- Impulsive. The patient's behavior becomes aggressive.
- Fury is characteristic of the final stage. The patient can direct destructive power both on himself and on others.
Due to the abrupt onset and the presence of unmotivated aggression, catatonic arousal is considered a dangerous condition. If there are signs of it, the patient must be taken to a medical facility as soon as possible.
Diagnosis
When a person has catatonic symptoms, he needs to be shown to a neurologist. If the patient is in contact with others, the doctor will talk to him. Otherwise, the collection of anamnesis should be carried out with the help of relatives. The purpose of the survey is to identify the root cause, that is, the provoking factor that became the impetus for the development of the disorder.
The next step is a comprehensive neurological examination. It includes:
- Hemogram.
- Blood tests (general and biochemical).
- Study of liquid connective tissue for hormones.
- Immunogram.
- Clinical urinalysis.
- Microbiological studies of urine and blood.
- CT and MRI of the brain.
- Encephalography.
- ECG.
- Lumbar puncture.
- Ultrasound of the kidneys and thyroid gland.
- Test for the detection of heavy metals in the body.
Based on the results of the diagnosis, the doctor chooses the tactics of managing the patient.
Medicated treatment
All therapeutic activities are carried out exclusively in a psychiatric dispensary. In severe cases, the patient is tied to the bed. This measure is necessary to ensure the safety of both others and the person suffering from the disorder.
The main goal of treating catatonic arousal is to relieve symptoms. All drugs are prescribed by a doctor on an individual basis. When choosing treatment tactics, the specialist takes into account even the smallest features of the patient's he alth.
The classic treatment regimen for the disorder involves the use of benzodiazepine tranquilizers. Currently, the anxiolyticlorazepam component shows the maximum effectiveness in relation to the disease. It is the active ingredient in Lorazepam. In addition, the drug has an undeniable advantage over other similar drugs - low toxicity.
A few years ago, the treatment of catatonic arousal involved the administration of neuroleptics to the patient. In modern psychiatry, this group of drugs is not used. This is due to the fact that they can lead to the development of neuroleptic malignant syndrome. This is a condition that poses a threat to the lives of patients.
Currently, the treatment of catatonic arousal involves the use of the following groups of drugs:
- Normotimics. These are medicines, the active components of which contribute to the stabilization of mood in patients. An example is "Carbamazepine".
- Antagonists n-methyld-aspartate receptor. As a rule, doctors prescribe Amantadine.
- Agonists of dopamine receptors. Example: "Bromocriptine".
- Sleeping pills. Most often, doctors prescribe Zolpidem.
- Muscle relaxants. Example: the drug "Dantrolene".
Immediately after stopping the acute phase, patients are shown a course of treatment by a psychotherapist.
Contrary to popular belief, catatonic disorder is not a death sentence. With a competent approach to the disease, most patients experience a stable period of remission.
Electroconvulsive Therapy
It is shown only if drug treatment has not led to positive dynamics. The essence of the method is as follows: the doctor, using a special device, supplies an electric current to the brain. In this case, the latter passes through all the structures of the body. Against the background of electroconvulsive therapy, the patient continues to receive medications.
Treatment is also carried out exclusively in a hospital setting. The patient is constantly monitored by medical personnel, ready to provide emergency assistance at any second.
Electroconvulsive therapy should only be carried out by highly qualified specialists. This is due to the fact that any wrong action can lead to irreversible consequences and even death of the patient.
This method of treatment has been used in psychiatry for many years. However, it has a number of contraindications. These include pregnancy, lactation,pathologies of the cardiovascular system, diseases of the musculoskeletal system, disorders of the functioning of the digestive and respiratory organs, infections in the acute stage.
Consequences
Catatonic arousal is a condition that is recognized by doctors as extremely dangerous. This is due to the fact that the slightest delay threatens the development of serious complications in the patient.
First of all, all undesirable consequences can be provoked by the following factors:
- Mutism. This term refers to speech initiation disorder.
- Extended immobility.
- Insufficient or illiterate care for patients admitted to hospital.
- Lack of emotions due to lack of contact with the environment.
- Doctors' pessimism. Many experts still believe that catatonic disorder is incurable and accompanies a person for the rest of his life. As a rule, patients feel the mood of doctors very subtly.
- Illiteracy when choosing an approach to the patient. All medications must be prescribed on an individual basis.
- Lack of preventive measures.
Thanks to this, all patients suffering from a catatonic disorder are susceptible to the development of pathologies of a somatic nature.
Possible complications:
- Pneumonia. Occurs against the background of aspiration into the respiratory tract of the contents of the stomach.
- Venous thrombosis of an acute nature. develops against the backgroundexcessive blood clotting in the lumen of the vessels.
- Pulmonary embolism. Large branches become clogged with blood clots.
- Pneumothorax. This is a pathology in which an accumulation of gases occurs in the pleural cavity.
- Fistula formation between lungs and bronchi.
- The occurrence of all kinds of disorders of the digestive tract. Most often diagnosed: diarrhea, constipation, intestinal obstruction.
- Metabolic disorders. They arise due to the fact that the patient eats through a special tube. In the blood, the concentration of glucose decreases and the amount of oxygen increases.
- Tooth decay.
- Fungal and bacterial infections of the mouth.
- Decubituses. In other words, it is soft tissue necrosis.
- Retention or, conversely, urinary incontinence.
- Sexual infections.
- Nerve palsy.
The risk of complications increases significantly with untimely hospitalization of a patient in a psychiatric clinic.
In closing
The term "catatonic excitation" refers to a pathological condition characterized by the occurrence of psychomotor disorders. The patient's behavior becomes inadequate, he often poses a danger to others, since one of the symptoms of the disorder is unmotivated aggression. Treatment of the disease is carried out in a psychiatric dispensary.
