Catatonic syndrome (psychiatry): treatment, symptoms

This concept in medical practice implies a set of symptoms manifested by psychomotor disorders. This pathology was first described in 1874 by Kahlbaum, who considered this disease as a separate nosological unit. Almost immediately it was recognized that catatonia is a symptom of schizophrenia. At the moment, experts do not adhere to such a clear position, highlighting several options for the causes of the pathology.

The disease can occur at any age. Including children. The peak of cases is in the age group of 17-30 years. The list of main symptoms includes:

• impulsive behavior;
• stupor;
• excitation.

Psychiatrists treat pathology. The combination of electroconvulsive and drug therapy makes it possible to successfully defeat the disease or transfer it to a stage of stable remission.

Catatonic syndrome: schizophrenia

The catatonic form is one of the manifestations of schizophrenia. It occurs in approximately 2.5% of all diagnosed cases of confirmation of this complex psychological illness. Many doctors believe that catatonic syndrome is unique to schizophrenia. In other situations, we can only talk about catatonic disorders.

The pathology is characterized by active and passive negativism, in which the patient resists when trying to change his posture. Patients suffering from active negativism refuse to carry out tasks received from the doctor. For example, when asked to sit down, the patient may defiantly remain standing and turn his back. In the passive form, the patient resists due to muscle tension.

Cotard's syndrome

One of the striking characteristics of this syndrome is delusions of grandeur turned inside out: a person believes that he or certain parts and organs of his body have already died, rotted, decomposed, or are simply missing.

Still from the film "Pirates of the Caribbean: Dead Men Tell No Tales"

A person with Cotard's syndrome is often convinced that he is causing catastrophic harm to humanity: that he has infected everyone with a terrible infection, poisoned or completely wiped out humanity from the face of the earth, that because of his putrefactive breath the planet will soon die out.

Reminds me of some of the characters from Pirates of the Caribbean, doesn't it?

Symptoms of catatonic syndrome

The presence of pathology can be determined by the symptoms of catatonic syndrome. It is necessary to contact for consultation at the first manifestations of the diagnosis. Timely initiation of treatment speeds up recovery.

The list of the most common symptoms includes:

• persistent repetition of facial expressions and movements surrounding stereotypy;
• counteracting attitude negativism;

• echo symptoms, in which the patient involuntarily repeats phrases and words;
• isolation;
• mutism, characterized by the patient’s inability to speak with full health of the speech apparatus;
• a strange body position with the head elevated, called “air cushion syndrome”;
• the grasping reflex, which manifests itself in the unreasonable grasping of surrounding objects;
• the presence of pathological flexibility;
• excessive facial expressions, grimaces;
• hypertrophied wide eyes.

The number of symptoms accompanying catatonic disorders is varied. Only a doctor can make an accurate determination. Some of them are particularly common. For example, the proboscis symptom noted in catatonic syndrome.

Proboscis symptom (In catatonic syndrome)

The position of the lips, in which, due to muscle contraction, they are constantly extended forward and form a “tube,” is a natural stage in the development of the facial muscles and facial expressions of a child in the first year of life. When pathology appears in an adult, it indicates the possible onset of catatonia.

Often proboscis syndrome is not accompanied by other manifestations of stupor or increased excitability. To eliminate the pathology, you need to contact a psychiatrist.

Material and methods

The study was a prospective, comparative, open study. The results of treatment of 750 patients who suffered an ischemic stroke and suffered from the phenomenon of neglect were analyzed, of which 396 were women and 354 men, whose average age was 63.46 ± 18.54 years.

Inclusion criteria

patients in this study:

— diagnosis: cerebral infarction, confirmed by computed tomography or magnetic resonance imaging;

— presence of ignoring syndrome;

— degree of impairment of neurological functions (the number of points on the Lindmark and Scandinavian scales is no more than 24% of the maximum);

- the degree of dependence of the patient on others (the number of points on the Barthel scale is no more than 24% of the maximum);

- the degree of social and everyday maladjustment (the number of points on the Merton and Sutton scale is no more than 24% of the maximum);

— level of quality of life (the number of points according to the disease impact profile is more than 55);

— the presence of cognitive disorders of any severity identified using the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment Scale (MoCA);

— availability of written consent to participate in the study.

Non-inclusion criteria

into the study:

- participation in a clinical trial of any drugs less than 3 months before the start of this study;

- severe concomitant diseases of the nervous system (Parkinson's disease, demyelinating diseases of the nervous system, hereditary degenerative diseases and infectious diseases of the central nervous system, traumatic injuries of the brain and spinal cord);

- severe decompensated diseases of the heart, liver, kidneys, lungs, acute/chronic renal/liver failure;

— acute surgical pathology;

- acute infectious diseases less than 4 weeks before the start of the study;

- history of mental illness;

— data on hypersensitivity to the study drug;

— pregnancy, lactation period;

- any other conditions that, in the opinion of the physician-researcher, make it difficult to participate in this study;

— non-compliance with at least one of the inclusion criteria.

All patients were divided into two groups of 375 people: those who received (main group) and those who did not receive Cortexin (control group), which were standardized according to various indicators, such as age, gender, severity of neurological and psycho-emotional disorders, level of everyday adaptation, quality life, as well as the types and methods of physical, physiotherapeutic, neuropsychological, psychotherapeutic rehabilitation carried out and compliance with uniform rules for the management of patients with the phenomenon of neglect (the matched-controlled principle). Cortexin was prescribed 1-2 months after the onset of stroke daily intramuscularly at a dose of 10 mg 2 times a day for 10 days with a repeat course after 10 days. Standardization of the study groups is presented in Table. 1.

Table 1. Main characteristics of the studied groups Note. * - cardiomagnyl, chimes (dipyridamole), plagril (clopidogrel), warfarin, xarelto (rivaroxaban), pradaxa (dabigatran), Eliquis (apixaban); ** - amitriptyline, velafax (venlafaxine), Zoloft (sertraline), teraligen (alimemazine), trittico (trazodone), fevarin (fluvoxamine).

As part of the rehabilitation of patients during this study, the above rules for patient management were followed to overcome symptoms of inattention and stimulate impaired spatial perception.

The main neurological symptoms of patients participating in the study were distributed as follows.

Hemiparesis was observed in 750 (100%) patients, including those with predominant damage to the upper limb in 438 (58.4%), lower - in 22 (2.9%), with uniformly expressed damage to the limbs in 300 (40.0%) ).

In all patients, hemiparesis was combined with certain sensory disturbances in the form of various manifestations and their combinations: tactile “fading”, hemihypesthesia, hyperpathia, alloesthesia. In the majority of patients (75.8%) tactile “fading” was observed (loss of the ability to respond to tactile stimuli with simultaneous tactile stimulation of both sides of the patient’s body), 38.2% of patients had anosognosia, 10.2% had arnesomelia, 8 .3% - alloesthesia.

All patients also had visual “fading,” characterized by the loss of the ability to respond to visual stimuli while both visual fields are simultaneously stimulated.

Patients were examined upon inclusion in the study and after completion of the course of treatment. Each examination included an assessment of the severity of neurological disorders using the Lindmark scale [21] and the Scandinavian Stroke Scale [22], an assessment of the patient’s dependence on others using the Barthel scale [23], an assessment of everyday capabilities using the Merton and Sutton scale [24], and level testing. depression using the Beck Inventory [25], as well as analysis of visuospatial perception using the Albert test [9]. Cognitive functions were assessed using the MMSE [26] and MoCA scales [27].

The impairment and degree of recovery of neurological functions were determined using the Barthel, Lindmark and Scandinavian scales. The degree of recovery was established as follows: lack of recovery - the arithmetic average number of points scored on all three listed scales was less than 30% of their maximum number; minimum - 30-49%; satisfactory - 50-74%; sufficient - 75-94%; complete - more than 94%.

The level of everyday and social adaptation was determined using the self-assessment scale of everyday life capabilities of Merton and Sutton [21]. The degree of everyday adaptation was determined as follows: absence of everyday adaptation - 0 points; minimum - 1-29 points; satisfactory - 30-45 points; sufficient - 46-58 points; full - 59 points.

According to the MMSE scale, the state of cognitive functions was established as follows: 28-30 points - no impairment of cognitive functions, 24-27 points - moderate cognitive impairment, 20-23 points - mild dementia, 11-19 points - moderate dementia, 0 —10 points—severe dementia; the degree of improvement in cognitive functions was determined as follows: minor improvement - an increase in the number of points by 1-6; satisfactory - 7-13; pronounced improvement - by 14 or more.

According to the results obtained on the MoCA scale, the presence of cognitive disorders was recognized when a score of 25 or less was detected; the degree of improvement in cognitive functions, according to the MoCA scale, was determined as follows: slight improvement - an increase in the number of points by 1-5; satisfactory - 6-11; pronounced improvement - by 12 or more.

Also, the effectiveness of treatment for patients with the phenomenon of ignoring was assessed by the absence of its various signs:

- heminal inattention;

- tactile extinction;

- visual fading;

- alloesthesia;

- anosognosia;

- Arnesomelia.

In the presence of at least one of the above signs, neglect syndrome was considered positive.

Analysis of visuospatial perception and quantitative assessment of unilateral spatial neglect were performed using the Albert test [9].

The data presented in table. 2, evidence

Table 2. Distribution of patients according to the severity of neurological deficit, level of everyday adaptation and cognitive impairment in the examined groups that patients in the study groups at the start of the course of therapy were comparable in the degree of physical and household activity, the state of cognitive functions and the severity of neglect syndrome.

The quality of life of patients was determined using the disease impact profile (Sickness Impact Profile) [28, 29], according to which physical (ability to move, mobility, body care), psychosocial (emotionality, social interaction, initiative and energetic behavior and communication) were assessed. and everyday (work, sleep, nutrition, housekeeping, rest/leisure) components of the concept of quality of life.

According to this profile of the impact of the disease, the quality of life was assessed as follows: absence of disturbances in the quality of life - 0 points; minimal violations - 1-10 points; mild violations - 11-25 points; moderate violations - 26-40 points; severe violations - 41-55 points; gross violations - more than 55 points.

All patients signed informed consent. Each patient could refuse to participate in the study at any time, however, there were no patients who completed the study early.

Based on the information obtained, a computer database with the possibility of statistical analysis was created. All clinical indicators recorded during the examination of patients were adapted for mathematical processing and studied using multivariate statistical analysis methods.

To check the closeness to the normal distribution of the observed values ​​of factors and parameters (i.e., comparison of theoretically and experimentally obtained distributions), the Pearson χ2 test and the Kolmogorov-Smirnov test were used. The following application software packages were used in the study: Statistica for Windows 8.0 (for statistical analysis), MS Office 2010 (for organizing and generating a data matrix, preparing graphs and diagrams). The significance of differences in mean values ​​for independent variables was assessed using Student's t-test. Differences were considered significant at p

<0.05. If the frequency of the event under study was less than 5 observations in one of the table cells, the use of the χ2 criterion was considered incorrect and Fisher’s exact test was used.

Treatment of catatonic syndrome

Treatment of this pathology can only be carried out in a specialized psychiatric hospital. After a thorough examination, an individual course of therapy is developed for each patient. Medications play a major role in this:

• mood stabilizers;
• benzodiazepines;
• antiglutamantics;
• muscle relaxants;
• neuroleptics.

Additionally, electroconvulsive therapy is prescribed. In the case of malignant forms of pathology, such therapy is prescribed primarily to relieve the acute stage. The therapy involves passing electrical impulses through the brain tissue. The procedure is performed only in a hospital under the supervision of a doctor. If necessary, call an ambulance. After completion of the course, drug therapy continues.

Treatment

Recovery from Cotard's syndrome can occur quickly and spontaneously. However, there are several shaping factors that influence the healing process:

• if Cotard's syndrome arose against the background of mild mental dysfunction, the cause of which could be a mild head injury, the prognosis is favorable;
• if the disorder manifests itself against the background of depression, then there is a high probability of long-term persistence of negative distortions;
• in the case of chronic depression, Cotard's syndrome will have “wave-like manifestations”;
• against the background of schizophrenia, Cotard's syndrome will be most pronounced and will appear together with other symptoms of the disease.

In each case, individual treatment should be prescribed taking into account the clinical picture and manifestations of this disorder. Somewhere they use electroconvulsive therapy, somewhere everything gets by with conversations with a psychologist or a little medication intervention. To date, the causes of Cotard's syndrome and methods of its treatment have not been definitively formulated. This is an additional reason to seek help from specialists.

Types of catatonic syndrome

Manifestations of pathology differ depending on the type. Only a doctor can make an accurate diagnosis.

Affective syndromes

They are accompanied by frequent changes in behavior from a high level of disinhibition to states of catatonic sleep and complete refusal to interact with the outside world.

Delusional syndromes

Obsessive movements are accompanied by delirium. Delusional states can also occur with passive negativism. This further aggravates the patient’s retreat into his inner world and refusal to communicate.

Hallucinatory syndromes

Patients in both the active and passive stages may experience hallucinations. In a state of stupor and lack of reaction to the outside world, this further worsens the patient’s condition. With active negativity of the patient, they can become socially dangerous.

Oneiric catatonic syndrome

It begins immediately with the acute phase, characterized by a noticeable increase in psychomotor agitation. In this state, the patient can be dangerous to others, and manic thoughts may arise. Moreover, in this state the patient seems to be in a waking dream. In perception, real and fictitious circumstances alternate.

Regressive catatonic syndrome

This variant of pathology turns an adult into a child in terms of behavioral style. Moreover, often in an infant. The sounds produced may resemble meowing.

Lucid catatonic syndrome

Characterized by the absence of delirium, stupor, or hallucinations. An increased level of excitement manifests itself, movements become abrupt and fussy. Stupor with numbness and negativistic stupor will occur.

Munchausen syndrome

Named after a famous liar, this syndrome is characterized by pathological lying about one's health. A person exaggerates, feigns, or deliberately causes symptoms of illness.

A person goes to great lengths to achieve medical procedures of varying complexity, including surgical interventions, insurance payments, foundation support and - most importantly - support, sympathy, attention and help from others. A related disorder, Munchausen syndrome by proxy, involves a relative (usually a mother or spouse) causing symptoms of the disease in a loved one (usually a child).

Still from the documentary Mommy Dead Dearest

An example of the full scale and tragedy of this disorder is last year’s story of Dee Dee Blanchard and her daughter Gypsy: her mother spent her entire life instilling in her child that she was seriously ill with a whole “bouquet” of serious diseases - from epilepsy to muscular dystrophy. The grown-up daughter could not stand it and persuaded the young man to kill his mother. Now she is under investigation - and she does not have a single symptom of any of the diseases that she “suffered from.”

Introduction

Chromosomal diseases are a large group of congenital hereditary diseases characterized by multiple malformations and polymorphism of clinical manifestations [1, 2].

Currently, about 350 syndromes associated with chromosomal pathology have been described, and there are more than 1000 manifestations of syndromes with both incomplete and additional clinical signs [2]. Syndromes with incomplete clinical signs are often quite compatible with life, but can lead to disability and mental retardation of varying severity.

This article is devoted to a congenital chromosomal abnormality - Schmid-Fraccaro syndrome, or “cat-eye” syndrome SCG (in foreign literature - Cat-Eye syndrome) [3, 4]. SCH is a fairly rare syndrome and occurs in one case per 150,000 live births. This syndrome was first described by O. Haab in 1898 as a triad of symptoms: congenital iris coloboma, closed anus and auricular abnormalities. In 1965, a connection between the syndrome and chromosome 22 was established [3].

The authors had the opportunity to observe three cases of SCH with incomplete clinical signs of the syndrome. Two of them did not have anal atresia. In one case there was a complete and incomplete coloboma of the irises and there were no auricular marks; in the other, on the contrary, there was a unilateral auricular mark, but there was no coloboma of the irises.

This article describes one of the observations in more detail.