Posturing – maintaining a specific position for prolonged periods of time Negativism – no response to external stimuli Waxy flexibility – resistance to positioning, like a feeling of bending a candle Stupor – overall decreased activity or decreased interaction with the environmentĬatalepsy – muscular rigidity, i.e. In the DSM-V definition of catatonia, the patient must present with at least three of the following: Some of the classic features of catatonia are listed below. Catatonia can be a difficult diagnosis to make due to a variety of presentations. Although it was originally thought to be associated solely with schizophrenia, it has now been found to be associated with any psychiatric condition including PTSD, bipolar disorder, depression as well as neurologic conditions such as encephalitis, stroke, malignancy, or dementia. The syndrome can present with a variety of psychomotor symptoms and often decreased mental state. This reminds you of a condition that you learned about in medical school… catatonia!Ĭatatonia is a syndrome characterized by psychomotor abnormalities and often associated with a variety of psychiatric and neurologic conditions, classically schizophrenia. On re-examination, she continues leave her limbs in the exact position you place them in until re-positioned. The radiologist calls to inform you of her normal non-contrast CT and CTA of the brain and neck. While performing her neurologic exam, you lift her arm into the air and she holds it there indefinitely until you move the arm again. Despite her concerning neurologic exam, she is maintaining O2 saturations at 98% on room air and a respiratory rate of 14 with full deep breaths. Her extremities do localize to painful stimulation. She groans and mumbles words but does not make coherent sentences. She does grimace with painful stimulation such as sternal rub. The patient is lying in bed with her eyes closed, she does not arouse to voice. After returning from the CT scan, you go in to perform a comprehensive neurologic exam. She is activated as a Code Stroke and brought immediately to CT scan upon arrival. On EMS arrival to the patient’s home, she is somnolent and unable to speak. An 82 year-old female presents to the ED with her daughter due to altered mental status.
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