Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Ramchandani, D. Search for Related Content Articles by Ramchandani, D. Schizophrenia Spectrum Disorders

Catatonia: From Psychopathology to Neurobiology

Dilip Ramchandani, M.D.

This book comes in a concise volume of 17 chapters written by an international array of neuropsychiatrists. The preface introduces the concept of catatonia by drawing on the analogy to the childhood game called "Statues" and follows with a succinctly written chapter on the historical evolution of the syndrome by Drs. Peter Braunig and Stephanie Kruger. They trace the evolution of the syndrome from Kahlbaum's descriptions to Kraeplin's revision of the understanding of catatonia to fit with his classification of mental disorders. They acknowledge the contributions of Kleist, Leonhard, and Wernicke to the growing clarification of the group of conditions characterized by motor symptoms and allude to the relationship of catatonic symptoms to hysteria and obsessive-compulsive disorder. They conclude by asserting that a useful approach is to regard catatonia "as part of a motor-behavior continuum that may be interpreted as an independent dimension reflecting a disturbance of executive function that cuts across diagnostic categories." Along the way to reaching this conclusion, the chapter provides interesting figurative depictions of Kraeplin's catatonic patients in 1916 but gives short shrift to the Freudian-Bleulerian view of catatonia as a manifestation of "subconscious" conflict.

An outstanding chapter on the epidemiology of catatonia addresses the controversial issues of non-specificity and the decline in its incidence; this is followed by a thorough review of its nosology. Michael Alan Taylor's chapter on clinical examination describes each motor symptom and behavior pattern in a well-elucidated table. Mortimer's chapter on standardized instruments is a bit confusing but likely reflects the existing state of conflicting paradigms. The chapter on laboratory findings appropriately focuses on the differentiation of neuroleptic malignant syndrome by means of qualitative and quantitative assessments for leukocytosis and abnormal creatinine phosphokinase levels. The finding of low serum iron was of particular interest because this reviewer was unfamiliar with its association with catatonia.

George Northoff's summary of his work and that of others on the neurophysiology and neuroimaging of catatonia and the distinction he draws between the "top-down" mechanism of catatonia and the "bottom-up" modulation of neuroleptic malignant syndrome is both intriguing and persuasive. Individual detailed chapters on periodic catatonia, malignant catatonia, and drug-induced catatonia round up the diagnostic and phenomenological issues related to the syndrome. There is good discussion of treatment issues, including pharmacology and the role of electroconvulsive treatment as well as syndromal complications and prognosis.

Three chapters comprise the concluding section of the book. Gerald Stober describes the "state-of-the-art" status of genetic understanding of this complex condition, while focusing on the study of the catatonic subtype of schizophrenia and the much-talked-about but rarely seen (perhaps, underrecognized) syndrome of periodic catatonia. Stephen Kanes reviews the experimental evidence in animal immobility and the role of animal models in the understanding of catatonia. Gregory Fricchione concludes the book with a masterful synthesis of the evolutionary underpinnings of the catatonic state in terms of primitive avoidance-separation behaviors.

The book has an evocative cover, a comprehensive bibliography for each chapter, user-friendly tables and figures, and an effective index. All in all, this small volume packs a lot of punch and will prove to be a very useful addition to every psychiatrist's library.

FOOTNOTES

 
Dr. Ramchandani is Professor and Director of Medical Student Education, Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA.

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Ramchandani, D. Search for Related Content Articles by Ramchandani, D. Schizophrenia Spectrum Disorders

Get information about faster international access.

Privacy Policy

Copyright © 2006 Academy of Psychosomatic Medicine. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us