Comparison of Catatonia Presentation in Patients with Schizophrenia Andmood Disorder in Lagos, Nigeria

Article excerpt

Objective: To compare the clinical profile and pattern of catatonic symptoms of patients with schizophrenia and mood disorder.

Method: Records of 13,968 patients seen between 1983-1985 and 2003- 2005 were reviewed for symptoms of catatonia by resident doctors in psychiatry. Cases in which the diagnosis were schizophrenia or mood disorder were then noted. Socio-demographic and clinical features were described for each diagnosis.

Results: There were a total of 98 cases with catatonia out of the 13,968 case notes reviewed. Schizophrenia accounted for 82.5% and 53.4% in the two periods, while the proportion associated with mood disorders increased from 10% to 20.7%. Male to female ratio was 1.2:1 in schizophrenia and 1:3 in mood disorder. Those with schizophrenia were younger and with an earlier age of onset of symptoms than those with mood disorders.

Conclusion: Catatonia associated with mood disorder was found to be increasing over the years when compared with schizophrenia. Differences were observed in socio-demographic characteristics and number of predominant catatonic symptoms. Having a separate category for catatonia due to the mood disorders in the current diagnostic guidelines (10^sup th^ edition of the International Classification of Diseases and the 4^sup th^ edition of the Diagnostic and Statistical Manual) will help in better diagnosis of catatonia.

Keywords: Catatonia, Mood disorders, Mutism, Schizophrenia, Stupor

The concept of catatonia was first described by Kahlbaum in 1874. He described a

state "in which the patient remains completely mute and immobile, with staring expression, gaze fixed into space, with an apparent complete loss of will, no reaction to sensory stimuli, sometimes with the symptom of waxy flexibility completely developed, as in catalepsy, sometimes of a mild degree, but clearly recognisable" (1). Emil Kraepelin, who developed the concept of dementia praecox suggested that symptoms of catatonia were a separate classification under dementia praecox (2).

Catatonia presents commonly in psychiatric patients in both acute and long term settings. Despite its common occurrence, catatonia remains a poorly understood, poorly studied, and poorly recognized syndrome, presenting with a variety of psychiatric and medical illnesses, which can be treatable once a diagnosis is established (3).

Various prevalence rates have been reported for catatonia occurring among patients with schizophrenia and mood disorders. According to rajagopal, catatonia is more commonly a consequence of mood disorders than of schizophrenia though historically catatonia has been regarded as being much more strongly associated with schizophrenia (4). He further stated that this bias giving schizophrenia an exaggerated place in the discussion of catatonia is also reflected in ICD-10 (Tenth Revision of the International Classification of Diseases and Related Health Problems) and DSM-IV( 4th Edition of Diagnostic and Statistical Manual of Mental Disorders) diagnostic guidelines in psychiatry (4).

In ICD-10, presence of one of the following signs is sufficient to make a diagnosis of catatonic schizophrenia (provided the individual already met criteria for schizophrenia): stupor, excitement, posturing, negativism, rigidity, waxy flexibility and command automatism (automatic obedience) (5). However, if a patient with severe depression is in a stupor, a diagnosis of 'severe depressive episode with psychotic symptoms' (F32.3) is made, even if there are no delusions or hallucinations (5). In addition, a patient with manic stupor will be diagnosed as having 'mania with psychotic symptoms' (F30.2) (5).

Similarly, in DSM-IV a diagnosis of 'schizophrenia, catatonic type' (code 295.20) is made if the clinical picture is dominated by at least two of the following: motor immobility, excessive motor activity, extreme negativism, peculiarities of voluntary movements, and echolalia/echopraxia (6). …