Catatonia as a putative nosological entity: A historical sketch

Abstract

Kahlbaum was the first to propose catatonia as a separate disease following the example of general paresis of the insane, which served as a model for establishing a nosological entity. However, Kahlbaum was uncertain about the nosological position of catatonia and considered it a syndrome, or “a temporary stage or a part of a complex picture of various disease forms”. Until recently, the issue of catatonia as a separate diagnostic category was not entertained, mainly due to a misinterpretation of Kraepelin’s influential views on catatonia as a subtype of schizophrenia. Kraepelin concluded that patients presenting with persistent catatonic symptoms, which he called “genuine catatonic morbid symptoms”, particularly including negativism, bizarre mannerisms, and stereotypes, had a poor prognosis similar to those of paranoid and hebephrenic presentations. Accordingly, catatonia was classified as a subtype of dementia praecox/schizophrenia. Despite Kraepelin’s influence on psychiatric nosology throughout the 20th century, there have only been isolated attempts to describe and classify catatonia outside of the Kraepelinian system. For example, the Wernicke-Kleist-Leonhard school attempted to comprehensively elucidate the complexities of psychomotor disturbances associated with major psychoses. However, the Leonhardian categories have never been subjected to the scrutiny of modern investigations. The first three editions of the DSM included the narrow and simplified version of Kraepelin’s catatonia concept. Recent developments in catatonia research are reflected in DSM-5, which includes three diagnostic categories: Catatonic Disorder due to Another Medical Condition, Catatonia Associated with another Mental Disorder (Catatonia Specifier), and Unspecified Catatonia. Additionally, the traditional category of catatonic schizophrenia has been deleted. The Unspecified Catatonia category could encourage research exploring catatonia as an independent diagnostic entity.

Topiramate as Possible Treatment for Catatonia in Anti-NMDA Receptor Encephalitis

“…Catatonia is a well-described clinical syndrome with unclear pathophysiology (2). It is typically associated with psychiatric disorders, such as schizophrenia and bipolar disorder (10). The current pathophysiological hypothesis implicates GABA-A, dopamine D2 receptors, and NMDA receptors.…”

First 150 years of catatonia: Looking back at its complicated history and forward to the road ahead

“…Most American psychiatrists mainly relied on Kraepelin’s and Bleuler’s concepts of catatonia. In the first three editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM)[ 15 - 17 ] published by the American Psychiatric Association, catatonia only appeared as a subtype of schizophrenia; this approach likely resulted in significant neglect, underdiagnosis and inadequate treatment of catatonia[ 18 , 19 ].…”

Repositioning synthetic glucocorticoids in psychiatric disease associated with neural autoantibodies: a narrative review

“…A further psychiatric disease entity is catatonia-often considered an aspect of schizophrenia-but nowadays also classified as an independent psychiatric disease entity (Gazdag et al 2017). Furthermore, catatonia might appear as a symptomatic manifestation of autoimmune encephalitis, as in NMDAR encephalitis (Al-Diwani et al 2019).…”