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Domschke K. [Mutism in Han Kang's "Greek Lessons" - A reading from a psychiatric perspective]. DER NERVENARZT 2025:10.1007/s00115-025-01817-7. [PMID: 40009177 DOI: 10.1007/s00115-025-01817-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2025] [Indexed: 02/27/2025]
Affiliation(s)
- Katharina Domschke
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland.
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Liao PH, Chiu HH, Wang TY, Chen YC. A 44-Year-Old Man With Acute Mutism: Acute Stroke, Psychiatric Disorder, or Substance Abuse? J Acute Med 2022; 12:34-38. [PMID: 35619726 PMCID: PMC9096507 DOI: 10.6705/j.jacme.202203_12(1).0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/11/2021] [Accepted: 04/22/2021] [Indexed: 06/15/2023]
Abstract
Mutism is a common presentation of psychiatric diseases. However, patients presenting to the emergency department with mutism should be assumed to have an organic pathology irrespective of their psychiatric history. Little is known about the causality between mutism and illicit drug use. We report a case of a 44-year-old man with acute mutism who was initially diagnosed with ischemic cerebral infarction involving the dorsolateral frontal cortex causing Broca's aphasia. He was later found to have a history of amphetamine, ketamine, and new psychoactive substance use. Substance abuse could be a precipitating factor for acute stroke, especially among patients aged below 55 years. Patients should be routinely screened and counseled regarding illicit drug use. The present case report highlights the possibility that transient ischemia could be associated with acute mutism in drug abusers. Prompt acquisition of drug abuse history or basic drug screening is especially mandatory.
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Affiliation(s)
- Po-Hsiang Liao
- Taipei Veterans General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Hsu-Huai Chiu
- Neurological Institute Department of Neurology Taipei Veterans General Hospital, Taipei Taiwan
| | - Tse-Yao Wang
- Taipei Veterans General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Yen-Chia Chen
- Taipei Veterans General Hospital Department of Emergency Medicine Taipei Taiwan
- Faculty of Medicine Emergency Medicine Taipei Veterans General Hospital, Taipei Taiwan
- National Defense Medical Center Department of Emergency Medicine Taipei Taiwan
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Jaimes-Albornoz W, Ruiz de Pellon-Santamaria A, Nizama-Vía A, Isetta M, Albajar I, Serra-Mestres J. Catatonia in older adults: A systematic review. World J Psychiatry 2022; 12:348-367. [PMID: 35317341 PMCID: PMC8900590 DOI: 10.5498/wjp.v12.i2.348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/27/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Catatonia is a complex psychomotor syndrome that often goes unrecognized and untreated, even though its classification has evolved in recent years. Prompt and correct identification of catatonia allows for highly effective treatment and prevention of possible complications. The underrecognition of catatonia in older patients is also frequent, and research in this population is scarce.
AIM To conduct a systematic review of the literature on catatonia in older people to ascertain its clinical characteristics across settings.
METHODS Following the PRISMA guidelines, MEDLINE, EMBASE, and PsycINFO databases were searched from inception to December 2021, with a strategy aimed at identifying all articles published on catatonia in older adults. Titles and abstracts were scanned and selected independently by two authors. Papers investigating issues related to catatonia and/or catatonic symptoms in older people, with English abstracts available, were included. References of selected articles were revised to identify other relevant studies.
RESULTS In total, 1355 articles were retrieved. After removing duplicates, 879 remained. Of the 879 identified abstracts, 669 were excluded because they did not meet the inclusion criteria. A total of 210 articles underwent full text review, and 51 were eliminated for various reasons. Fourteen more articles were selected from the references. Overall, 173 articles were reviewed: 108 case reports, 35 case series, 11 prospective cohort studies, 6 case-control studies, 3 retrospective cohort studies and 10 reviews. We found several particular aspects of catatonia in this population. Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. Older patients, compared to younger patients, have a higher risk of developing catatonia with benzodiazepine (BZD) withdrawal, in bipolar disorder, and in the general hospital. Age, together with other risk factors, was significantly associated with the incidence of deep venous thrombosis, neuroleptic malignant syndrome poor outcome, other complications and mortality. Treatment with BZDs and electroconvulsive therapy is safe and effective. Prompt treatment of its cause is essential to ensure a good prognosis.
CONCLUSION Catatonia in older patients is highly prevalent and tends to have a multifactorial etiology. The risk of developing catatonia in some settings and conditions, as well as of developing complications, is high in this population. Symptomatic treatment is safe and effective, and timely etiologic treatment is fundamental.
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Affiliation(s)
- Walter Jaimes-Albornoz
- Psychiatry Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Angel Ruiz de Pellon-Santamaria
- Psychiatry Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Ayar Nizama-Vía
- Psychiatry Service “Virgen del Cisne” Mental Health Community Center, Regional Health Directorate, Tumbes 24002, Peru
| | - Marco Isetta
- Library and Knowledge Services, Central & North West London NHS Foundation Trust, St Charles’ Hospital, London W10 6DZ, United Kingdom
| | - Ines Albajar
- Neurology Service, Hospital Universitario Donostia, Basque Health Service - Osakidetza, San Sebastian 20014, Gipuzkoa, Spain
| | - Jordi Serra-Mestres
- Old Age Psychiatry Service, Cardinal Clinic, Windsor SL4 5UL, United Kingdom
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Jaimes-Albornoz W, Ruiz de Pellon-Santamaria A, Nizama-Vía A, Isetta M, Albajar I, Serra-Mestres J. Catatonia in older adults: A systematic review. World J Psychiatry 2022; 12:359-381. [DOI: 10.5498/wjp.v12.i2.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Seeman MV. Long-term non-catatonic mutism in schizophrenia: cultural influences. INTERNATIONAL JOURNAL OF CULTURE AND MENTAL HEALTH 2017; 10:121-126. [DOI: 10.1080/17542863.2016.1246582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Affiliation(s)
- Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Muneoka K, Kanahara N, Kimura S. Switching to aripiprazole for the treatment of residual mutism resulted in distinct clinical courses in two catatonic schizophrenia cases. SAGE Open Med Case Rep 2017; 5:2050313X17692936. [PMID: 28255444 PMCID: PMC5315413 DOI: 10.1177/2050313x17692936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/13/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The efficacy of a partial agonist for the dopamine D2 receptor, aripiprazole, for catatonia in schizophrenia has been reported. METHODS We report distinct clinical courses in challenging aripiprazole to treat residual mutism after severe catatonic symptoms improved. RESULTS In the first case, mutism was successfully treated when the patient was switched from olanzapine to aripiprazole. In contract, switching to aripiprazole from risperidone aggravated auditory hallucinations in the second case. CONCLUSIONS We will discuss the benefits and risks of using aripiprazole for the treatment of catatonic schizophrenia and the possibility of dopamine supersensitivity psychosis.
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Affiliation(s)
- Katsumasa Muneoka
- Gakuji-Kai Kimura Hospital, Chiba, Japan; Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhisa Kanahara
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan; Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba, Japan
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Dar MA, Rather YH, Shah MS, Wani RA, Hussain A. Rapid Response of Long-Standing, Treatment-Resistant Non-Catatonic Mutism in Paranoid Schizophrenia with Single ECT session. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:591-4. [PMID: 25535609 PMCID: PMC4264296 DOI: 10.4103/1947-2714.145480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Mutism is a common manifestation of catatonia, but mutism due to other forms of psychopathology and neurological disorders have also been described. Although not common, long-standing mutism has also been a feature of non-catatonic schizophrenia and traditionally responds less to conventional therapies. Case Report: We describe a rare case of paranoid schizophrenia presenting with continuous mutism for about 4 years. This 26-year-old male had symptoms of schizophrenia without catatonia. After failed trial of adequate pharmacotherapy and psychological intervention and considering his level of dysfunction, he was started on electroconvulsive therapy (ECT). To our surprise, he improved with a single session of ECT while he was on concurrent pharmacotherapy. We also discuss the possible explanation for this rapid effect of ECT in such clinical presentation. To our knowledge, this is the first case of non-catatonic mutism of schizophrenia of this long duration responding so promptly to ECT, although there are other reports as well in literature, but multiple ECT sessions were applied in those cases. Conclusion: Non-catatonic mutism is perhaps presenting as a cultural variant in this part of the world and whenever encountered, ECT should be an option. Further research should be carried out to validate this idea.
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Affiliation(s)
- Mansoor Ahmad Dar
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Yasir Hassan Rather
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Majid Shafi Shah
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Rayees Ahmad Wani
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
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Mishra NK, Russmann H, Granziera C, Maeder P, Annoni JM. Mutism and Amnesia following High-Voltage Electrical Injury: Psychogenic Symptomatology Triggered by Organic Dysfunction? Eur Neurol 2011; 66:229-34. [DOI: 10.1159/000330953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 07/04/2011] [Indexed: 01/23/2023]
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Aggarwal A, Sharma DD, Kumar R, Sharma RC. Mutism as the presenting symptom: three case reports and selective review of literature. Indian J Psychol Med 2010; 32:61-4. [PMID: 21799563 PMCID: PMC3137816 DOI: 10.4103/0253-7176.70542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mutism, defined as an inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output, is a common clinical symptom seen in psychiatric as well as neurology outpatient department. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. It is often a focus of clinical attention, both for the physician and the relatives. Mutism occurs in a number of conditions, both functional and organic, and a proper diagnosis is important for the management. We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. The authors also selectively reviewed the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes.
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Affiliation(s)
- Ashish Aggarwal
- Department of Psychiatry, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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McMillan HJ, Keene DL, Matzinger MA, Vassilyadi M, Nzau M, Ventureyra ECG. Brainstem compression: a predictor of postoperative cerebellar mutism. Childs Nerv Syst 2009; 25:677-81. [PMID: 19082829 DOI: 10.1007/s00381-008-0777-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Cerebellar mutism is a common complication of posterior fossa tumor resection. We observed marked, preoperative brainstem compression on MR imaging, among patients who developed postoperative mutism. This study was designed to investigate if an association was indeed present. MATERIALS AND METHODS Patients (18 months-18 years) undergoing resection of a midline, posterior fossa tumor were retrospectively reviewed. Demographic data, tumor pathology, mutism onset and duration, and postoperative complications were obtained from hospital records. Pre- and postoperative MR images were studied to assess tumor size and the severity of pons compression (an estimate of the mechanical and distortional forces imparted by the tumor). RESULTS Patients with mutism showed greater preoperative pons compression and a greater increase in postoperative pons diameter. CONCLUSION We predict that brainstem compression may represent white-matter injury from (1) surgical manipulation and traction, and (2) axonal damage caused by the release of the tumor's compressive force and ensuing axon distortion and dysfunction. The results provide support that mutism may be largely caused by white-matter damage disrupted axon integrity and function.
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Affiliation(s)
- H J McMillan
- Division of Neurology, Children's Hospital of Eastern Ontario, ON, Canada
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Gellman-Garçon È. Le mutisme sélectif chez l'enfant : un concept trans-nosographique. revue de la littérature et discussion psychopathologique. PSYCHIATRIE DE L ENFANT 2008. [DOI: 10.3917/psye.501.0259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
The uses of lorazepam and electroconvulsive therapy (ECT) have been proven to be effective in treating catatonia. In the present study a modified treatment strategy (i.e. lorazepam i.m. injection or diazepam infused i.v. if lorazepam failed, not with ECT) was proposed to rapidly relieve catatonic signs in patients with schizophrenia. During a 3-year period, 14 patients with catatonic schizophrenia in Chinese ethnic background Taiwanese were brought to the emergency unit of a general hospital. First, the patients were immediately treated with lorazepam 1 or 2 ampules (2 mg/mL per ampule) i.m. injection (IMI) during 2 h. Second, if the previous 2 ampules of lorazepam IMI failed, diazepam infused i.v. (10 mg/2 mL per ampule) in normal saline 500 mL every 8 h would be done during 1 day. The response rate of catatonic signs in these 14 patients with lorazepam IMI during the first 2 h was 85.7% (12/14). However, according to the results of this method, the total response rate to benzodiazepines during 1 day was 100%(14/14). These results suggested that this modified treatment strategy could rapidly and completely relieve catatonic signs, even without the use of ECT.
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Affiliation(s)
- Tiao-Lai Huang
- Department of Psychiatry, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
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Abstract
Catatonia in geriatric patients has been insufficiently investigated. We reviewed 71 case descriptions from 45 studies to clarify the phenomenology, diagnosis, etiology, and treatment of catatonia in the elderly. In elderly patients, catatonia is frequently observed in association with general medical conditions. In patients with a history of depression or schizophrenia, physicians occasionally overlook the medical conditions because they believe the previous psychosis to be the cause of the catatonic features. Despite historical discussions of a relation between the disorders, the number of patients with catatonia and a prior diagnosis of schizophrenia or another psychotic disorder is not large. A diagnosis of catatonia should be considered in cases of atypical "collapse" in elderly patients with a previous psychiatric history of mood disorder. Catatonia due to anxiety/adjustment disorder is quite rare, whereas catatonia in association with neuroleptic malignant syndrome is fairly common. For early commencement of treatment, early detection of catatonia in the elderly is important. In studies of psychotropic drug treatment, many authors observed a beneficial response to lorazepam in catatonic patients. For medication-refractory patients, electroconvulsive therapy should be considered. It is important to prevent the development of venous thrombosis as a serious complication in stuporous catatonic patients.
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Affiliation(s)
- Tomoji Takata
- Department of Psychopathology, Gifu University Graduate School of Medicine, Gifu, Japan
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Abstract
Child and adolescent catatonia has been poorly investigated. A literature review was undertaken to clarify phenomenology, diagnosis, etiology, and treatment as well as ethical problems of catatonia in childhood and adolescence. Although there are no accepted standardized criteria for catatonia in childhood and adolescence, catatonic features described by child psychiatrists are similar to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for catatonia. With respect to etiology, the motor and behavioral symptoms that are part of catatonia bear some similarities with those seen in autism. Several case reports suggest an association between catatonia and general medical conditions. Certain drugs abused by youngsters as well as prescribed medicine can induce catatonia. Regarding catatonic cases originally diagnosed as schizophrenia, it is unclear whether all of these cases should be identified as schizophrenia or whether some of them are pervasive developmental disorders that develop psychic features in adolescence. Environmental changes preceding the onset of catatonia in patients with mood disorder play a possibly important role. Examples that suggest stress-induced catatonia, although rare, also exist. A few patients exhibit features of malignant catatonia, some without taking neuroleptics and others having taken them. Benzodiazepines and electroconvulsive therapy are considered to be effective treatments for catatonic youngsters.
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Affiliation(s)
- Ken Takaoka
- Department of Psychopathology, Faculty of Medicine, Gifu University, Japan.
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Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain disability exaggeration/malingering and submaximal effort research. Clin J Pain 1999; 15:244-74. [PMID: 10617254 DOI: 10.1097/00002508-199912000-00002] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This is the first review of chronic pain (CP) malingering/disease simulation research. The purpose of this review was to determine the prevalence of malingering within CP patients (CPPs), whether evidence exists that malingering can be detected within CPPs, and to suggest some avenues of research for this topic. DESIGN A computer and manual literature search produced 328 references related to malingering, disease simulation, dissimulation, symptom magnification syndrome, and submaximal effort. Of these, 68 related to one of these topics and to pain. The references were reviewed in detail, sorted into 12 topic areas, and placed into tabular form. These 12 topic areas addressed the following: existence of malingering within the CP setting; dissimulation, identification simulated (faked) facial expressions of pain; identification of malingering by questionnaire; identification of malingered sensory impairment; identification of malingered loss of hand grip strength; identification of submaximal effort by isometric strength testing; identification of submaximal or malingered effort by isokinetic strength testing; identification of submaximal or malingered effort by the method of coefficient of variation; self-deception; symptom magnification syndrome; and miscellaneous malingering identification studies. Each report, in each topic area, was rated for scientific quality according to guidelines developed by the Agency for Health Care, Policy and Research (AHCPR) for rating the level of evidence presented in the reviewed study. The AHCPR guidelines were then used to rate the strength and consistency of the research evidence in each topic area based on the type of evidence the reports represented. All review conclusions were based on the results of these ratings. SETTING Any medical setting reporting on either malingering or disease simulation, or dissimulation, or submaximal effort and pain. PATIENTS Normal volunteers, CPPs, or any group asked to produce a submaximal or malingered effort or a malingered test profile. RESULTS The reviewed studies indicated that malingering and dissimulation do occur within the CP setting. Malingering may be present in 1.25-10.4% of CPPs. However, because of poor study quality, these prevalence percentages are not reliable. The study evidence also indicated that malingering cannot be reliably identified by facial expression testing, questionnaire, sensory testing, or clinical examination. There was no acceptable scientific information on symptom magnification syndrome. Hand grip testing using the Jamar dynamometer and other types of isometric strength testing did not reliably discriminate between a submaximal/malingering effort and a maximal/best effort. However, isokinetic strength testing appeared to have potential for discriminating between maximal and submaximal effort and between best and malingered efforts. Repetitive testing with the coefficient of variation was not a reliable method for discriminating a real/best effort from a malingered effort. CONCLUSIONS Current data on the prevalence of malingering within CPPs is not consistent, and no conclusions can be drawn from these data. As yet, there is no reliable method for detecting malingering within CPPs, although isokinetic testing shows promise. Claims by professionals that such a determination can be made should be viewed with caution.
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Affiliation(s)
- D A Fishbain
- Department of Psychiatry, University of Miami, School of Medicine, Comprehensive Pain and Rehabilitation Center at South Shore Hospital, Miami Beach, Florida 33139, USA
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Abstract
The relationship between selective mutism (SM) and childhood anxiety disorders is illustrated through an examination of their temperamental, environmental, and biological etiologies. SM is also explored as a symptom of the specific anxiety disorders of social phobia, separation anxiety, and posttraumatic stress disorder. The etiology and symptom overlap demonstrates SM as being an anxiety disorder or a variant of a specific anxiety disorder. The conceptualization of SM as an anxiety disorder is helpful in effectively treating afflicted children. There is enough evidence in the current literature to challenge the current classification, from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders of SM as an Other Disorder of Infancy, Childhood, and Adolescence.
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Affiliation(s)
- K D Anstendig
- Department of Applied Psychology, New York University, New York 10003, USA.
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Fricchione G, Bush G, Fozdar M, Francis A, Fink M. Recognition and Treatment of the Catatonic Syndrome. J Intensive Care Med 1997. [DOI: 10.1177/088506669701200304] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We define the catatonic syndrome and review the history of the concept of catatonia, including its recent acceptance as a syndrome. Diagnosis of the catatonic syndrome, with its associated extensive differential diagnoses related to systemic and mental disorders, is addressed. Catatonia is related to variants of the syndrome, such as lethal (malignant) catatonia and the neuroleptic malignant syndrome (NMS). Medical sequelae of these conditions are outlined. The literature on the treatment of the catatonic syndrome is reviewed, and a suggested approach to treatment and management of catatonic patients in the intensive care unit is provided. An hypothesis regarding the neuropathophysiological basis for the syndrome is also offered.
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Affiliation(s)
- Gregory Fricchione
- From the Department of Medicine, Division of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - George Bush
- From the Department of Medicine, Division of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Manish Fozdar
- From the Department of Medicine, Division of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Andrew Francis
- From the Department of Medicine, Division of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Max Fink
- From the Department of Medicine, Division of Psychiatry, Brigham and Women's Hospital, Boston, MA
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Aguiar PH, Plese JP, Ciquini O, Marino R. Transient mutism following a posterior fossa approach to cerebellar tumors in children: a critical review of the literature. Childs Nerv Syst 1995; 11:306-10. [PMID: 7648574 DOI: 10.1007/bf00301766] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Transient mutism has been known as a rare complication following a posterior fossa approach to cerebellar tumors and its cause has not been clearly elucidated. The cerebellar mutism is not accompanied by cranial nerve deficits and disorders of consciousness. Since 1985 only 23 cases of mutism following removal of a cerebellar tumor in children have been reported in the literature. Two additional cases have been operated upon in our department. Extensive injury to the vermian and paravermian cerebellar area, involving the hemispheric cortex, cerebellar peduncles, fibers from the dentato-thalamocortical pathway, and dentate and interpositum nuclei may be the most important anatomical substrate of mutism. The mechanism of such transient mutism seems to be a complex of two or more factors (vascular disturbances due to manipulation or retraction of the cerebellar region around the IV ventricle and emotional factors). On the basis of these 25 cases the major features of the cerebellar mutism are discussed.
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Affiliation(s)
- P H Aguiar
- Department of Neurology, Hospital das Clínicas, University of São Paulo, Brazil
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Crutchfield JS, Sawaya R, Meyers CA, Moore BD. Postoperative mutism in neurosurgery. Report of two cases. J Neurosurg 1994; 81:115-21. [PMID: 8207512 DOI: 10.3171/jns.1994.81.1.0115] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Mutism is defined as a state in which a patient is conscious but unwilling or unable to speak. It has been reported to occur in association with a multitude of conditions, including trauma, epilepsy, tumors, stroke, psychoses, and brain surgery. The cases of two patients who became mute in the immediate postoperative period are presented. The first patient developed mutism following removal of a parasagittal meningioma, and the second following removal of a posterior fossa medulloblastoma. It is believed that transient injury may have occurred to the supplementary motor cortex in the first case and to the dentate nuclei in the second case. It is interesting that these two areas are connected via pathways involving the ventrolateral nucleus of the thalamus, and that lesions of this thalamic nucleus can also lead to mutism. It therefore appears plausible that interruption of these pathways may be involved in the pathogenesis of mutism. Although mutism is an infrequent complication of brain surgery, neurosurgeons should be aware that it may occur following removal of lesions in these areas and that it is generally a transient condition.
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Affiliation(s)
- J S Crutchfield
- Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston
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Abstract
OBJECTIVE The aim of this study is to identify the frequency, presentation, identification, treatment recommendations and outcome of patients with catatonia in the general hospital setting. METHOD All patients seen on a consultation-liaison (C-L) service over a six-month period were screened prospectively for catatonic disorders. Research and DSM-IV criteria for catatonic disorder were applied. Treatment and outcome were naturalistic. RESULTS Five (1.6%) of 297 patients met restrictive criteria for catatonic disorder. Data were extracted from medical charts. Case reports are presented to reflect the diagnosis and treatment. Extensive medical treatment was required in most cases and most had an unfavorable outcome. CONCLUSION Catatonia is infrequent but underrecognized in medical-surgical settings. The C-L clinician should screen for catatonic signs in order to diagnose and treat patients with the catatonic disorders.
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Affiliation(s)
- B T Carroll
- Ohio State University College of Medicine, Columbus, USA
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Realmuto GM, August GJ. Catatonia in autistic disorder: a sign of comorbidity or variable expression? J Autism Dev Disord 1991; 21:517-28. [PMID: 1778964 DOI: 10.1007/bf02206874] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Catatonia, once solely attributed to schizophrenia, is now thought to be associated with many disorders. Autistic disorder shares some symptoms with catatonia, namely, mutism, echopraxia/echolalia, and sterotypes. Catatonia in autism may therefore be a variant of the autistic condition. However, organic deficits and psychiatric disorders, such as bipolar disorder, have also been deficits and psychiatric disorders, such as bipolar disorder, have also been linked with the manifestation of catatonia. Individuals with autism presenting with these comorbid conditions may therefore be at increased risk for catatonia. Little is written of the association of autism and catatonia to clarify the possibility of catatonia as a variant or a sign of a comorbid condition. The authors discuss three autistic patients and suggest specific etiologies for the symptoms of catatonia which presented in these cases. The therapeutic and diagnostic importance of comorbid disorders in autism is stressed.
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Nakasu Y, Isozumi T, Nioka H, Handa J. Mechanism of mutism following the transcallosal approach to the ventricles. Acta Neurochir (Wien) 1991; 110:146-53. [PMID: 1927607 DOI: 10.1007/bf01400683] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Transient mutism has been known as a common manifestation following callosotomy for medically intractable epilepsy, but its cause has not been clearly elucidated. In this paper, we report three cases of mutism following a transcallosal approach to tumours in the lateral and third ventricles and retrospectively analyze the surgical, neurological and radiological features which may suggest the cause of this type of mutism. Mutism may be a result of division of the corpus callosum. Suppression of the limbic system caused by lesions in the anterior cingulate gyrus, septum pellucidum, and fornix may have been of importance in at least two of these three cases. Impairments of the supplementary motor cortex, thalamus and basal ganglia may also be factors reducing speech production. The mechanism of such transient mutism seems to be a complex of two or more of these factors, and their combinations may be different from one case to the other.
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Affiliation(s)
- Y Nakasu
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
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Harris D, Menza MA. Benzodiazepines and catatonia: a case report. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1989; 34:725-7. [PMID: 2804884 DOI: 10.1177/070674378903400718] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The case history of a patient with presumed psychogenic catatonia who responded dramatically to two mg of IM lorazepam is presented. This patient, who had been largely mute and immobile for over a week despite neuroleptic therapy, became freely conversant and mobile within 30 minutes of the administration of lorazepam. This response was repeated the next day after the patient had again become mute and immobile. Catatonia and its diverse etiologies are discussed, with an emphasis on its syndromic nature. The literature on the response of catatonia to the benzodiazepines is reviewed and it is suggested that a trial of benzodiazepines may be helpful in both the evaluation and long term management of patients with catatonia.
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Affiliation(s)
- D Harris
- Psychiatric Consult Service, Robert Wood Johnson Medical School, New Brunswick, New Jersey
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