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Mass psychogenic illness, traditionally epidemic hysteria, exhibit certain characteristics (Levy and Nail, 1993; Boss, 1997; Bartholomew and Wessley, 2002). Highly segregated groups where stress, control or obligations are evident and inescapable are predisposed and historically in particular religious settings are overrepresented. Epidemics involve typical symptoms, including fatigue and unconsciousness, without demonstrable organic lesions. Media reports are known to enable transmission of illness behavior. “La Grand Hystérie” illustrates how psychogenic symptoms evolve over time, transpire epidemically and affect by suggestion.

In situations where the psychosis is triggered by a prescription drug used to manage a medical condition, patient and doctor need to find an alternative treatment. In practice, clinicians often struggle to distinguish a substance-induced psychosis from a primary psychotic illness or a psychotic illness with comorbid substance use. The distinction matters for indicating the best course of treatment. Chronicity eco sober house complaints of usage and amount of substance consumed are also linked to conversion to schizophrenia. All told, the evidence suggests that there are both factors within people and properties of psychoactive substances that make them neurotoxic, able to indelibly alter brain function. Marijuana, too, has been changing—significant because marijuana use it at historically high levels among high school and college students.

Disruption of the body’s ability to reduce core body temperature has been attributed to antipsychotic medicines. No pathophysiological mechanism has been identified to explain this finding, and no consistent pattern for cause of death observed. Nevertheless, caution should be exercised and the risks and benefits of this combination or co-treatment with other potent diuretics should be considered prior to the decision to use. There was no increased incidence of mortality among patients taking other diuretics as concomitant treatment with risperidone.

From a diagnostic viewpoint the introduction has been argued unnecessary (Engström, 2013). RS classified among the depressive entities (F32–33) should be interpreted as pragmatic solution to controversies regarding the nature of the phenomenon . Routine work-up includes toxic screening and anamnestic interviewing via interpreter. Neuroradiology, neurophysiological examinations and lumbar puncture are considered optional . Electroencephalogram and computed tomography of the skull have generally been unimpressive as well as laboratory screenings (Bodegård, 2004; Aronsson et al., 2009; Forslund and Johansson, 2013).

drugs that cause catatonic state

Anyone with an established mental health problem, or who is prone to psychosis, is at a higher risk of developing a psychotic disorder from overintoxication, abuse of, or withdrawal from a legal or illegal substance. Nevertheless, the propensity to develop psychosis seems to be a function of the severity and chronicity of substance use. The most commonly reported symptoms—psychogenic non-epileptic seizures , loss of consciousness and motor symptoms (Brown and Lewis-Fernández, 2011)—imitate organic disorders. Prevalence is increased following brain injury , prior to debut of, and parallel to, epilepsy (Devinsky et al., 2011), with depression, PTSD , anxiety and borderline personality disorder (Brown and Lewis-Fernández, 2011). Although transculturally understudied (Brown and Lewis-Fernández, 2011), functional disorders have been claimed to vary little in incidence and semiology across cultures . Catatonia is a severe psychomotor syndrome with an excellent prognosis if recognized and treated appropriately.

Culture-Bound Psychogenesis Explains the Regional Distribution of RS

Nevertheless, a condition lacking both arousal and awareness is the general impression when examining RS patients. The authors predict high energy consumption as well as activity shifts in amygdala and insula to be present (Nunn et al., 2014). Interestingly, indirect calorimetry demonstrated energy expenditure below the requirement of basal metabolism in two patients suggesting an equivalent of hibernation .

However, treatment of catatonia caused by both conditions has good outcomes. Therefore, once catatonia is confirmed and diagnosed, most people will need to take lorazepam more than once a day on a regular schedule. Catatonia can be treated, and people with the condition can make a good recovery. If catatonia is diagnosed early, it can sometimes be treated at home. However, someone with catatonia will often need more intensive treatment or support. Other than treatment already routinely offered in catatonia—which is reported safe and efficient, also in children adolescents—our model predicts no magic bullet.

drugs that cause catatonic state

In 2003–2005, the estimated annual incidence of RS was 2.8% in 0–17 year old asylum seekers. Catatonia incidence has been examined in two pediatric and adolescent psychiatric materials and found to be 0.6 and 5.5% respectively (Cohen et al., 1999; Thakur et al., 2003). The general incidence in the young population was estimated at 0.16% in Paris (Cohen et al., 1999). Estimated RS incidence is thus comparable to that of catatonia in psychiatric materials but does not correspond to that in a general material.

What are the symptoms of catatonia?

Around 8 in 10 people with catatonia have their symptoms improve after one dose of lorazepam. If someone can’t move, eat or drink, they might become very physically unwell. This is a treatment where a person’s brain is stimulated with short electric pulses while they are under general anaesthetic and asleep. A person may be prescribed a course of ECT over several weeks to help relieve their symptoms. If the person’s symptoms improve after one dose, this can help a doctor confirm the diagnosis of catatonia. Sometimes, treating the underlying cause of catatonia will be enough to treat the catatonia too.

  • Among prescribed medications, the perhaps best known are steroids, widely prescribed short-term and long-term to suppress inflammatory and immune processes.
  • In case of severe extrapyramidal symptoms, an anticholinergic medicinal product should be administered.
  • A family history of schizophrenia has been identified as a marker of vulnerability to psychotic response to substance use.
  • This theory probably helps us to understand better what is happening to a person with catatonia.
  • Usually, the induction of anaesthesia is with methohexital, 1.5 mg per kg IV or propofol 1 mg per kg IV and succinylcholine, 1.0 mg per kg IV.
  • If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider.

At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination.

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Resignation, apathy and eventually death in response to severe unavoidable threat is a consistent finding throughout history and across cultures. January 1st 2014, the Swedish National Board of Health and Welfare recognized the novel diagnostic entity resignation syndrome (RS; Socialstyrelsen, 2013). Implying a psychological etiology, its appropriateness remains to be demonstrated. In this presentation, the term will be used; however, should be interpreted free from theory. From January 1st 2003 to April 31st 2005, 424 cases were reported and out of the 6547 asylum applications submitted for children (0–17 years) in Sweden in 2004 , 2.8% were thus diagnosed. No cases reported from other countries, the phenomenon appears unique to Sweden.

Sometimes, doctors will think someone has catatonia but may not be sure. When this happens, before starting full treatment, the doctor might give the person a single dose of lorazepam. Lorazepam is a benzodiazepine, which is a type of sedative medication. This means that it helps to slow down the body and brain and relax the muscles. It is also used to treat epileptic fits, and in the short term it can be used to treat anxiety, insomnia and panic attacks. Catatonia can also affect people with autism spectrum disorders .

Importantly, this does not preclude other factors to interplay in pathogenesis. On the contrary, individual predisposition, traumatization, contextual factors as well as culturally sanctioned beliefs and expectations, may all be involved. At this stage, negative predictions having generalized in higher and lower levels of the hierarchy, and physiological systems threatening homeostasis, the organism, at some point, adopts a behavior which elicits support from its surroundings; an idiom of distress.

It is therefore important to study the various aspects of this mode of treatment especially anesthetic considerations for such a treatment. Many studies have been done to observe the negative effects of many anesthetic regimens and to prevent such adverse effects. These studies may have limitations, thus there need to be more studies conducted on a higher number of patients to improve anesthetic care during ECT and prevent adverse complications. Further studies have also shown the efficacy of nondepolarizing neuromuscular blocking agents in ECT. Kadoi et al., studied the recovery period of rocuronium and compared it to succinylcholine. They subsequently observed that repeated doses of rocuronium-sugammadex did not have any negative complications including nausea, vomiting or QT interval prolongation.

Relying on a framework of predictive coding, a mechanism answering to the protean nature of phenomena attributed to psychogenesis, we argue, may be attained. Importantly, such a mechanism permits also organic genesis of symptoms. Nevertheless, in relation to the present context—the notion of culture-bound serving to explain the regional distribution of RS—it should be emphasized that a description solely on the level of the brain is unlikely to be successful. This starting point is infertile and so, denying psychogenesis—understood as implying psychological impact on symptom generation and precipitation—altogether, is equally absurd as is the opposite. Scientific and journalistic reports paralleled the spread and increase of cases with predicted symptomatology.

  • In a material of 23 patients, Bodegård described the typical patient as “totally passive, immobile, lacks tonus, withdrawn, mute, unable to eat and drink, incontinent and not reacting to physical stimuli or pain”.
  • Resignation, apathy and eventually death in response to severe unavoidable threat is a consistent finding throughout history and across cultures.
  • In general, type of adverse reactions in children is expected to be similar to those observed in adults.
  • The impact of a PRP on remission is taken to support the stress hypothesis and obtaining it is therefore considered an essential element in treatment .
  • Another type of cognitive disorder is short-term retrograde amnesia which includes gaps in memory for occurrences a few weeks or even a few months prior to ECT.

Metabolic disorders, e.g. diabetes – these are where the body uses too much or too little of the essential chemicals that keep you healthy. If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider. Thirdly, the regional distribution, we have argued, is best explained by perceiving RS as culture-bound.

Patients with impaired hepatic function have increases in plasma concentration of the free fraction of risperidone. This dosage can be individually adjusted by increments of 0.25 mg twice daily, not more frequently than every other day, if needed. Some patients, however, may benefit from doses up to 1 mg twice daily. People with psychotic depression have an increased risk of thinking about suicide.


Dr Amitta Shah is a Consultant Clinical Psychologist with over 35 years’ experience in working with autistic children and adults. She has expertise in the diagnosis and management of catatonia in autism and has published papers on the subject with Dr Lorna Wing. Here she shares her insight and expertise of this under-recognised and poorly understood condition.

  • The reconceptualization of catatonia invites to a re-evaluation of RS, more so now than ever, and its correspondence to catatonia.
  • Also, Bodegård’s proposal involves a family system perspective attractive in relation to the observation that, to our knowledge, RS in unaccompanied minors have not been observed.
  • Other substances that can trigger a psychotic event include cocaine, amphetamines, phencyclidine , and alcohol.
  • • Have a better side effect profile than typical antipsychotics.

Studies have found that chronic use of cannabis, especially when started at a young age, can also induce psychosis. The symptoms can be distressing and terrifying to those who have them— they don’t know what is real and what is not—and may be accompanied by thoughts of suicide. In this altered state of reality perception, people can be withdrawn or agitated, and they may become aggressive, threatening harm to others as well as self. Amphetamines, cocaine, and cannabis are the most common precipitants among drugs of abuse, but prescribed medications such as steroids are also known to precipitate a psychotic episode. Only after the first application of this combination our patient made a complete recovery and had reached a stable condition after 24 hours. With a smile he spoke about “something underlying he could not talk about” and freely admitted to having felt strong regrets when his sister became married.

There is little research into long-term harm to brain structure or function from highly potent synthetic substances manufactured illicitly and widely distributed, but concern is warranted. There is very good converging evidence from multiple types of studies of multiple populations that cannabis use can precipitate acute, short-term psychosis, especially in chronic users and heavy users, the majority of whom are young males. An initial differential diagnosis included an acute reaction to stress with conversion disorder, acute paranoid reaction to some stressful experience or some form of drug-induced psychosis. Initial routine blood samples were indicative of dehydration and showed a mild unspecific alteration of the liver function, i.e. a borderline raised ALT and total bilirubin. In the previous section the notion of psychogenesis was inherent and served to transform culturally transpiring idioms of distress into generation of corresponding symptoms. Such neurological dysfunction in the absence of demonstrable organic lesion has been know to physicians since ancient times as hysteria.

Provided the condition is promptly reversed, patients would not reach the prolonged stuporous state RS exhibits. This hypothesis predicts the incidences of catatonia—and/or other similar disorders—and RS to correspond. In DSM-5, catatonia is defined as the presence of three or more symptoms out of a list of twelve . Among these, stupor, mutism and negativism are all general finding in RS . Nevertheless, pediatric catatonia has been suggested to consist of three cardinal symptoms; immobility, mutism and withdrawal or refusal to ingest . Depending on clinical presentation, either the specifier with catatonia together with major depressive disorder, or, the separate entity catatonic disorder NOS (not otherwise specified; Tandon et al., 2013) would be applicable to RS.

There is no consensus on how long benzodiazepines are to be continued, and generally they are discontinued once the underlying illness has remitted. In a number of cases, however, catatonic symptoms will emerge each time lorazepam is tapered off, urging the clinician to continue benzodiazepines for an extended period of time . Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%.