A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek σύνδρομον, meaning "concurrence". When a syndrome is paired with a definite cause this becomes a disease. In some instances, a syndrome is so closely linked with a pathogenesis or cause that the words syndrome , disease , and disorder end up being used interchangeably for them. This substitution of terminology often confuses the reality and meaning of medical diagnoses. This is especially true of inherited syndromes. About one third of all phenotypes that are listed in OMIM are described as dysmorphic, which usually refers to the facial gestalt. For example, Down syndrome , Wolf–Hirschhorn syndrome , and Andersen–Tawil syndrome are disorders with known pathogeneses, so each is more than just a set of signs and symptoms, despite the syndrome nomenclature. In other instances, a syndrome is not specific to only one disease. For example, toxic shock syndrome can be caused by various toxins; another medical syndrome named as premotor syndrome can be caused by various brain lesions; and premenstrual syndrome is not a disease but simply a set of symptoms.
82-1059: Catatonia is a complex syndrome , most commonly seen in people with underlying mood (e.g major depressive disorder) or psychotic disorders (e.g schizophrenia). People with catatonia have abnormal movement and behaviors, which vary from person to person and fluctuate in intensity within a single episode. People with catatonia appear withdrawn, meaning that they do not interact with the outside world and have difficulty processing information. They may be nearly motionless for days on end or perform repetitive purposeless movements. Two people may exhibit very different sets of behaviors and both still be diagnosed with catatonia. Treatment with benzodiazepines or ECT are most effective and lead to remission of symptoms in most cases. There are different subtypes of catatonia, which represent groups of symptoms that commonly occur together. These include stuporous/akinetic catatonia, excited catatonia, malignant catatonia, and periodic catatonia. Catatonia has historically been related to schizophrenia (catatonic schizophrenia), but
164-436: A " psychosis ", and described "the three major psychoses" as schizophrenia, epilepsy, and manic-depressive illness . In the field of medical genetics, the term "syndrome" is traditionally only used when the underlying genetic cause is known. Thus, trisomy 21 is commonly known as Down syndrome. Until 2005, CHARGE syndrome was most frequently referred to as "CHARGE association". When the major causative gene ( CHD7 ) for
246-618: A catatonic state. The nature of these complications will depend on the type of catatonia being experienced by the patient. For example, patients presenting with withdrawn catatonia may have refusal to eat which will in turn lead to malnutrition and dehydration. Furthermore, if immobility is a symptom the patient is presenting with, then they may develop pressure ulcers , muscle contractions , and are at risk of developing deep vein thrombosis (DVT) and pulmonary embolus (PE). Patients with excited catatonia may be aggressive and violent, and physical trauma may result from this. Catatonia may progress to
328-561: A defense against the potentially destructive consequences of responsibility, and the passivity of the disorder provides relief. Catatonia is also seen in many medical disorders, encephalitis, meningitis , autoimmune disorders , focal neurological lesions (including strokes ), alcohol withdrawal, abrupt or overly rapid benzodiazepine withdrawal , cerebrovascular disease , neoplasms , head injury , and some metabolic conditions ( homocystinuria , diabetic ketoacidosis , hepatic encephalopathy , and hypercalcaemia ). Catatonia can occur due to
410-427: A distinct clinical entity, but its status as a syndrome is unclear. Although abulia has been known to clinicians since 1838, it has been subjected to different interpretations – from 'a pure lack of will', in the absence of motor paralysis to, more recently, being considered 'a reduction in action emotion and cognition'. As a result of the changing definition of abulia, there is currently a debate on whether or not abulia
492-404: A general medical condition. Syndrome If an underlying genetic cause is suspected but not known, a condition may be referred to as a genetic association (often just "association" in context). By definition, an association indicates that the collection of signs and symptoms occurs in combination more frequently than would be likely by chance alone . Syndromes are often named after
574-406: A medical condition not classified under mental, behavioral, or neurodevelopmental disorders. Catatonia is often overlooked and under-diagnosed. Patients with catatonia most commonly have an underlying psychiatric disorder, for this reason, physicians may overlook signs of catatonia due to the severity of the psychosis the patient is presenting with. Furthermore, the patient may not be presenting with
656-447: A mild case Alzheimer's disease to 61% in patients with a severe case of Alzheimer's disease, which most likely developed over time as the patient got older. Most current treatments for abulia are pharmacological, including the use of antidepressants. However, antidepressant treatment is not always successful and this has opened the door to alternative methods of treatment. The first step to successful treatment of abulia, or any other DDM,
738-930: A movement, a "counter-will" or "resistance" rises up to meet them. The clinical condition denoted abulia was first described in 1838; however, since that time, a number of different, some contradictory, definitions have emerged. Abulia has been described as a loss of drive, expression, behavior and speech output, with slowing and prolonged speech latency, and reduction of spontaneous thought content and initiative, being considered more recently as 'a reduction in action emotion and cognition'. The clinical features most commonly associated with abulia are: Especially in patients with progressive dementia, it may affect feeding. Patients may continue to chew or hold food in their mouths for hours without swallowing it. The behavior may be most evident after these patients have eaten part of their meals and no longer have strong appetites. Both neurologists and psychiatrists recognize abulia to be
820-446: A neurotransmitter which is thought to contribute to motor dysfunction in people with catatonia. Abnormal thyroid function can cause catatonia when the thyroid overproduces or underproduces thyroid hormones. This is thought to occur due to thyroid hormones impact on metabolism including in the cells of the nervous system. Abnormal electrolyte levels have also been shown to cause catatonia in rare cases. Most notably low levels of sodium in
902-481: A number of neurological conditions. For instance, certain types of encephalitis can cause catatonia. Anti-NMDA receptor encephalitis is a form of autoimmune encephalitis which is known to cause catatonia in some people. Additionally encephalitis has been reported to cause catatonia in people who have encephalitis due to HIV and Herpes Simplex Virus (HSV). The research is limited, but some evidence suggests that people can develop catatonia after traumatic brain injury without
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#1732898969668984-436: A number of symptoms suggesting a particular disease or condition but does not meet the defined criteria used to make a diagnosis of that disease or condition. This can be a bit subjective because it is ultimately up to the clinician to make the diagnosis. This could be because it has not advanced to the level or passed a threshold or just similar symptoms cause by other issues. Subclinical is synonymous since one of its definitions
1066-605: A person has another underlying illness, and can be associated with a wide range of illnesses including psychiatric disorders, medical conditions, and substance use. Mood disorders such as a bipolar disorder and depression are the most common conditions underlying catatonia. Other psychiatric conditions that can cause catatonia include schizophrenia and other primary psychotic disorders, autism spectrum disorders , ADHD , and Post-traumatic Stress Disorder. In autism, people tend to present with catatonia during periods of regression. Psychodynamic theorists have interpreted catatonia as
1148-501: A potential cause if another cause is not apparent and discontinued if possible. Antipsychotics are sometimes used in those with a co-existing psychosis, however they should be used with care as they may worsen catatonia and have a risk of neuroleptic malignant syndrome , a dangerous condition that can mimic catatonia and requires immediate discontinuation of the antipsychotic. There is evidence that clozapine works better than other antipsychotics to treat catatonia. Supportive care
1230-412: A primary psychiatric disorder. Similarly, there are several case reports suggesting that people have experienced catatonia after a stroke, with some people having catatonia-associated symptoms that were unexplainable by their stroke itself, and which improved after treatment with benzodiazepines. Parkinson disease can cause catatonia for some people by impairing their ability to produce and secrete dopamine,
1312-840: A single identifiable pathogenesis. Examples of infectious syndromes include encephalitis and hepatitis , which can both have several different infectious causes. The more specific definition employed in medical genetics describes a subset of all medical syndromes. Early texts by physicians noted the symptoms of various maladies and introduced diagnoses based upon those symptoms. For example, Avicenna 's The Canon of Medicine (1025) describes diagnosing pleurisy by its symptoms, including chronic fever, cough, shooting pains, and labored breathing. The 17th century doctor Thomas Sydenham likewise approached diagnoses based upon collections of symptoms. Psychiatric syndromes often called psychopathological syndromes ( psychopathology refers both to psychic dysfunctions occurring in mental disorders , and
1394-467: A stroke patient is uninterested in performing tasks like walking despite being capable of doing so. It should be differentiated from apraxia , when a brain injured patient has impairment in comprehending the movements necessary to perform a motor task despite not having any paralysis that prevents performing the task; that condition can also result in lack of initiation of activity. A case study involving two patients with acute confusional state and abulia
1476-402: Is "where some criteria are met but not enough to achieve clinical status"; but subclinical is not always interchangeable since it can also mean "not detectable or producing effects that are not detectable by the usual clinical tests"; i.e., asymptomatic. In medicine, a broad definition of syndrome is used, which describes a collection of symptoms and findings without necessarily tying them to
1558-416: Is 50–70%, with treatment failure being associated with a poor prognosis. Many of these patients will require long-term and continuous mental health care. The prognosis for people with catatonia due to schizophrenia is much worse compared to other causes. In cases of catatonia that develop into malignant catatonia, the mortality rate is as high as 20%. Patients may experience several complications from being in
1640-455: Is a preliminary evaluation of the patient's general medical condition and fixing the problems that can be fixed easily. This may mean controlling seizures or headaches, arranging physical or cognitive rehabilitation for cognitive and sensorimotor loss, or ensuring optimal hearing, vision, and speech. These elementary steps also increase motivation because improved physical status may enhance functional capacity, drive, and energy and thereby increase
1722-463: Is a sign or a symptom of another disease, or its own disease that seems to appear in the presence of other more well-researched diseases, such as Alzheimer's disease. A 2002 survey of two movement disorder experts, two neuropsychiatrists, and two rehabilitation experts, did not seem to shed any light on the matter of differentiating abulia from other DDMs. The experts used the terms " apathy " and "abulia" interchangeably and debated whether or not abulia
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#17328989696681804-484: Is also commonly used to treat catatonia in people who don't improve with medication alone or whose symptoms reoccur whenever the dose of medications are reduced. ECT is usually administered with multiple sessions per week over two to four weeks. ECT has a success rate of 80% to 100%. ECT is effective for all subtypes of catatonia, however people who have catatonia with an underlying neurological condition show less improvement with ECT treatment. Excessive glutamate activity
1886-402: Is another treatment option for resistant catatonia; it produces its therapeutic effects by producing glutamate antagonism via modulation of AMPA receptors. There are many medications that are known to cause catatonia in some people including steroids, stimulants, anticonvulsants, neuroleptics or dopamine blockers. If a person has catatonia and is on these medications, they should be considered as
1968-432: Is as follows: Treating catatonia effectively requires treating the catatonia itself, treating the underlying condition, and helping them with their basic needs, like eating, drinking, and staying clean and safe, while they are withdrawn and incapable of caring for themselves. The specifics of treating catatonia itself can vary from region to region, hospital to hospital, and individual to individual, but typically involves
2050-504: Is believed to be involved in catatonia; when first-line treatment options fail, NMDA antagonists such as amantadine or memantine may be used. Amantadine may have an increased incidence of tolerance with prolonged use and can cause psychosis, due to its additional effects on the dopamine system. Memantine has a more targeted pharmacological profile for the glutamate system, reduced incidence of psychosis and may therefore be preferred for individuals who cannot tolerate amantadine. Topiramate
2132-417: Is characterized by fever, dramatic and rapid changes in blood pressure, increased heart rate and respiratory rate, and excessive sweating. Laboratory tests may be abnormal. Periodic Catatonia: This form of catatonia is characterized by only by a person having recurrent episodes of catatonia. Individuals will experience multiple episodes over time, without signs of catatonia in between episodes. Historically,
2214-409: Is characterized by odd mannerisms and gestures, purposeless or inappropriate actions, excessive motor activity, restlessness, stereotypy, impulsivity, agitation, and combativeness. Speech and actions may be repetitive or mimic another person's. People in this state are extremely hyperactive and may have delusions and hallucinations. Malignant Catatonia : This form of catatonia is a life threatening. It
2296-576: Is defined as a syndrome of primarily psychomotor disturbances that is characterized by the simultaneous occurrence of several symptoms such as stupor; catalepsy; waxy flexibility; mutism; negativism; posturing; mannerisms; stereotypies; psychomotor agitation; grimacing; echolalia and echopraxia. Catatonia may occur in the context of specific mental disorders, including mood disorders, schizophrenia or other primary psychotic disorders, and Neurodevelopmental disorders, and may be induced by psychoactive substances, including medications. Catatonia may also be caused by
2378-469: Is diagnosed by the presence of three or more of the following 12 psychomotor symptoms in association with a mental disorder, medical condition, or unspecified: Other disorders (additional code 293.89 [F06.1] to indicate the presence of the co-morbid catatonia): If catatonic symptoms are present but do not form the catatonic syndrome , a medication- or substance-induced aetiology should first be considered. ICD-11 classification In ICD-11 catatonia
2460-402: Is driving the syndrome, then an EEG would also be helpful in detecting this. CT or MRI will not show catatonia; however, they might reveal abnormalities that might be leading to the syndrome. Metabolic screens, inflammatory markers, or autoantibodies may reveal reversible medical causes of catatonia. Vital signs should be frequently monitored as catatonia can progress to malignant catatonia which
2542-453: Is in fact a case of diminished motivation . In recent years, imaging studies using a CT or MRI scan have been shown to be quite helpful in localizing brain lesions which have been shown to be one of the main causes of abulia. A lack of motivation has been reported in 25–50% of patients with Alzheimer's disease . While depression is also common in patients with this disease, abulia is not a mere symptom of depressions because more than half of
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2624-505: Is life-threatening. Malignant catatonia is characterized by fever, hypertension, tachycardia, and tachypnea. Various rating scales for catatonia have been developed, however, their utility for clinical care has not been well established. The most commonly used scale is the Bush-Francis Catatonia Rating Scale (BFCRS) (external link is provided below). The scale is composed of 23 items with the first 14 items being used as
2706-617: Is most often seen in mood disorders . It is now known that catatonic symptoms are nonspecific and may be observed in other mental, neurological, and medical conditions. The ICD-11 is the most common manual used globally to define and diagnose illness, including mental illness. It diagnoses catatonia in someone who has three different symptoms associated with catatonia at one time. These symptoms are called stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypies, psychomotor agitation, grimacing, echolalia, and echopraxia. It divides catatonia into three groups based on
2788-427: Is required in those with catatonia. This includes monitoring vital signs and fluid status, and in those with chronic symptoms; maintaining nutrition and hydration, medications to prevent a blood clot , and measures to prevent the development of pressure ulcers. Twenty-five percent of psychiatric patients with catatonia will have more than one episode throughout their lives. Treatment response for patients with catatonia
2870-405: Is thought to be due to changes in the function of circuits of the brain associated with dopamine release. The mechanisms in the brain that cause catatonia are poorly understood. Currently, there are two main categories of explanations for what may be happening in the brain to cause catatonia. The first, is that there is disruption of normal neurotransmitter production or release in certain areas of
2952-461: Is usually not a separate discipline from nosology and differential diagnosis generally, which inherently involve pattern recognition (both sentient and automated ) and differentiation among overlapping sets of signs and symptoms. Teratology (dysmorphology) by its nature involves the defining of congenital syndromes that may include birth defects (pathoanatomy), dysmetabolism (pathophysiology), and neurodevelopmental disorders . When there are
3034-811: The World Health Organization's eleventh edition of the International Classification of Diseases ( ICD-11 , 2022), the classification is more homogeneous than in earlier editions. Prominent researchers in the field have other suggestions for diagnostic criteria. Still, diagnosing catatonia can be challenging. Evidence suggests that there is as high as a 15 day average delay to diagnosis for people with catatonia. DSM-5 classification The DSM-5 does not classify catatonia as an independent disorder, but rather it classifies it as catatonia associated with another mental disorder, due to another medical condition, or as unspecified catatonia. Catatonia
3116-462: The NMDA receptor. People with Anti-NMDA receptor encephalitis can develop catatonia, because their own antibodies attack the NMDA receptor, which reduces the ability of the brain to activate different areas of the brain using glutamate. Several pathways in the brain have been studied which seem to contribute to catatonia when they aren't functioning properly. However, these studies were unable to determine if
3198-485: The Wernicke-Kleist-Leonhard School considered periodic catatonia a distinct form of "non-system schizophrenia" characterized by recurrent acute phases with hyperkinetic and akinetic features and often psychotic symptoms, and the build-up of a residual state in between these acute phases, which is characterized by low-level catatonic features and aboulia of varying severity. Catatonia can only exist if
3280-574: The abnormalities they observed were the cause of catatonia or if the catatonia caused the abnormalities. Furthermore, it has also been hypothesized that pathways that connect the basal ganglia with the cortex and thalamus is involved in the development of catatonia. There is not yet a definitive consensus regarding diagnostic criteria of catatonia. In the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 , 2013) and
3362-401: The activity of the systems of the brain it acts on. In catatonia, people have low levels of GABA which causes them to be overly activated, especially in the areas of the brain that cause inhibition. This is thought to cause the behavioral symptoms associated with catatonia including withdrawal. Dopamine can increase or decrease the activity of the area of the brain it acts on depending on where in
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3444-420: The blood can cause catatonia in some people. As discussed previously, Anti-NMDA receptor encephalitis is a form of autoimmune encephalitis which can cause catatonia. Additionally, autoimmune diseases that are not exclusively neurological can cause neurological and psychiatric symptoms including catatonia. For instance, systemic lupus erythematosus can cause catatonia and is thought to do by causing inflammation in
3526-518: The blood vessels of the brain or possibly by the body's own antibodies damaging neurons. Certain types of infections are known to cause catatonia either through directly impairing brain function or by making a person more likely to contract diseases that impair brain function. HIV and AIDS can cause catatonia, most likely by predisposing one to infections in the brain, including different types of viral encephalitis. Borrelia burgdorferi causes Lyme disease, which has been shown to cause catatonia by infecting
3608-402: The brain and causing encephalitis. Use of NMDA receptor antagonists including ketamine and phencyclidine (PCP) can lead to catatonia-like states. Information about these effects has improved scientific understanding of the role of glutamate in catatonia. High dose and chronic use of stimulants like Cocaine and Amphetamines can lead to cases of catatonia, typically associated with psychosis. This
3690-440: The brain it is. dopamine is lower than normal in people with catatonia, which is thought to cause a lot of the motor symptoms, because dopamine is the main neurotransmitter which activates the parts of the brain responsible for movement. Glutamate is an excitatory neurotransmitter, meaning that it increases the activity of the areas of the brain it acts on. Notably, glutamate increases tells the neuron it acts on to fire, by binding to
3772-430: The brain prevents normal function of those areas of the brain leading to behavioral and motor symptoms associated with catatonia. The second, claims that disruption of communication between different areas of the brain cause catatonia. The neurotransmitters that are most strongly associated with catatonia are GABA, dopamine, and glutamate. GABA is the main inhibitory neurotransmitter of the brain, meaning that it slows down
3854-413: The common signs of catatonia such as mutism and posturing. Additionally, the motor abnormalities seen in catatonia are also present in psychiatric disorders. For example, a patient with mania will show increased motor activity and may not be considered for a diagnosis of Excited Catatonia, even if symptoms are developing that are not associated with mania. One way in which physicians can differentiate between
3936-489: The condition was discovered, the name was changed. The consensus underlying cause of VACTERL association has not been determined, and thus it is not commonly referred to as a "syndrome". In biology, "syndrome" is used in a more general sense to describe characteristic sets of features in various contexts. Examples include behavioral syndromes , as well as pollination syndromes and seed dispersal syndromes . In orbital mechanics and astronomy, Kessler syndrome refers to
4018-452: The described symptoms. Signs and symptoms Syndrome Disease Medical diagnosis Differential diagnosis Prognosis Acute Chronic Cure Eponymous disease Acronym or abbreviation Remission Aboulia In neurology , abulia , or aboulia (from Ancient Greek : βουλή , meaning "will"), refers to a lack of will or initiative and can be seen as a disorder of diminished motivation . Abulia falls in
4100-428: The effect where the density of objects in low Earth orbit (LEO) is high enough that collisions between objects could cause a cascade in which each collision generates space debris that increases the likelihood of further collisions. In quantum error correction theory syndromes correspond to errors in code words which are determined with syndrome measurements, which only collapse the state on an error state, so that
4182-407: The error can be corrected without affecting the quantum information stored in the code words. There is no set common convention for the naming of newly identified syndromes. In the past, syndromes were often named after the physician or scientist who identified and described the condition in an initial publication. These are referred to as "eponymous syndromes". In some cases, diseases are named after
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#17328989696684264-520: The following 12 behaviors; stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, or echopraxia.” As a syndrome, catatonia can only occur in people with an existing illness. The DSM-5 divides catatonia into 3 diagnoses. The most common of the three diagnoses is Catatonia Associated with Another Mental Disorder. Around 20% of cases are caused by an underlying medical condition, and known as Catatonic Disorder Due to Another Medical Condition. When
4346-551: The group of symptoms and associated features that a person is experiencing or displaying. Notably, while catatonia can be divided into various subtypes, the appearance of catatonia is often dynamic and the same individual may have different subtypes at different times. Stuporous Catatonia : This form of catatonia is characterized by immobility, mutism, and a lack of response to the world around them. They may appear frozen in one position for long periods of time unable to eat, drink, or speak. Excited Catatonia : This form of catatonia
4428-488: The majority will present with worsening depression, mania, or psychosis followed by catatonia symptoms. Even when unable to interact, It should not be assumed that patients presenting with catatonia are unaware of their surroundings as some patients can recall in detail their catatonic state and their actions. There are several subtypes of catatonia which are used currently; Stuporous Catatonia, Excited Catatonia, Malignant Catatonia and Periodic Catatonia. Subtypes are defined by
4510-520: The malignant type which will present with autonomic instability and may be life-threatening. Other complications also include the development of pneumonia and neuroleptic malignant syndrome. Catatonia has been historically studied in psychiatric patients. Catatonia is under-recognized because the features are often mistaken for other disorders including delirium or the negative symptoms of schizophrenia. The prevalence has been reported to be as high as 10% in those with acute psychiatric illnesses, and 9-30% in
4592-452: The middle of the spectrum of diminished motivation, with apathy being less extreme and akinetic mutism being more extreme than abulia. The condition was originally considered to be a disorder of the will, and aboulic individuals are unable to act or make decisions independently; and their condition may range in severity from subtle to overwhelming. In the case of akinetic mutism, many patients describe that as soon as they "will" or attempt
4674-465: The mild disorders, consists of five syndromes: emotional, paranoid, hysterical , delirious , and impulsive. The second, intermediate, group includes two syndromes: schizophrenic syndrome and speech-hallucinatory syndrome . The third includes the most severe disorders, and consists of three syndromes: epileptic , oligophrenic and dementia . In Kraepelin's era, epilepsy was viewed as a mental illness; Karl Jaspers also considered "genuine epilepsy"
4756-477: The non-possessive form, while European references often use the possessive. A 2009 study demonstrated a trend away from the possessive form in Europe in medical literature from 1970 through 2008. Even in syndromes with no known etiology , the presence of the associated symptoms with a statistically improbable correlation normally leads the researchers to hypothesize that there exists an unknown underlying cause for all
4838-448: The patient who initially presents with symptoms, or their home town ( Stockholm syndrome ). There have been isolated cases of patients being eager to have their syndromes named after them, while their physicians are hesitant. When a syndrome is named after a person, there is some difference of opinion as to whether it should take the possessive form or not (e.g. Down syndrome vs. Down's syndrome). North American usage has tended to favor
4920-403: The patient with physical rehabilitation or other interventions where a source of strong motivation would be necessary to succeed but would still be absent. The best way to diagnose abulia is through clinical observation of the patient as well as questioning of close relatives and loved ones to give the doctor a frame of reference with which they can compare the patient's new behavior to see if there
5002-433: The patients did not show any functional deficits at the follow-up one year after the stroke and were not depressed but did show diminished motivations. This result supports the idea that abulia may exist independently of depression as its own syndrome. The anterior cingulate circuit consists of the anterior cingulate cortex , also referred to as Brodmann area 24 , and its projections to the ventral striatum which includes
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#17328989696685084-459: The patients with Alzheimer's disease with abulia do not have depression. Several studies have shown that abulia is most prevalent in cases of severe dementia which may result from reduced metabolic activity in the prefrontal regions of the brain. Patients with Alzheimer's disease and abulia are significantly older than patients with Alzheimer's who do not lack motivation. Going along with that, the prevalence of abulia increased from 14% in patients with
5166-402: The person doesn't improve within 30 minutes they're given a second dose and the process is repeated once more. If the person responds to either of the doses then they can be given benzodiazepines at a consistent dose and timing until their catatonia resolves. Depending on the person, a person may need to reduce their dosing slowly over time in order to prevent reoccurrence of their symptoms. ECT
5248-445: The physician or group of physicians that discovered them or initially described the full clinical picture. Such eponymous syndrome names are examples of medical eponyms . Recently, there has been a shift towards naming conditions descriptively (by symptoms or underlying cause) rather than eponymously, but the eponymous syndrome names often persist in common usage. The defining of syndromes has sometimes been termed syndromology, but it
5330-545: The results of laboratory tests need to be considered in the context of clinical history, review of medications, and physical exam findings. The differential diagnosis of catatonia is extensive as signs and symptoms of catatonia may overlap significantly with those of other conditions. Therefore, a careful and detailed history, medication review, and physical exam are key to diagnosing catatonia and differentiating it from other conditions. Furthermore, some of these conditions can themselves lead to catatonia. The differential diagnosis
5412-400: The right hemisphere. Injuries to the frontal lobe and/or the basal ganglia can interfere with an individual's ability to initiate speech, movement, and social interaction. Studies have shown that 5-67% of all patients with traumatic brain injuries and 13% of patients with lesions on their basal ganglia experience some form of diminished motivation. It may complicate rehabilitation when
5494-673: The screening tool. If 2 of the 14 are positive, this prompts for further evaluation and completion of the remaining 9 items. A diagnosis can be supported by the lorazepam challenge or the zolpidem challenge. While proven useful in the past, barbiturates are no longer commonly used in psychiatry ; thus the option of either benzodiazepines or ECT. Certain lab findings are common with this malignant catatonia that are uncommon in other forms of catatonia. These lab findings include: leukocytosis , elevated creatine kinase , low serum iron. The signs and symptoms of malignant catatonia overlap significantly with neuroleptic malignant syndrome (NMS). Therefore
5576-514: The setting of inpatient psychiatric care. The incidence of catatonia is 10.6 episodes per 100 000 person-years, which essentially means that in a group of 100,000 people, the group as a whole would experience 10 to 11 episodes of catatonia per year. Catatonia can occur at any age, but is most commonly seen in adolescence or young adulthood or in older adults with existing medical conditions. It occurs in males and females in approximately equal numbers. Around 20% of all catatonia cases can be attributed to
5658-419: The side of the injury, but if there is bilateral damage, the patient will exhibit a more extreme case of diminished motivation, akinetic mutism . It s well documented that the caudate nucleus is involved in degenerative diseases of the central nervous system such as Huntington disease. In a case study of 32 acute caudate stroke patients, 48% were found to be experiencing abulia. Most of the cases where abulia
5740-415: The study of motivational processes been extended to integrate biological drives and emotional states in the explanation of purposeful behavior in human beings. Considering the number of disorders attributed to a lack of will and motivation, it is essential that abulia and apathy be defined more precisely to avoid confusion. Many different causes of abulia have been suggested. While there is some debate about
5822-1676: The study of the origin, diagnosis, development, and treatment of mental disorders). In Russia those psychopathological syndromes are used in modern clinical practice and described in psychiatric literature in the details: asthenic syndrome , obsessive syndrome , emotional syndromes (for example, manic syndrome , depressive syndrome), Cotard's syndrome , catatonic syndrome , hebephrenic syndrome, delusional and hallucinatory syndromes (for example, paranoid syndrome, paranoid-hallucinatory syndrome, Kandinsky - Clérambault's syndrome also known as syndrome of psychic automatism, hallucinosis), paraphrenic syndrome , psychopathic syndromes (includes all personality disorders), clouding of consciousness syndromes (for example, twilight clouding of consciousness, amential syndrome also known as amentia, delirious syndrome , stunned consciousness syndrome, oneiroid syndrome ), hysteric syndrome, neurotic syndrome , Korsakoff's syndrome , hypochondriacal syndrome , paranoiac syndrome, senestopathic syndrome, encephalopathic syndrome . Some examples of psychopathological syndromes used in modern Germany are psychoorganic syndrome , depressive syndrome, paranoid-hallucinatory syndrome, obsessive-compulsive syndrome , autonomic syndrome, hostility syndrome, manic syndrome , apathy syndrome . Münchausen syndrome , Ganser syndrome , neuroleptic-induced deficit syndrome , olfactory reference syndrome are also well-known. The most important psychopathological syndromes were classified into three groups ranked in order of severity by German psychiatrist Emil Kraepelin (1856—1926). The first group, which includes
5904-438: The two is to observe the motor abnormality. Patients with mania present with increased goal-directed activity. On the other hand, the increased activity in catatonia is not goal-directed and often repetitive. Catatonia is a clinical diagnosis and there is no specific laboratory test to diagnose it. However, certain testing can help determine what is causing the catatonia. An EEG will likely show diffuse slowing. If seizure activity
5986-470: The underlying cause; Catatonia associated with another mental disorder, catatonia induced by psychoactive substance, and secondary catatonia. The DSM-5 is the most common manual used by mental health professionals in the United States to define and diagnose different mental illnesses. The DSM-5 defines catatonia as, “a syndrome characterized by lack of movement and communication, along with three or more of
6068-533: The underlying condition is unknown it is considered Unspecified Catatonia. As discussed previously, the ICD-11 and DSM-5 both require 3 or more of the symptoms defined in the table below in order to diagnose Catatonia. However, each person can have a different set of symptoms may worsen, improve, and change in appearance throughout a single episode. Symptoms may develop over hours or days to weeks. Because most patients with catatonia have an underlying psychiatric illness,
6150-447: The use of benzodiazepines. In fact, in some cases it is unclear whether a person has catatonia or another condition which may present similarly. In these cases a "benzodiazepine challenge" is often done. During a "benzodiazepine challenge" a healtchare provider will give a moderate dose of a benzodiazepine to the patient and monitor them. If a person has catatonia they will often have improvements in their symptoms within 15 to 30 minutes. If
6232-569: The validity of abulia as a separate disease, experts mostly agree that abulia is the result of frontal lesions and not with cerebellar or brainstem lesions. As a result of more and more evidence showing that the mesolimbic and the mesocortical dopamine system are key to motivation and responsiveness to reward, abulia may be a dopamine-related dysfunction. Abulia may also result from a variety of brain injuries which cause personality change, such as dementing illnesses, trauma, or intracerebral hemorrhage (stroke), especially stroke causing diffuse injury to
6314-423: The ventral-anterior and medial-dorsal nuclei traverse the internal capsule genu. These tracts are part of a complex system of cortical and subcortical frontal circuits through which the flow of information from the entire cortex takes place before reaching the basal ganglia. Cognitive deterioration could have occurred through the genu infarcts affecting the inferior and anterior thalamic peduncles. In this case study
6396-419: The ventromedial caudate . The loop continues to connect to the ventral pallidum , which connects to the ventral anterior nucleus of the thalamus. This circuit is essential for the initiation of behavior, motivation and goal orientation, which are the very things missing from a patient with a disorder of diminished motivation. Unilateral injury or injury along any point in the circuit leads to abulia regardless of
6478-495: Was a discrete entity, or just a hazy gray area on a spectrum of more defined disorders. Four of the experts said abulia was a sign and a symptom, and the group was split on whether or not it was a syndrome. Another survey, which consisted of true and false questions about what abulia is distinct from, whether it is a sign, symptom, or syndrome, where lesions are present in cases of abulia, what diseases are commonly associated with abulia, and what current treatments are used for abulia,
6560-399: Was conducted to see if these symptoms were the result of an infarct in the capsular genu . Using clinical neuropsychological and MRI evaluations at baseline and one year later showed that the cognitive impairment was still there one year after the stroke. Cognitive and behavioral alterations due to a genu infarct are most likely because the thalamo-cortical projection fibers that originate from
6642-479: Was present were when the patients had a left caudate infarct that extended into the putamen as seen through a CT or MRI scan. Diagnosis for abulia can be quite difficult because it falls between two other disorders of diminished motivation, and one could easily see an extreme case of abulia as akinetic mutism or a lesser case of abulia as apathy and therefore, not treat the patient appropriately. If it were to be confused with apathy, it might lead to attempts to involve
6724-501: Was sent to 15 neurologists and 10 psychiatrists . Most experts agreed that abulia is clinically distinct from depression, akinetic mutism, and alexithymia . However, only 32% believed abulia was different from apathy, while 44% said they were not different, and 24% were unsure. Yet again, there was disagreement about whether or not abulia is a sign, symptom, or syndrome. The study of motivation has been mostly about how stimuli come to acquire significance for animals. Only recently has
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