100-446: Uncle Silas , subtitled "A Tale of Bartram Haugh", is an 1864 Victorian Gothic mystery - thriller novel by the Irish writer J. Sheridan Le Fanu . Despite Le Fanu resisting its classification as such, the novel has also been hailed as a work of sensation fiction by contemporary reviewers and modern critics alike. It is an early example of the locked-room mystery subgenre, rather than
200-460: A black sheep of the family whom she has never met; once an infamous rake and gambler, he is now apparently a fervently reformed Christian. His reputation has been tainted by the suspicious suicide of a man to whom Silas owed an enormous gambling debt, which took place within a locked, apparently impenetrable room in Silas's mansion at Bartram-Haugh. In the first part of the novel, Maud's father hires
300-458: A codicil to it so that Maud will live with Silas, who becomes her guardian until she comes of age. However, the will allows that, if she were to die whilst still a minor, the estate would then pass to Silas. Lady Knollys, together with Austin's executor and fellow Swedenborgian, Dr. Bryerly, attempts in vain to overturn the codicil, realizing its dangerous implications for the young heiress; despite their efforts, Maud consents willingly to spending
400-399: A French governess , Madame de la Rougierre, as a companion for her. Madame terrifies Maud and appears to have designs on her: during two of their walks together, Maud is brought into suspicious contact with strangers that seem to be known to Madame. (In a cutaway scene that breaks the first-person narrative, we learn that she is in league with Silas's good-for-nothing son Dudley.) The governess
500-620: 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 For example, patients presenting with withdrawn catatonia may have refusal to eat which will in turn lead to malnutrition and dehydration.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
600-414: A childlike interest (e.g. Lewis Carroll 's " Jabberwocky "). School stories flourished: Thomas Hughes ' Tom Brown's Schooldays and Kipling 's Stalky & Co. are classics. Rarely were these publications designed to capture a child’s pleasure; however, with the increase in the use of illustrations, children began to enjoy literature and were able to learn morals in a more entertaining way. With
700-543: A collection until 1898. The poetry of Gerard Manley Hopkins (1844–1889) was published posthumously in 1918. Algernon Charles Swinburne (1837–1909) is also considered an important literary figure of the period, especially his poems and critical writings. Early poetry of W. B. Yeats was also published in Victoria's reign. It was not until the last decades of the 19th century that any significant theatrical works were produced, beginning with Gilbert and Sullivan 's comic operas of
800-570: 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
900-510: A gothic novel are foreign monsters, ghosts, curses, hidden rooms, and witchcraft. Gothic tales usually take place in locations such as castles, monasteries, and cemeteries, although the gothic monsters sometimes cross over into the real world, making appearances in cities such as London. Writers from the United States and the British colonies of Australia, New Zealand, and Canada were influenced by
1000-474: A male-dominated world where women writers often had to use masculine pseudonyms. Dickens employed humor and an approachable tone while addressing social problems such as wealth disparity. Hardy used his novels to question religion and social structures. Poetry and theatre were also present during the Victorian era. Robert Browning and Alfred Tennyson were Victorian England's most famous poets. With regard to
1100-407: 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
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#17328520652701200-446: 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
1300-490: A novel of the supernatural (despite a few creepily ambiguous touches), but does show a strong interest in the occult and in the ideas of Emanuel Swedenborg , a Swedish scientist, philosopher and Christian mystic . Like many of Le Fanu's novels, Uncle Silas grew out of an earlier short story, in this case "A Passage in the Secret History of an Irish Countess" (1839), which he also published as "The Murdered Cousin" in
1400-481: 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
1500-610: 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
1600-451: A popular form in Victorian literature: a historical novel in which recent history is depicted. Charlotte , Emily , and Anne Brontë produced notable works of the period, although these were not immediately appreciated by Victorian critics. Wuthering Heights (1847), Emily's only work, is an example of Gothic Romanticism from a woman's point of view, which examines class, myth, and gender. Jane Eyre (1847), by her sister Charlotte,
1700-505: 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
1800-415: 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,
1900-439: A tendency in much of Victorian writing. William Makepeace Thackeray was Dickens' great rival in the first half of Queen Victoria's reign. With a similar style but a slightly more detached, acerbic and barbed satirical view of his characters, he also tended to depict a more middle-class society than Dickens did. He is best known for his novels The Luck of Barry Lyndon (1844) and Vanity Fair (1847–1848) which are examples of
2000-605: Is English literature during the reign of Queen Victoria (1837–1901). The 19th century is considered by some the Golden Age of English Literature, especially for British novels. In the Victorian era , the novel became the leading literary genre in English. English writing from this era reflects the major transformations in most aspects of English life, from scientific, economic, and technological advances to changes in class structures and
2100-418: 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
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#17328520652702200-488: 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
2300-557: Is another major Victorian novel with Gothic themes. Anne's second novel The Tenant of Wildfell Hall (1848), written in a realistic rather than romantic style, is mainly considered to be the first sustained feminist novel. Elizabeth Gaskell produced notable works during this period, including Mary Barton (1848), Cranford (1851–1853), North and South (1854–1855), and Wives and Daughters (1864–1866). George Eliot (Mary Ann Evans) also produced major works during this period, most notably Adam Bede (1859), The Mill on
2400-404: 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
2500-432: 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
2600-505: 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
2700-419: 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,
2800-413: 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
2900-576: 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
3000-472: 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
3100-403: 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
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3200-418: Is eventually dismissed when she is discovered by Maud in the act of searching her father's locked desk. Maud is asked in obscure terms by her father, a Swedenborgian , if she is willing to undergo some kind of "ordeal" to clear the name of her uncle, and of the family more generally; shortly after she assents, her father dies from a ruptured aneurysm . At the reading of his will , it emerges that he had added
3300-456: Is frequently regarded as Edwardian. Catatonia 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
3400-508: 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
3500-620: 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
3600-595: Is now held by scholars to be a stronger poet. In drama, farces , musical burlesques , extravaganzas and comic operas competed with Shakespeare productions and serious drama by the likes of James Planché and Thomas William Robertson . In 1855, the German Reed Entertainments began a process of elevating the level of (formerly risqué) musical theatre in Britain that culminated in the famous series of comic operas by Gilbert and Sullivan and were followed by
3700-429: 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
3800-526: Is swiftly conveyed by carriage to Lady Knollys's estate, and away from Bartram-Haugh. Silas is discovered in the morning lying dead of a laudanum overdose , while Dudley becomes a fugitive and is thought to be hiding in Australia. Maud is happily married to the charming and handsome Lord Ilbury and ends her recollections on a philosophical note: This world is a parable—the habitation of symbols—the phantoms of spiritual things immortal shown in material shape. May
3900-407: 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
4000-521: The Church of England , exacerbated by Newman's own conversion to Catholicism, which he wrote about in his autobiography Apologia Pro Vita Sua . A number of monumental references works were published in this era, most notably the Oxford English Dictionary which would eventually become the most important historical dictionary of the English language. Also published during the later Victorian era
4100-779: The Romantic poetry and the Georgian poetry of the early 20th century. However, Hopkins's poetry was not published until 1918. Arnold's works anticipate some of the themes of these later poets, while Hopkins drew inspiration from verse forms of Old English poetry such as Beowulf . The reclaiming of the past was a major part of Victorian literature with an interest in both classical literature and also medieval literature of England. This movement can be traced back to Letitia Elizabeth Landon and her poetry collections. Victorians loved chivalrous stories of knights of old; they hoped to regain some of that courtly behavior for readers at home and in
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4200-483: The Victorian era , writers focused on social issues. Writers such as Thomas Carlyle called attention to the dehumanizing effects of the Industrial Revolution and what Carlyle called the "Mechanical Age". This awareness inspired the subject matter of other authors, like poet Elizabeth Barrett Browning and novelists Charles Dickens and Thomas Hardy . Barrett's works on child labor cemented her success in
4300-815: 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
4400-419: The 1870s, George Bernard Shaw 's (1856–1950) plays of the 1890s, and Oscar Wilde 's (1854–1900) The Importance of Being Earnest . Elizabeth Barrett Browning and Robert Browning became acquainted first by reading each other's poetry and both produced poems inspired by their relationship. Both Matthew Arnold and Gerard Manley Hopkins wrote poems that sit somewhere in between the exultation of nature of
4500-493: The 1890s with the first Edwardian musical comedies . The first play to achieve 500 consecutive performances was the London comedy Our Boys by H. J. Byron , opening in 1875. Its astonishing new record of 1,362 performances was bested in 1892 by Charley's Aunt by Brandon Thomas . After W. S. Gilbert , Oscar Wilde became the leading poet and dramatist of the late Victorian period. Wilde's plays, in particular, stand apart from
4600-532: The English countryside, Hardy's work pushed back against widespread urbanization that came to symbolize the Victorian age. Other significant novelists of this era were Anthony Trollope (1815–1882), Wilkie Collins (1824-1889), George Meredith (1828–1909), and George Gissing (1857–1903). Robert Browning (1812–1889) and Alfred Tennyson (1809–1892) were notable poets in Victorian England. Thomas Hardy wrote poetry throughout his life, but did not publish
4700-647: The Floss (1860), Silas Marner (1861), Middlemarch (1871–1872), and Daniel Deronda (1876). Like the Brontës she published under a masculine pseudonym. Later in this period, Thomas Hardy 's best-known novels are Far from the Madding Crowd (1874), The Mayor of Casterbridge (1886), Tess of the d'Urbervilles (1891), and Jude the Obscure (1895). Renowned for his cynical yet idyllic portrayal of pastoral life in
4800-461: The Gothic tradition, depict heroines who are far more highly developed than the persecuted maidens of Ann Radcliffe and others. A film version, also titled Uncle Silas (though initially released in the United States as The Inheritance ), was made by Gainsborough Studios in 1947. It was directed by Charles Frank, with Derrick De Marney as Silas and Jean Simmons as the heroine (whose given name
4900-688: The Heroic in History (1841) permeated political thought at the time. The writings of Thomas Babington Macaulay on English history helped codify the Whig narrative that dominated the historiography for many years. John Ruskin wrote a number of highly influential works on art and the history of art and championed such contemporary figures as J. M. W. Turner and the Pre-Raphaelites . The religious writer John Henry Newman 's Oxford Movement aroused intense debate within
5000-463: 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
5100-485: 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
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#17328520652705200-575: 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
5300-401: 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
5400-433: The beginning of the 19th century most novels were published in three volumes, monthly serialization was revived with the publication of Charles Dickens' Pickwick Papers in twenty parts between April 1836 and November 1837. Demand was high for each episode to introduce some new element, whether it was a plot twist or a new character, so as to maintain the readers' interest. Dickens worked diligently and prolifically to produce
5500-627: The blessed second-sight be mine—to recognise under these beautiful forms of earth the ANGELS who wear them; for I am sure we may walk with them if we will, and hear them speak! Uncle Silas remains Le Fanu's best-known novel. It was the source for Arthur Conan Doyle 's The Firm of Girdlestone , and remains a touchstone for contemporary mystery fiction. There are also strong connections between Uncle Silas and some of Wilkie Collins ' novels, especially The Woman in White ; both writers, while recognisably within
5600-424: 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
5700-520: 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
5800-406: 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
5900-440: 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
6000-430: 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
6100-481: The building and enters the unlit room, which is the one in which the supposed suicide took place; the window he uses is set upon concealed hinges that allow it to be opened only from the outside. Hidden out of sight, Maud witnesses Dudley brutally murder Madame in the near-darkness, mistaking her for Maud. Silas enters the room, having been waiting outside; as he does this, Maud slips out undetected. Assisted by Dickon's daughter, whom Maud had befriended during her stay, she
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#17328520652706200-656: The collection Ghost Stories and Tales of Mystery (1851). While this earlier story was set in Ireland, the novel's action takes place in Derbyshire ; the author Elizabeth Bowen was the first to identify a distinctly Irish subtext to the novel, however, in spite of its English setting. It was first serialized in the Dublin University Magazine in 1864, under the title Maud Ruthyn and Uncle Silas , and appeared in December of
6300-413: 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
6400-453: The early works of the period and the later works which had more in common with the writers of the Edwardian period and many writers straddle this divide. People such as Arthur Conan Doyle , Rudyard Kipling , H. G. Wells , Bram Stoker , H. Rider Haggard , Jerome K. Jerome and Joseph Conrad all wrote some of their important works during Victoria's reign but the sensibility of their writing
6500-522: The entertaining writing that the public wanted, but also to offer commentary on social problems and the plight of the poor and oppressed. His most important works include Oliver Twist (1837–1839), Nicholas Nickleby (1838–1839) , A Christmas Carol (1843), Dombey and Son (1846–1848), David Copperfield (1849–1850), Bleak House (1852–1853), Little Dorrit (1855–1857), A Tale of Two Cities (1859), and Great Expectations (1860–1861). His later novels become progressively darker, mirroring
6600-463: The estate. During her stay, Maud is subject to various attempts by her cousin Dudley to court her, but she rejects him thoroughly on each occasion. Silas is periodically subject to mysterious catatonic fits, attributed to his massive consumption of laudanum . Various ominous happenings begin to take place at Bartram-Haugh, and it becomes increasingly difficult for Maud and Millicent to find any way out of
6700-467: The estate. Meanwhile, Dudley's courtship culminates in a marriage proposal to Maud; when she complains to Silas about it, he attempts to coax her into accepting. She is relieved when it is discovered that Dudley is already married , and after being disowned by his father, he and his wife leave to set sail to Australia. Silas decides that Millicent should attend a boarding school in France, and sends her away with
6800-522: 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
6900-554: 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
7000-576: The journey and being escorted under the cover of darkness, Maud awakes to find herself again at Bartram-Haugh: she had in fact been on a round trip to London and back. Maud finds herself now imprisoned in one of the mansion's many bedrooms under the guard of Madame, whilst everyone believes she is in France. Remembering the earlier warnings of Meg Hawkes, Maud refuses to drink anything offered to her; instead, Madame, ignorant of Silas's true intentions, drinks drugged claret intended for Maud and promptly falls asleep on Maud's bed. Later that night, Dudley scales
7100-982: The last few decades. The Victorians are credited with "inventing childhood", partly via their efforts to stop child labor and the introduction of compulsory education . As children began to be able to read, literature for young people became a growth industry, with not only established writers producing works for children (such as Dickens' A Child's History of England ) but also a new group of dedicated children's authors . Writers like Lewis Carroll ( Alice's Adventures in Wonderland ), Anna Sewell ( Black Beauty ), and R. M. Ballantyne ( The Coral Island ) wrote mainly for children, although they had an adult following. Other authors such as Robert Louis Stevenson ( Treasure Island ) and Anthony Hope ( The Prisoner of Zenda ) wrote mainly for adults, but their adventure novels are now generally classified as for children. Other genres include nonsense verse , poetry which required
7200-470: The literature of Britain and are often classed as a part of Victorian literature, although they were gradually developing their own distinctive voices. Victorian writers of Canadian literature include Grant Allen , Susanna Moodie and Catherine Parr Traill . Australian literature has the poets Adam Lindsay Gordon and Banjo Paterson , who wrote Waltzing Matilda , and New Zealand literature includes Thomas Bracken and Frederick Edward Maning . From
7300-490: 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
7400-522: 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
7500-494: The many now-forgotten plays of Victorian times and have a closer relationship to those of the Edwardian dramatists such as George Bernard Shaw , whose career began in the 1890s. Wilde's 1895 comic masterpiece, The Importance of Being Earnest , was the greatest of the plays in which he held an ironic mirror to the aristocracy while displaying virtuosic mastery of wit and paradoxical wisdom. It has remained extremely popular. The plays of Arthur Wing Pinero have been staged again in
7600-460: The newfound acceptance of reading for pleasure, fairy tales and folk tales became popular. Compiling folk tales by many authors with different topics made it possible for children to read literature about many topics which interested them. There were different types of books and magazines written for boys and girls. Girls' stories tended to be domestic and to focus on family life, whereas boys' stories were more about adventures. The Victorian era
7700-568: The next three and a half years at Bartram-Haugh. Maud initially finds life at Bartram-Haugh strange but not unpleasant, despite ominous signs such as the uniformly unfriendly servants and Silas's malevolent factotum , the one-legged Dickon Hawkes. Silas himself frightens Maud but is nonetheless seemingly kind to her, in contrast to his treatment of his own children, the loutish Dudley and the uneducated Millicent ('Milly'). Although Maud initially deprecates Millicent's rustic manners they become best friends, and each other's only source of companionship at
7800-675: 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
7900-402: 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
8000-456: The promise that Maud is to join her after three months. Maud is shocked to discover Madame de la Rougierre is residing at Bartram-Haugh in the employ of Silas, and suspects also that Dudley may not have left the country. Despite Maud's strong protests, Madame is charged with accompanying her first to London , and then on to Dover and across the English Channel . After falling asleep during
8100-545: 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
8200-447: The role of religion in society. The number of new novels published each year increased from 100 at the start of the period to 1000 by the end of it. Famous novelists from this period include Charles Dickens , William Makepeace Thackeray , the three Brontë sisters, Elizabeth Gaskell , George Eliot (Mary Ann Evans), Thomas Hardy , and Rudyard Kipling . The Romantic period was a time of abstract expression and inward focus; during
8300-594: The same year as a three-volume novel from the London publisher Richard Bentley . Several changes were made from the serialization to the volume edition, such as resolving the inconsistencies of names. The novel is a first-person narrative told from the point of view of the adolescent girl Maud Ruthyn, an heiress living with her wealthy, sombre, reclusive father Austin Ruthyn in their mansion at Knowl. Through her father and her worldly, cheerful cousin, Lady Monica Knollys, she gradually learns more regarding her uncle, Silas Ruthyn,
8400-675: 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
8500-520: 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
8600-413: The sphere of literature of the United States during this time are some of the country's greats including: Emily Dickinson , Ralph Waldo Emerson , Nathaniel Hawthorne , Oliver Wendell Holmes Sr. , Henry James , Herman Melville , Harriet Beecher Stowe , Henry David Thoreau , Mark Twain and Walt Whitman . The problem with the classification of "Victorian literature" is the great difference between
8700-420: The theatre it was not until the last decades of the 19th century that any significant works were produced. Notable playwrights of the time include Gilbert and Sullivan , George Bernard Shaw , and Oscar Wilde . Charles Dickens is the most famous Victorian novelist. With a focus on strong characterization, Dickens became extraordinarily popular in his day and remains one of the most popular and read authors of
8800-414: The times, Sexton Blake , and other fictional characters of the era, such as Dracula , Edward Hyde , The Invisible Man , and many other fictional characters who often had exotic enemies to foil. Spanning the 18th and 19th centuries, there was a particular type of story-writing known as gothic. Gothic literature combines romance and horror in an attempt to thrill and terrify the reader. Possible features in
8900-439: 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
9000-414: 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
9100-534: 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,
9200-447: 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
9300-458: The wider empire . The best example of this is Alfred Tennyson 's Idylls of the King , which blended the stories of King Arthur , particularly those by Thomas Malory , with contemporary concerns and ideas. The Pre-Raphaelite Brotherhood also drew on myth and folklore for their art, with Dante Gabriel Rossetti contemporaneously regarded as the chief poet amongst them, although his sister Christina
9400-617: The world. Although it took a long time to be widely accepted, it would dramatically change subsequent thoughts and literature. Much of the work of popularizing Darwin's theories was done by his younger contemporary Thomas Henry Huxley , who wrote widely on the subject. A number of other non-fiction works of the era made their mark on the literature of the period. The philosophical writings of John Stuart Mill covered logic , economics, liberty and utilitarianism . The large and influential histories of Thomas Carlyle , The French Revolution: A History (1837), and On Heroes, Hero-Worship, &
9500-419: The world. Dickens began his literary career with Sketches by Boz (1833–1836) which collected short stories published in various newspapers and other periodicals. His first novel, The Pickwick Papers (1836–1837) written when he was twenty-five, was an overnight success, and all his subsequent works sold extremely well. The comedy of his first novel has a satirical edge and this pervades his writing. While at
9600-547: Was an important time for the development of science and the Victorians had a mission to describe and classify the entire natural world. Much of this writing does not rise to the level of being regarded as literature but one book in particular, Charles Darwin 's On the Origin of Species , remains famous. The theory of evolution contained within the work challenged many of the ideas the Victorians had about themselves and their place in
9700-482: Was broadcast on PBS in the US on 21 March 1991. In October 2021, principal photography began on an adaptation financed by Fís Éireann/Screen Ireland . It is being directed by Lisa Mulcahy, with Agnes O'Casey as Maud and David Wilmot as Silas. It was released in 2023 under the title Lies We Tell. The BBC has also broadcast radio adaptations of the novel, including: Victorian literature Victorian literature
9800-512: Was changed from Maud to Carolyn). A feature-length British television adaptation was made for the Thames Television series Mystery and Imagination (1968). Maud was played by Lucy Fleming with Robert Eddison as Silas. In 1977 a West German series Uncle Silas was produced featuring Hannes Messemer in the title role. The Dark Angel , a further adaptation starring Peter O'Toole as Silas, premiered on BBC Television in 1989, and
9900-609: Was the Dictionary of National Biography and the ninth edition of the Encyclopædia Britannica . In the United States, Henry David Thoreau 's works and Susan Fenimore Cooper 's Rural Hours (1850) were canonical influences on Victorian nature writing . In the UK, Philip Gosse and Sarah Bowdich Lee were two of the most popular nature writers in the early part of the Victorian era. The Illustrated London News , founded in 1842,
10000-504: Was the world's first illustrated weekly newspaper and often published articles and illustrations dealing with nature; in the second half of the 19th century, books, articles, and illustrations on nature became widespread and popular among an increasingly urbanized reading public. The old Gothic tales that came out of the late 19th century are the first examples of the genre of fantasy fiction. These tales often centered on larger-than-life characters such as Sherlock Holmes , famous detective of
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