Catatonia: The rise and fall of an intriguing psychopathological dimension

Background: For at least 125 years the discussion about the clinical relevance of catatonic symptoms in psychiatry continues. It started from the original description by Kahlbaum and was revived by modern factor analytical studies, that identified the catatonic dimension in about 10% of newly admitted patients. Objective: Over a period of 2 years, four patients with an acute episodic psychosis and prominent catatonic symptoms were examined. Methods: A clinical description is given of the psychopathology and classification is performed according to the various diagnostic instruments. Results: All patients showed a circular fluctuation of their psychoses, with motor symptoms ranging from the excited to the inhibited pole within one episode. Their clinical pictures also comprised mood swings and anxieties as well as hallucinatory and delusional experiences, whereas the course of disease was characterized by complete recovery without residual symptoms. Conclusions: The significance of catatonic symptoms is not recognized in the current taxonomies despite the fact that this has major pharmacological treatment implications.

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