Letální katatonie

Pavlovský P.
, Kukanová P., Pietrucha S., Zvolský P.: Lethal CatatoniaThe authors present a review of views on lethal (malignant) catatonia described by K. H. Stauderin 1934. With regard to the probable different etiology of the catatonic picture, frequently onlythe term catatonic syndrome or catatonic dilemma is used which indicates the doubts regardingthe possible relationship or difference of catatonia and NMS. Hitherto accomplished researchindicated that the induction of both pathological pictures is the result of hypoactivity of thedopaminergic system and its impaired balance with the GABA-ergic system. Risk factors whichlead to the development of catatonic or neuroleptic malignant syndrome include preexistinghypodopaminergy which in addition to genetic factors may be produced by the action of acute orchronic stress, organic brain damage (in particular Parkinson’s disease), by the administration ofclassical (sometimes also atypical) neuroleptic preparations, by the sudden discontinuation ofdopaminergic substances and a number of other factors.The author presents two cases of lethal catatonia in young women where psychosis developedsuddenly after prodromes lasting only two days. In neither patient the condition was preceded bythe use of neuroleptics. As a stressogenic factor in one case strenuous travel and change of thecultural environment may have acted, in the second case surgical delivery of twins and sub-sequent domestic strain. The authors draw attention to the fact that it is not suitable to treatcatatonia by classical neuroleptics, and consistent with data in the literature, they recommend asearly as possible treatment by electroconvulsions. As to atypical neuroleptics they mention theirfavourable experience with clozapine. They are in favour of the view that lethal catatonia andNMS are similar, as almost identical treatment has a favourable effect.

Key words:
lethal (malignant) catatonia, catatonic syndrome, catatonic dilemma, dopaminergichypoactivity, neuroleptic malignant syndrome, treatment of catatonic disorder by electroconvul-sions, atypical neuroleptics and benzodiazepins.