DOCSLIB.ORG

On Catatonia and Dementia: a Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
On Catatonia and Dementia: a Case Report Neurological Bulletin Volume 2 Issue 1 Article 3 December 2010 On Catatonia and Dementia: A Case Report Jordan Eisenstock University of Massachusetts Memorial Medical Center Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/neurol_bull Repository Citation Eisenstock J. On Catatonia and Dementia: A Case Report. Neurological Bulletin 2010;2:12-16. https://doi.org/10.7191/neurol_bull.2010.1019. Retrieved from https://escholarship.umassmed.edu/ neurol_bull/vol2/iss1/3 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Neurological Bulletin by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Eisenstock: On Catatonia and Dementia: A Case Report Neurol. Bull. 2: 12-16, 2010 http://escholarship.umassmed.edu/neurol_bull doi:10.7191/neurol_bull.2010.1019 On Catatonia and Dementia: A Case Report Jordan Eisenstock Department of Neurology University of Massachusetts Memorial Medical Center, Worcester, MA The many pitfalls in the accurate diagnosis of cently passed away about two months prior dementias are well documented. While de- to admission. finitive diagnosis remains the goal, the limits of clinicopathologic knowledge and current With the exception of one prior psychiatric technology oftentimes preclude firm deci- admission about 20 years earlier, also for sions on a specific diagnosis, treatment and worsening depression in the context of a plans. This is particularly pertinent in those family issue, the patient had never consist- cases where the lines between neurology and ently required psychiatric attention. About psychiatry become somewhat blurred. In this two years prior to this admission he had seen report, I present the case of a patient with an outpatient psychiatrist for a couple of probable catatonic depression masquerading months secondary to anxiety and panic initially as frontotemporal dementia. Includ- symptoms and was started on an SSRI and a ed is a brief discussion outlining our current benzodiazepine. At the time of admission knowledge about catatonia: its pertinent his only medications were HCTZ/ signs and symptoms for accurate diagnosis, Triamterene for hypertension and Lumigan its possible pathophysiologic mechanisms, drops for glaucoma. He had been off of all and its relationship to dementia. neuropsychiatric medications for at least one year. His family history was only notable for Case Report question of late-onset dementia in the pa- tient’s mother. The patient is a 56 year old right-handed gentleman who worked for several years in a The neurology service came to be involved supervisory role with the city department of with this patient after the admitting examina- public works and presented to our inpatient tion by the psychiatry resident noted subtle psychiatry unit for one month of worsening perseveration on testing of extraocular move- depression. Neurovegetative symptoms in- ments, brisk reflexes and difficulty changing cluded insomnia, poor appetite and difficulty set despite a MMSE of 30/30. An initial concentrating. There was a potential precipi- neurology consultation yielded a diagnosis of tating event as the patient’s mother had re- Cognitive Symptoms Due to Depression and Correspondence to Jordan Eisenstock: [email protected] Keywords: catatonia, electroconvulsive therapy, lorazepam, frontotemporal dementia, glutamate, GABA 12 Eisenstock: On Catatonia and Dementia: A Case Report Neurol. Bull. 2: 12-16, 2010 doi:10.7191/neurol_bull.2010.1019 Figure 1: Left image dated April 2006. Right image dated September 2007. the brisk reflexes were explained by cervical directly admitted to the inpatient neurology pathology on MRI. The inpatient psychiatry service for a rapidly progressive dementia team resumed the patient’s SSRI and added workup. Of significance, the patient’s MRI an atypical antipsychotic to the regimen and showed minimal nonspecific white matter after two weeks the patient was discharged to changes but no atrophy (Figure 1) and the his home. laboratory findings were not suggestive of any underlying neurologic etiology After continued deterioration despite compli- (summarized in Table 1). An EEG in both ance with medications the patient returned to the awake and asleep states was also normal. the psychiatric emergency room a couple of months later. Again he was admitted to the Over the course of the next four months the inpatient psychiatry unit and trials of new patient continued to decline, his verbal out- SSRI’s and atypical antipsychotic produced put decreased and there were few spontane- little clinical response. Shortly after dis- ous movements. The patient was no longer charge from the psychiatry service he was getting out of bed to toilet himself, and he seen in the outpatient neurology clinic for would not voluntarily eat even if the food follow-up of the original consultation. was delivered to him. Though there was no formal disagreement, the psychiatry service By this time the patient demonstrated mini- suspected a dementia diagnosis and the neu- mal verbal output, most responses being a rology service tended toward a psychiatric rather stereotypic and hesitant “I don’t etiology. Eventually a trial of ECT was or- know” to all variety of questions. His family dered but was unfortunately suspended early noted significant balance problems and he secondary to presumed increased confusion had fallen several times at home. In addition in the setting of a urinary tract infection. to mild rigidity and a grasp reflex, the patient Soon thereafter the patient was sent for a se- was also noted to have startle myoclonus on cond opinion at another large academic med- examination. Subsequently the patient was ical center and returned to our outpatient 13 Eisenstock: On Catatonia and Dementia: A Case Report Neurol. Bull. 2: 12-16, 2010 doi:10.7191/neurol_bull.2010.1019 Table 1: Laboratory Summary Basic Metabolic Panel: normal Drugs of Abuse Screen: negative Complete Blood Count: normal Sedimentation Rate: 45 (High, >20) Liver Function Tests: normal HbA1C: normal Fasting Lipid Profile: normal Serum Protein Electrophoresis: normal Amylase/Lipase: normal Anti-Ri/Ma/Ta/Yo/Hu: negative Porphyrins: normal VDRL/RPR: non-reactive TSH: normal Lyme Serum & CSF: unremarkable B12: normal EBV CSF: negative Folate: normal Parv B19: negative CSF: 0 WBC, 0 RBC VCA-IgM/IgG: negative CSF: protein, glucose normal EBNA-IgG: negative CSF: oligoclonal bands absent Admark Tau/ABeta42: unremarkable CSF: 14-3-3 negative clinic one month later with the opinion of tient’s initial presentation on the psychiatric likely frontotemporal dementia. A decision unit. His current medications include me- had been made at the other institution to de- mantine, topiramate and citalopram. For a fer further ECT treatments, and the family short period of time the patient also required was advised to explore nursing home place- olanzepine secondary to paranoid thoughts ment options. A PET scan at the other insti- about leaving his home; but this medication, tution had apparently demonstrated fronto- along with maintenance lorazepam, has been temporal hypometabolism, which along with successfully discontinued over the past sev- the clinical evaluation had precipitated the eral months. Though he has been unable to above diagnosis. return to his previous work, his sense of hu- mor has returned, his abnormal gait has re- Approximately six months after the first psy- solved and his performance on formal neuro- chiatric hospitalization the patient returned to psychological testing has improved. A re- the inpatient neurology service. On the se- peat PET scan was obtained and was normal, cond evening of admission the patient rather likely indicating that his previous scan was suddenly and unexpectedly shifted from his secondary to severe refractory depression longstanding stuporous state to a verbally rather than frontotemporal dementia. and physically aggressive appearance. Intra- muscular lorazepam was prescribed and Discussion within minutes the patient not only calmed down but voluntarily proceeded to get out of This patient’s case illustrates many of the bed and go to the restroom. Later that even- important teaching points when considering a ing he seemed to enjoy his dinner and con- diagnosis of catatonia. Most experts agree versed with family for the first time in that catatonia is severely under-diagnosed in months. A standing dose of lorazepam was the neuropsychiatric community. Theories initiated, and a previously suggested diagno- exist to explain this phenomenon, such as sis of a catatonic-like, rather than frontotem- lack of teaching about catatonia in medical poral-like, state was supported. school, lack of agreed-upon classifications and guidelines for recognizing catatonia, and It is now two and a half years since the pa- a general lack of understanding of the patho- 14 Eisenstock: On Catatonia and Dementia: A Case Report Neurol. Bull. 2: 12-16, 2010 doi:10.7191/neurol_bull.2010.1019 Table 2: Phenomenology of Catatonia EXCITEMENT STUPOR Hyperkinesis Motor Behaviors Stereotypies [repetitive/ritualistic movements, Catalepsy postures or utterances] Rigidity Mannerisms [gestures that become abnormal Waxy Flexibility [maintained immobile posture] with exaggeration] Euphoria Posturing Irritability
Load more

Recommended publications
  • Psychosis, Catatonia and Post-Psychosis PTSD
    British Journal of Medicine & Medical Research 15(8): 1-5, 2016, Article no.BJMMR.26114 ISSN: 2231-0614, NLM ID: 101570965 SCIENCEDOMAIN international www.sciencedomain.org Psychosis, Catatonia and Post-psychosis PTSD Evita Rocha 1, Andrei Novac 2, Daniel Kirsten 1, Jiwon Shin 3, Diana Totoiu 4 and Robert G. Bota 3* 1Resident Psychiatry, UC, Irvine, USA. 2Department of Psychiatry, UC, Irvine, USA. 3UC Irvine, USA. 4Department of Psychology, Cal State Fullerton, USA. Authors’ contributions This work was carried out in collaboration between all authors. Author ER wrote the first draft of the case reports and helped with literature search and part of introduction. Author AN contributed the writing of the manuscript and formulated the theoretical frame of the psychopathology. Authors DK, JS, DT managed the literature searches, contributed to writing of the manuscript and edited the final versions. Author RGB designed the study, supervised the process and wrote parts of the manuscript. All authors read and approved the final manuscript. Article Information DOI: 10.9734/BJMMR/2016/26114 Editor(s): (1) Domenico De Berardis, Department of Mental Health, National Health Service, Psychiatric Service of Diagnosis and Treatment, “G. Mazzini” Hospital, Italy. Reviewers: (1) Sara Marelli, Vita-Salute San Raffaele University, Milan, Italy. (2) Takashi Ikeno, National Center of Neurology and Psychiatry, Japan. Complete Peer review History: http://sciencedomain.org/review-history/14521 Received 1st April 2016 nd Case Study Accepted 2 May 2016 Published 9th May 2016 ABSTRACT We are describing the case of a 27-year-old female with no previous psychiatric history who developed post-psychotic PTSD after presenting with first episode catatonia and psychosis.
    [Show full text]
  • Cannabis-Induced Catatonia: a Case Series
    Open Access Case Report DOI: 10.7759/cureus.8603 Cannabis-Induced Catatonia: A Case Series Hema Mekala 1 , Zamaar Malik 2 , Judith Lone 2 , Kaushal Shah 1 , Muhammad Ishaq 1 1. Psychiatry, Griffin Memorial Hospital, Norman, USA 2. Psychiatry, Medical University of the Americas, Camps, KNA Corresponding author: Kaushal Shah, [email protected] Abstract Catatonia is a psychomotor condition characterized by physical presentations ranging from severe immobility to excessive psychomotor agitation with an array of accompanying emotional aspects. Though initially thought to be a subform of schizophrenia, it is now recognized to be associated with many different psychiatric, neurological, and medical diagnoses. The emergence of catatonia is becoming more prevalent with its changing pattern and extensive use of recreational and illegal drugs. With the legalization of marijuana, its use is on the rise leading to several mental health conditions, including catatonia. If left untreated, catatonia has a significant morbidity and mortality rate; hence, prompt evaluation and diagnosis are critical for the prevention of adverse events. Benzodiazepines (BZDs) and electroconvulsive therapy (ECT) have been found to be most effective and remained as the preferred treatment options. In this paper, we present the case of two patients who presented with catatonia after cannabis consumption and discuss their treatment course and management. Categories: Emergency Medicine, Neurology, Psychiatry Keywords: synthetic cannabis, k2, cannabis, catatonia, addiction, thc, schizophrenia, benzodiazepine, ect, psychiatry Introduction Catatonia is a common condition observed in acutely ill patients with mental health conditions. In the United States, approximately 90,000 people tend to suffer from catatonia each year, with a prevalence ranging between 7.6% to 38% [1].
    [Show full text]
  • The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1
    The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1 Psychotic Disorders Slide 2 As with all the disorders, it is preferable to pick Archetype one “archetypal” disorder for the category of • Schizophrenia disorder, understand it well, and then know the others as they compare. For the psychotic disorders, the diagnosis we will concentrate on will be Schizophrenia. Slide 3 A good way to organize discussions of Phenomenology phenomenology is by using the same structure • The mental status exam as the mental status examination. – Appearance –Mood – Thought – Cognition – Judgment and Insight Clinical Presentation of Psychotic Disorders. Slide 4 Motor disturbances include disorders of Appearance mobility, activity and volition. Catatonic – Motor disturbances • Catatonia stupor is a state in which patients are •Stereotypy • Mannerisms immobile, mute, yet conscious. They exhibit – Behavioral problems •Hygiene waxy flexibility, or assumption of bizarre • Social functioning – “Soft signs” postures as most dramatic example. Catatonic excitement is uncontrolled and aimless motor activity. It is important to differentiate from substance-induced movement disorders, such as extrapyramidal symptoms and tardive dyskinesia. Slide 5 Disorders of behavior may involve Appearance deterioration of social functioning-- social • Behavioral Problems • Social functioning withdrawal, self neglect, neglect of • Other – Ex. Neuro soft signs environment (deterioration of housing, etc.), or socially inappropriate behaviors (talking to themselves in
    [Show full text]
  • Movement Disorders in Catatonia Subhashie Wijemanne, Joseph Jankovic
    Movement disorders J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2014-309098 on 19 November 2014. Downloaded from REVIEW Movement disorders in catatonia Subhashie Wijemanne, Joseph Jankovic ▸ Additional material, ABSTRACT between 7.6% and 38% among all psychiatric including videos, is published Catatonia is a complex neuropsychiatric syndrome patients.10 The percentage of catatonia due to a online only. To view please characterised by a broad range of motor, speech and general medical condition is reported to range visit the journal online (http:// 11 dx.doi.org/10.1136/jnnp-2014- behavioural abnormalities. ‘Waxy flexibility’, ‘posturing’ from 20% to 39%. Catatonia may be subtle and 309098). and ‘catalepsy’ are among the well-recognised motor overlooked, which may account for reports suggest- Department of Neurology, abnormalities seen in catatonia. However, there are ing a declining incidence. People with bipolar disor- Parkinson’s Disease Center and many other motor abnormalities associated with ders probably constitute the largest subgroup of Movement Disorders Clinic, catatonia. Recognition of the full spectrum of the catatonic patients.51012In a minority of cases, no Baylor College of Medicine, phenomenology is critical for an accurate diagnosis. cause is found and the current prevalence of idio- Houston, Texas, USA Although controlled trials are lacking benzodiazepines pathic catatonia is unknown. Correspondence to are considered first-line therapy and N-Methyl-D- Owing to the wide range of underlying diagnoses, Dr Joseph Jankovic, aspartate receptor antagonists also appears to be patients with catatonia may present as a medical or Department of Neurology, effective. Electroconvulsive therapy is used in those psychiatric emergency13 or develop symptoms ’ Parkinson s Disease Center and patients who are resistant to medical therapy.
    [Show full text]
  • Presence of Isolated Catatonic Signs in Chronic Psychosis
    JOURNAL OF PSYCHOPATHOLOGY Case report 2018;24:237-238 K. Navin, G. Sathyanarayanan, Presence of isolated catatonic signs B. Bharadwaj in chronic psychosis: Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & is chronic catatonia under-recognised? Research, Puducherry, India A case series Introduction Catatonia is a complex syndrome of specific motor abnormalities associ- ated with various psychiatric disorders. Historically, more than 50 clinical signs have been described in catatonia, however, it is now confined to the 23 signs mentioned in the Bush-Francis Catatonia Rating Scale 1. In clinical practice we are apt to recognise catatonia in its stuporous form presenting in emergency with risks due to compromised food and water intake and immobility. Excited catatonia is often missed or diagnosed in hindsight when it presents with manic excitement 2. In this case series we want to highlight that the presence of a few catatonic signs may often be missed as has been pointed out earlier 3. This under-recognition may account for the discrepancy between findings in literature 4. In the Inter- national Pilot Study of Schizophrenia (IPSS) though catatonic signs were noted in 96 patients only a few among them were diagnosed as catatonic schizophrenia. Conversely, most of the 55 patients diagnosed as having catatonic schizophrenia did not have catatonic symptoms 5. In this case series, we would like to present three patients with persistent catatonic symptoms occurring during their psychotic illnesses. The cata- tonic signs were recognized on clinical evaluation. The signs specifically re- sponded to treatment with lorazepam and in two of the cases, drug default or attempts to taper the dose; led to resurgence of catatonic symptoms.
    [Show full text]
  • Catatonia: an Under-Recognised, Acutely Treatable Condition in Young People with Intellectual Disability/ASD
    Catatonia: an under-recognised, acutely treatable condition in young people with intellectual disability/ASD. Associate Professor David Dossetor The Children’s Hospital at Westmead Area Director for Mental Health Child Psychiatrist with a Special interest in Intellectual Disability A case example inaudible words in the consultation and didn’t A 15-year-old girl with Down Syndrome was referred to respond to questions. She had waxy flexibility and neurology due to a neurocognitive decline over a two- mild increased muscle tone. She drew a few small month period. She had been socially active, happy, indistinct pictures and was eventually able to write cheeky, talkative and an enthusiastic school attender. her name. She appeared to respond to unseen She had acquired basic self-care and hygiene skills, stimuli. There was no access to her internal mental and achieved primary school educational skills. At a state but she did laugh to herself regularly, out of school swimming carnival, the girl was severely context. It was not possible to assess her cognitive sunburnt. That night she became a little delirious and skills. was uncharacteristically incontinent; this incontinence persisted. The next day she was found sitting in bed The girl was diagnosed with a psychotic disorder with with arms out stiff and staring blankly. A GP review catatonic features and started on olanzapine 2.5mg revealed nothing, with a normal urine screen. Over the three times daily (tds), adding 0.5mg lorazepam tds next month she became progressively quieter until she a week later which was increased to 1mg tds two became mute. She also became apathetic and lost weeks later.
    [Show full text]
  • Neutrophil-Lymphocyte Ratio in Catatonia
    Original article Neutrophil-lymphocyte ratio in catatonia SENGUL KOCAMER SAHIN1 https://orcid.org/0000-0002-5371-3907 CELAL YAşAMALI1 https://orcid.org/0000-0002-2813-2270 MUHAMMET BERKAY ÖZYÜREK2 https://orcid.org/0000-0002-7016-1411 GÜLÇIN ELBOğA1 https://orcid.org/0000-0003-3903-1835 ABDURRAHMAN ALTINDAğ1 https://orcid.org/0000-0001-5531-4419 AHMET ZIYA şAHIN3 https://orcid.org/0000-0001-5853-8709 1 Department of Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey. 2 Department of Psychiatry, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey. 3 Department of Internal Medicine, Faculty of Medicine, Sanko University, Gaziantep, Turkey. Received: 05/18/2019 – Accepted: 01/14/2020 DOI: 10.1590/0101-60830000000232 Abstract Background: There is growing evidence of subclinical inflammation in mental disorders. Objective: The aim of this study was to investigate frequency of symptoms of catatonia and the newly diagnosed subclinical inflammatory markers which are neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), monocyte/lymphocyte (MLR) ratios in catatonia patients due to mental disorders. Methods: Patients who were admitted to psychiatry clinic with the diagnosis of catatonia according to DSM 5 in the last two years and equal number of control group were included in this retrospective study. Univariate analysis of covariance controlled for possible confounders was used to compare NLR, PLR, MLR ratios between patients and the control group. Results: A total of 34 catatonia patients and 34 healthy controls were included in the study. Patients’ mean age was 30.88 + 13.4. NLR value was significantly higher in the patient group than control group. There was no significant difference between the patients and control group according to PLR, MLR values.Discussion: The presence of subclinical inflammation in catatonic syndrome due to mental disorders should be considered.
    [Show full text]
  • Catatonia in Depression: Prevalence, Clinical J Neurol Neurosurg Psychiatry: First Published As 10.1136/Jnnp.60.3.326 on 1 March 1996
    32632ournal ofNeurology, Neurosurgery, and Psychiatry 1996;60:326-332 Catatonia in depression: prevalence, clinical J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.60.3.326 on 1 March 1996. Downloaded from correlates, and validation of a scale Sergio E Starkstein, Gustavo Petracca, Alejandra Teson, Eran Chemerinski, Marcelo Merello, Ricardo Migliorelli, Ramon Leiguarda Abstract mute and immobile, with staring expression, Objectives-To examine the clinical cor- gaze fixed into space, with an apparent com- relates of catatonia in depression, to vali- plete loss of will, no reaction to sensory stim- date a scale for catatonia, and to assess uli, sometimes with the symptom of waxy the validity of the DSM-IV criteria of the flexibility completely developed, as in catatonic features specifier for mood dis- catalepsy, sometimes of a mild degree, but orders. clearly recognisable," and labelled this state Methods-A series of 79 consecutive "vesania katatonica".2 Stressing that catatonia patients with depression and 41 patients was not related to "affective" melancholy with Parkinson's disease without depres- sensu strictu, Wernicke suggested the term sion were examined using the modified "motilitatpsychose", and suggested that this Rogers scale (MRS), the unified disorder may be the result of dysfunction of a Parkinson's disease rating scale "psychomotor path", producing either akine- (UPDRS), and the structured clinical sis, parakinesis, or hyperkinesis.3 Whereas interview for DSM-III-R (SCID). Kahlbaum and Wernicke placed catatonia Results-Sixteen of the 79 depressed within the range of the affective disorders, patients (20%) had catatonia. Depressed Kraepelin4 considered catatonia as a type of patients with catatonia had significantly schizophrenia, and this disorder aroused little higher scores on the MRS than non-cata- interest until recently.
    [Show full text]
  • Catatonia Associated with Late-Life Psychosis Successfully Treated With
    Sugawara et al. Ann Gen Psychiatry (2021) 20:14 https://doi.org/10.1186/s12991-021-00336-4 Annals of General Psychiatry CASE REPORT Open Access Catatonia associated with late-life psychosis successfully treated with lithium: a case report Hiroko Sugawara1,2*, Junpei Takamatsu3, Mamoru Hashimoto2 and Manabu Ikeda2 Abstract Background: Catatonia is a psychomotor syndrome that presents various symptoms ranging from stupor to agita- tion, with prominent disturbances of volition. Its pathogenesis is poorly understood. Benzodiazepines and electrocon- vulsive therapy (ECT) are safe and efective standard treatments for catatonia; however, alternative treatment strate- gies have not been established in cases where these treatments are either inefective or unavailable. Here, we report a case of catatonia associated with late-life psychosis, which was successfully treated with lithium. Case presentation: A 66-year-old single man with hearing impairment developed hallucination and delusions and presented with catatonic stupor after a fall. He initially responded to benzodiazepine therapy; however, his psychotic symptoms became clinically evident and benzodiazepine provided limited efcacy. Blonanserin was inefective, and ECT was unavailable. His catatonic and psychotic symptoms were fnally relieved by lithium monotherapy. Conclusions: Catatonic symptoms are common in patients with mood disorders, suggesting that lithium may be efective in these cases. Moreover, lithium may be efective for both catatonic and psychotic symptoms, as it nor- malizes imbalances of excitatory and inhibitory systems in the brain, which underlies major psychosis. Cumulative evidence from further cases is needed to validate our fndings. Keywords: Catatonia, Late-life psychosis, Lithium, Benzodiazepine, Psychotic symptoms Background schizophrenia (10–15%) [5]. A prospective cohort study Catatonia is a psychomotor syndrome that presents vari- has also reported the incidence of catatonia to be only ous symptoms ranging from stupor to agitation, with 7.6% in patients with schizophrenia [6].
    [Show full text]
  • The Harmony of Illusions the Harmony of Illusions
    THE HARMONY OF ILLUSIONS THE HARMONY OF ILLUSIONS I NVENTING POST-TRAUMATIC STRESS DISORDER Allan Young PRINCETON UNIVERSITY PRESS PRINCETON, NEW JERSEY Copyright 1995 by Princeton University Press Published by Princeton University Press, 41 William Street, Princeton, New Jersey 08540 In the United Kingdom: Princeton University Press, Chichester, West Sussex All Rights Reserved Library of Congress Cataloging-in-Publication Data Young, Allan, 1938– The harmony of illusions : inventing post-traumatic stress disorder / Allan Young. p. cm. Includes bibliographical references and index. ISBN 0-691-03352-8 (cloth : alk. paper) 1. Post-traumatic stress disorder—Philosophy. 2. Social epistemology. I. Title. RC552.P67Y68 1995 616.85′21—dc20 95-16254 This book has been composed in Times Roman Princeton University Press books are printed on acid-free paper and meet the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources Printed in the United States of America by Princeton Academic Press 10987654321 For Roberta Contents Acknowledgments ix Introduction 3 PART I: THE ORIGINS OF TRAUMATIC MEMORY One Making Traumatic Memory 13 Two World War I 43 PART II: THE TRANSFORMATION OF TRAUMATIC MEMORY Three The DSM-III Revolution 89 Four The Architecture of Traumatic Time 118 PART III: POST-TRAUMATIC STRESS DISORDER IN PRACTICE Five The Technology of Diagnosis 145 Six Everyday Life in a Psychiatric Unit 176 Seven Talking about PTSD 224 Eight The Biology of Traumatic Memory 264 Conclusion 287 Notes 291 Works Cited 299 Index 321 Acknowledgments I OWE a debt to colleagues and friends in the Department of Social Studies of Medicine and the Department of Psychiatry at McGill University: I thank Don Bates, Alberto Cambrosio, Margaret Lock, Faith Wallis, George Weisz, and Laurence Kirmayer for their invaluable advice.
    [Show full text]
  • Catatonia and Psychosis Related to Epilepsy: a Case Report Laiana Quagliato 1, Roberto Piedade 1, Cristina Santana 2, Elie Cheniaux 1
    Case Reports Catatonia and Psychosis Related to Epilepsy: A Case Report Laiana Quagliato 1, Roberto Piedade 1, Cristina Santana 2, Elie Cheniaux 1 Abstract Although a variety of metabolic, toxic, psychiatric, and neurologic conditions can produce catatonic syndromes, it is less widely recognized that this state may be caused by epilepsy. We present the case of a woman with catatonic behavior, which she could not recall. She also exhibited olfactory, auditory and visual hallucinations. An EEG demonstrated dif- fuse abnormal electrical activity, mainly on left temporal and frontal areas. Treatment with anticonvulsant drugs yielded excellent response. Key Words: Temporal Lobe Epilepsy, Catatonic Syndrome, Epileptic Psychosis Introduction To illustrate the importance of diagnosing catatonic syn- Catatonia is a syndrome characterized by motor dysreg- dromes properly, we report the case of a patient with cata- ulation and speech disorders (1). A variety of conditions can tonic behavior, auditory, visual and olfactory hallucinations produce catatonic states. Although the association between associated to epilepsy. epilepsy and catatonia has been pointed out in a few review articles (2, 3), little recognition and research have been de- Case Study voted to the association. In every case of catatonic syndrome, Mrs. F’s symptoms were first noticed by her husband a process of clarification of the etiological diagnosis must be when she was 49-years old. He reported that sometimes the performed systematically. patient would suddenly stop talking, turn her head and neck Epilepsy and psychosis coexist more frequently than a little to the right, stare motionless and not interact with chance would predict. Typically, psychotic symptoms closely anyone.
    [Show full text]
  • Catatonia in DSM-5
    Schizophrenia Research 150 (2013) 26–30 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres Review Catatonia in DSM-5 Rajiv Tandon a,⁎, Stephan Heckers b, Juan Bustillo c, Deanna M. Barch d,e, Wolfgang Gaebel f, Raquel E. Gur g,h, Dolores Malaspina i,j, Michael J. Owen k, Susan Schultz l, Ming Tsuang m,n,o, Jim van Os p,q, William Carpenter r,s a Department of Psychiatry, University of Florida Medical School, Gainesville, FL, USA b Department of Psychiatry, Vanderbilt University, Nashville, TN, USA c Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA d Department of Psychology, Washington University, St. Louis, MO, USA e Department of Psychiatry and Radiology, Washington University, St. Louis, MO, USA f Department of Psychiatry, Duesseldorf, Germany g Department of Psychiatry, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA h Department of Neurology and Radiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA i Department of Psychiatry, New York University, New York, NY, USA j Creedmoor Psychiatric Center, New York State Office of Mental Health, USA k MRC Centre for Neuropsychiatric Genetics and Genomics and Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, Wales, United Kingdom l Department of Psychiatry, University of Iowa School of Medicine, Iowa City, IA, USA m Center for Behavioral Genomics, Department of Psychiatry and Institute of Genomic Medicine, University
    [Show full text]