Neurology Central

The nosology of catatonia and DSM-5

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Catatonia has been identified for over 100 years as a valid clinical entity. In its various forms and classifications, it has languished as a specifier, a subtype or as a disregarded entity. However, with the advent of DSM-5 and ICD-10, catatonia has a home of its own. This article is designed to provide the relevant psychopathology, syndrome definition and assessment tools including rating scales as they pertain to DSM-5.

Karl Kahlbaum first described catatonia using 26 cases spanning a variety of illnesses [1]. While some of these cases would meet the current criteria for psychosis or a mood disorder, others could be better explained by medical illnesses, such as syphilis or tuberculosis. Two decades later, Emil Kraepelin described cases similar to those of Kahlbaum, though he often saw catatonic symptoms in patients with dementia praecox. Kraepelin believed that dementia praecox could be marked by catatonia [2]. When dementia praecox was relabeled as schizophrenia, the specifier of catatonia continued. That is where catatonia has remained for over a century [3].

In 2003, Max Fink and Michael Taylor argued that catatonia met the criteria for a distinct clinical disorder, one that deserved a diagnostic and statistical manual of mental disorders class of its own. Part of their argument relied on the fact that catatonia and neuroleptic malignant syndrome were more effectively relieved by benzodiazepines and electroconvulsive therapy. They believed that distinguishing catatonia from other illnesses would allow it to gain recognition and would help providers more appropriately seek treatment options [4].

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