Catatonic Type Kasus Psikotik.docx

Referensi skizofrenia tipe katatonik Catatonic type A type of schizophrenia in which the clinical picture is dominated by at least two of the following: 1. motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor 2. excessive motor activity (that is apparently purposeless and not influenced by external stimuli) 3. extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism 4. peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing 5. echolalia or echopraxia

The catatonic type of schizophrenia, which was common several decades ago, has become rare in Europe and North America. The classic feature of the catatonic type is a marked disturbance in motor function; this disturbance may involve stupor, negativism, rigidity, excitement, or posturing (Fig. 13-6). Sometimes, the patient shows rapid alteration between extremes of excitement and stupor. Associated features include stereotypies, mannerisms, and waxy flexibility. Mutism is particularly common. During catatonic excitement, patients need careful supervision to prevent them from hurting themselves or others. Medical care may be needed because of malnutrition, exhaustion, hyperpyrexia, or self-inflicted injury. AC, age 32, was admitted to the hospital. On arrival, he was noted to be an asthenic, poorly nourished man with dilated pupils, hyperactive tendon reflexes, and a pulse rate of 120. He showed many mannerisms, laid down on the floor, pulled at his foot, made undirected violent striking movements, struck attendants, grimaced, assumed rigid and strange postures, refused to speak, and appeared to be having auditory hallucinations. When seen later in the day, he was found to be in a stuporous state. His face was without expression, he was mute and rigid, and he paid no attention to those about him or to their questions. His eyes were closed, and the lids could be separated only with effort. There was no response to pinpricks or other painful stimuli. He gradually became accessible, and when asked concerning himself, he referred to his stuporous period as sleep and maintained that he had no recollection of any events occurring during it. He said, “I didn't know anything. Everything seemed to be dark as far as my mind is concerned. Then I began to see a little light, like the shape of a star. Then my head got through the star gradually. I saw more and more light until I saw everything in a perfect form a few days ago.― He explained his mutism by saying that he had been afraid he would “say the wrong thing” and also that he “didn't know exactly what to talk about.― From his obviously inadequate emotional response and his statement that he was “a scientist and an inventor of the most extraordinary genius of the twentieth century,― it was plain that he was still far from well. (Adapted from case of Arthur P. Noyes, M.D., and Lawrence C. Kolb, M.D.) P.478

FIGURE 13-6 Photograph of a group of catatonic patients. This photograph appeared in the fifth edition of Emil Kraepelin's Psychiatrie (Leipzig Johann Ambrosius Barth, 1896).