Book contents
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- Chronology of catatonia concepts
- 1 Catatonia: A history
- 2 Signs of catatonia are identifiable
- 3 The many faces of catatonia
- 4 The differential diagnosis of catatonia
- 5 Catatonia is measurable and common
- 6 Past treatments for catatonia
- 7 Management of catatonia today
- 8 The neurology of catatonia
- 9 Back to the future
- Appendices
- References
- Index
7 - Management of catatonia today
Published online by Cambridge University Press: 31 July 2009
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- Chronology of catatonia concepts
- 1 Catatonia: A history
- 2 Signs of catatonia are identifiable
- 3 The many faces of catatonia
- 4 The differential diagnosis of catatonia
- 5 Catatonia is measurable and common
- 6 Past treatments for catatonia
- 7 Management of catatonia today
- 8 The neurology of catatonia
- 9 Back to the future
- Appendices
- References
- Index
Summary
Your image of catatonia will not be accepted. The treatments that you recommend cannot be patented; neither ECT nor lorazepam can lead to commercial exploitation or have industrial advocates.
Robert Michels, M.D.The failure to recognize catatonia in a timely fashion allows depressed, manic, and psychotic patients to remain ill for want of proper diagnosis and treatment. Clinicians offer their patients many medications and combinations, hoping that the next regimen will be effective, despite the experience that when the first choice of a drug treatment fails, additional therapy trials are unlikely to improve outcomes. Such tactics prolong illness and risk severe consequences.
Treatment failure can also occur when officially sanctioned treatment guidelines are at variance with clinical experience. For example, the American Psychiatric Association (APA) treatment guidelines for schizophrenia do not mention the catatonic subtype. This omission leads to the failure to comment on the need to avoid antipsychotic drugs, the benefits of the initial use of benzodiazepines, and the efficacy of ECT in these patients. In contrast, the APA guidelines for the treatment of depression and “bipolar” mood disorder recognize that catatonia may occur within depression and recommend that if “relief [from catatonia] is not immediately obtained by administrating barbiturates or benzodiazepines, the urgent provision of ECT should be considered.”
We are fortunate in our present skills to treat catatonia and in our ability to recognize its many variants. Once recognized, catatonia can be effectively and rapidly relieved.
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- CatatoniaA Clinician's Guide to Diagnosis and Treatment, pp. 147 - 176Publisher: Cambridge University PressPrint publication year: 2003
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