Catatonic features specifier
Catatonic Features Specifier
The specifier With Catatonic Features can be applied to the current Major Depressive, Manic, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder, or Bipolar II Disorder. If full criteria are no longer met for a mood episode, the specifier applies to the most recent mood episode. The specifier With Catatonic Features is appropriate when the clinical picture is characterized by marked psychomotor disturbance that may involve motoric immobility, excessive motor activity, extreme negativism, mutism, peculiarities of voluntary movement, echolalia, or echopraxia. Motoric immobility may be manifested by catalepsy (waxy flexibility) or stupor. The excessive motor activity is apparently purposeless and is not influenced by external stimuli. There may be extreme negativism that is manifested by the maintenance of a rigid posture against attempts to be moved or resistance to all instructions. Peculiarities of voluntary movement are manifested by the assumption of inappropriate or bizarre postures or by prominent grimacing. Echolalia (the pathological, parrotlike, and apparently senseless repetition of a word or phrase just spoken by another person) and echopraxia (the repetitive imitation of the movements of another person) are often present. Additional features may include stereotypies, mannerisms, and automatic obedience or mimicry. During severe catatonic stupor or excitement, the person may need careful supervision to avoid self-harm or harm to others. Potential consequences include malnutrition, exhaustion, hyperpyrexia, or self-inflicted injury.
Catatonic states have been found to occur in 5%-9% of inpatients. Among inpatients with catatonia, 25%-50% of cases occur in association with Mood Disorders, 10%-15% of cases occur in association with Schizophrenia (see Schizophrenia, Catatonic Type, p. 315), and the remainder occur in association with other mental disorders (e.g., Obsessive-Compulsive Disorder, Personality Disorders, and Dissociative Disorders). It is important to note that catatonia can also occur in a wide variety of general medical conditions including, but not limited to, those due to infectious, metabolic, neurological conditions (see Catatonic Disorder Due to a General Medical Condition, p. 185), or can be due to a side effect of a medication (e.g., a Medication-Induced Movement Disorder, see p. 791). Because of the seriousness of the complications, particular attention should be paid to the possibility that the catatonia is due to Neuroleptic Malignant Syndrome (p. 795).
Criteria for Catatonic Features Specifier
Specify if:
With Catatonic Features (can be applied to the current or most recent Major Depressive Episode, Manic Episode, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder, or Bipolar II Disorder)
The clinical picture is dominated by at least two of the following:
- motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
- excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
- extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
- peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
- echolalia or echopraxia