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Catatonia

Catatonia

Definition

Catatonia is a condition marked by changes in muscle tone or activity associated with a large number of serious mental and physical illnesses. There are two distinct sets of symptoms that are characteristic of this condition. In catatonic stupor the individual experiences a deficit of motor (movement) activity that can render him/her motionless. Catatonic excitement, or excessive movement, is associated with violent behavior directed toward oneself or others.

Features of catatonia may also be seen in Neuroleptic Malignant Syndrome (NMS) which is an uncommon (but potentially lethal) reaction to some medications used to treat major mental illnesses. NMS is considered a medical emergency since 25% of untreated cases result in death. Catatonia can also be present in individuals suffering from a number of other physical and emotional conditions such as drug intoxication, depression, and schizophrenia. It is most commonly associated with mood disorders.

Description

In catatonic stupor, motor activity may be reduced to zero. Individuals avoid bathing and grooming, make little or no eye contact with others, may be mute and rigid, and initiate no social behaviors. In catatonic excitement the individual is extremely hyperactive although the activity seems to have no purpose. Violence toward him/herself or others may also be seen.

NMS is observed as a dangerous side effect associated with certain neuroleptic (antipsychotic) drugs such as haloperidol (Haldol). It comes on suddenly and is characterized by stiffening of the muscles, fever, confusion and heavy sweating.

Catatonia can also be categorized as intrinsic or extrinsic. If the condition has an identifiable cause, it is designated as extrinsic. If no cause can be determined following physical examination, laboratory testing, and history taking, the illness is considered to be intrinsic.

Causes and symptoms

The causes of catatonia are largely unknown although research indicates that brain structure and function are altered in this condition. While this and other information point to a physical cause, none has yet been proven. A variety of medical conditions also may lead to catatonia including head trauma, cerebrovascular disease, encephalitis, and certain metabolic disorders. NMS is an adverse side effect of certain antipsychotic drugs.

A variety of symptoms are associated with catatonia. Among the more common are echopraxia (imitation of the gestures of others) and echolalia (parrot-like repetition of words spoken by others). Other signs and symptoms include violence directed toward him/herself, the assumption of inappropriate posture, selective mutism, negativism, facial grimaces, and animal-like noises.

Catatonic stupor is marked by immobility and a behavior known as cerea flexibilitas (waxy flexibility) in which the individual can be made to assume bizarre (and sometimes painful) postures that they will maintain for extended periods of time. The individual may become dehydrated and malnourished because food and liquids are refused. In extreme situations such individuals must be fed through a tube. Catatonic excitement is characterized by hyperactivity and violence; the individual may harm him/herself or others. On rare occasions, isolation or restraint may be needed to ensure the individual's safety and the safety of others.

Diagnosis

Recognition of catatonia is made on the basis of specific movement symptoms. These include odd ways of walking such as walking on tiptoes or ritualistic pacing, and rarely, hopping and skipping. Repetitive odd movements of the fingers or hands, as well as imitating the speech or movements of others also may indicate that catatonia is present. There are no laboratory or other tests that can be used to positively diagnose this condition, but medical and neurological tests are necessary to rule out underlying lesions or disorders that may be causing the symptoms observed.

Treatment

Treatment of catatonia includes medications such as benzodiazipines (which are the preferred treatment) and rarely barbiturates. Antipsychotic drugs may be appropriate in some cases, but often cause catatonia to worsen. Electroconvulsive therapy may prove beneficial for clients who do not respond to medication. If these approaches are unsuccessful, treatment will be redirected to attempts to control the signs and symptoms of the illness.

Prognosis

Catatonia usually responds quickly to medication interventions.

Prevention

There is currently no known way to prevent catatonia because the cause has not yet been identified. Research efforts continue to explore possible origins. Avoiding excessive use of neuroleptic drugs can help minimize the risk of developing catatonic-like symptoms.

Resources

BOOKS

Frisch, Noreen Cavan, and Lawrence E. Frisch. Psychiatric Mental Health Nursing. Albany, NY: Delmar Publishers, 1998.

KEY TERMS

Barbiturates A group of medicines that slow breathing and lower the body temperature and blood pressure. They can be habit forming and are now used chiefly for anesthesia.

Benzodiazipines This group of medicines is used to help reduce anxiety (especially before surgery) and to help people sleep.

Electroconvulsive therapy This type of therapy is used to treat major depression and severe mental illness that does not respond to medications. A measured dose of electricity is introduced into the brain in order to produce a convulsion. Electroconvulsive therapy is safe and effective.

Mutism The inability or refusal to speak.

Negativism Behavior characterized by resistance, opposition, and refusal to cooperate with requests, even the most reasonable ones.

Neuroleptic drugs Antipsychotic drugs, including major tranquilizers, used in the treatment of psychoses like schizophrenia.

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Catatonia

Catatonia

Definition

Catatonia is a disturbance of motor behavior that can have either a psychological or neurological cause. Its most well-known form involves a rigid, immobile position that is held by a person for a considerable length of time often days, weeks, or longer. It can also refer to agitated, purposeless motor activity that is not stimulated by something in the environment. A less extreme form of catatonia involves very slowed motor activity. Often, the physical posture of a catatonic individual is unusual and/or inappropriate, and the individual may hold a posture if placed in it by someone else. According to the handbook used by mental health professionals to diagnose mental disorders, the Diagnostic and Statistical Manual of the American Psychiatric Association, 4th Edition, Text Revision, also known as the DSM-IV-TR, some 59% of all psychiatric inpatients show some catatonic symptoms. Of these, 2550% are associated with mood disorders, 1015% are associated with schizophrenia , and the remainder are associated with other mental disorders.

Description

Types of catatonia

CATATONIC SCHIZOPHRENIA. As with all types of schizophrenia, the catatonic type, fortunately rare today, involves a marked disturbance in all spheres of life. As a schizophrenic disorder, the individual shows disturbances in thinking, feeling, and behavior. Most schizophrenics are unable to form meaningful intimate relationships or train for and sustain meaningful employment.

The catatonic type of schizophrenia is characterized by severe psychomotor disturbance. Individuals with this disorder show extreme immobility. They may stay in the same position for hours, days, weeks, or longer. The position they assume may be unusual and appear uncomfortable to the observer. If another person moves part of the catatonic individual's body, such as a limb, he or she may maintain the position into which they are placed, a condition known as "waxy flexibility." Sometimes catatonia presents itself as excessive motor activity, but the activity seems purposeless, and does not appear to fit with what is happening in the environment. In its most severe forms, whether stupor or agitation, the individual may need close supervision to keep from injuring him- or herself, or others.

DEPRESSION WITH CATATONIC FEATURES. Individuals who are severely depressed may show disturbances of motor behavior that is similar to that of catatonic schizophrenics, as previously described. They may be essentially immobile, or exhibit excessive but random-seeming motor activity. Extreme negativism, elective mutism (choosing not to speak), peculiar movements, mimicking words or phrases (known as "echolalia") or mimicking movements (known as "echopraxia") may also be part of the picture. Again, in its most extreme forms, catatonic stupor (not moving for hours, days, weeks, or longer), and catatonic activity (random-seeming activity) may necessitate supervision so that the individual does not hurt him- or herself, or others. Catatonic behaviors may also be seen in persons with other mood disorders, such as manic or mixed-mood states; these are also known as Bipolar I and Bipolar II disorders.

CATATONIC DISORDER DUE TO GENERAL MEDICAL CONDITION. Individuals with catatonia due to a medical condition may show symptoms similar to persons with catatonic schizophrenia and catatonic depression. However, the cause is believed to be physiological. Certain neurologic diseases, such as encephalitis, may cause catatonic symptoms that can be either temporary, or lasting.

See also Affect; Bipolar disorders; Catatonic disorder; Major depressive disorder; Manic episode; Schizophrenia

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Kaplan, Harold I., MD, and Benjamin J. Sadock, MD. Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 8th edition. Baltimore, MD: Lippincott Williams and Wilkins, 1998.

Barbara Sternberg, Ph.D.

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catatonia

catatonia (kăt´ətō´nēə), mental state generally characterized by statuesque posturing, muscular immobility, mutism, and apparent stupor. The muscles are held in a pliant state called waxy flexibility, and the catatonic person obediently permits himself to be rearranged into awkward positions that he may subsequently hold for hours. Another form of catatonia involves continuous incoherent shouting, psychomotor agitation, and a violent destructiveness which can lead to collapse and death if untreated. Loss of memory or intellect is not necessarily implied: catatonic patients often display excellent memory of their surroundings during the catatonic state. In recent years, drug therapy has been helpful in the avoidance of catatonic disturbances, and the appearance of catatonia is now quite rare. Described by Karl Kahlbaum (1874) as catatonia, the term was subsumed under Eugen Bleuler's concept of schizophrenia in 1911. It has recently been classified as catatonic schizophrenia by the American Psychiatric Association.

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catatonia

cat·a·to·ni·a / ˌkatəˈtōnēə/ • n. Psychiatry abnormality of movement and behavior arising from a disturbed mental state (typically schizophrenia). It may involve repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism. ∎ inf. a state of immobility and stupor.

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catatonia

catatonia (kat-ă-toh-niă) n. a state in which a person becomes mute or stuporous or adopts bizarre postures (see also flexibilitas cerea). Catatonia was once a noted feature of schizophrenia but is now hardly ever seen in developed countries. It remains common in developing countries.
catatonic adj.

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Catatonia

Catatonia

Pop band

For The Record

Outshined Other Newcomers

Scored Hits with International Velvet

Topped the British Album Chart

Selected discography

Sources

Although Catatonia boasts a wide range of influences, from classic rock bands to jazz and soul singers, the Welsh-based Britpop band earned recognition not as imitators of the past, but for their own spirited music. At the source of the groups appeal stands vocalist/guitarist Cerys Matthews, a brassy singer with an extraordinary voice, as well as a back-to-basics approach to entertaining audiences and having a good time. Cerys has the sort of voice that sends over-emotional hacks dizzying off into reams of praise, wrote Paul Whitelaw in a review for Melody Maker. Shes soul without bluster, skipping desultorily from tender-as-a-bruise cooing to a scabrous taunt, from awestruck glee to impossible sadness, sometimes in the space of a single syllable. At times its truly astonishingpainfully beautiful, naked, helpless and entirely unconthved. Like Bjork, there are times when she sounds like a 10,000-year-old child, weary and wise, yet wide-eyed and crackling with the sheer wonder of being alive.

However, Matthews cant take all the credit for bringing Catatonia so much notoriety and a string chart-topping albums and singles in Great Britain and throughout Europe. The other members of the quintet, likewise, contribute greatly in making Catatonia such a huge success. They include guitarist Mark Roberts; bassist Paul Jones, a former member, along with Roberts, of the Welsh-language punk band Y Cyrff; guitarist Owen Powell; and drummer Aled Richards, who replaced original drummer Dafydd luean, now a member of another popular Welsh band known as the Super Furry Animals.

Catatonia formed in 1992 after Roberts encountered Matthews performing acoustic versions of Jefferson Airplane and the Jam songs on a street corner in Cardiff, the capitol city of Wales. The two subsequently found that they shared similar musical influencesa diverse list of performers that included Billy Holiday, Eric Cantona, John Lennon, Rolf Harris, Abba, Soft Machine, Bob Marley, and Dolly Partonand decided to form a band. Next, Matthews and Roberts hooked up with Jones, Powell, and luean, and within a few short months as an official group, Catatonia had signed with the independent Welsh label Crai. In 1993, the band released their first two singles, For Tinkerbell and Hooked, the first of which was named NME(New Musical Express) Single of the Week.

An instant favorite of the British music press, who adored Matthews bluesy voice and enthusiastic persona, Catatonia followed their debut outings with Whale, another NME Single of the Week in 1994, and Bleed, the bands first top ten hit on the British indie chart released in early-1995 on the independent Nursery label. In April of 1995, after luean departed and Richards joined on drums, Catatonia signed with the Blanco Y Negro label, an A&R source run by Rough Trade founder Geoff Travis and owned by WEA United

For The Record

Members include Dafydd Iuean (left band in 1995; later joined the Welsh band Super Furry Animals), drums; Paul Jones (former member of the Welsh-language punk band Y Cyrff), bass; Cerys Matthews, vocals; Owen Powell, guitar; Aled Richards (joined band in 1995), drums; Mark Roberts (former member with Jones of the Welsh-language punk band Y Cyrff), guitar.

Formed band in 1992 in Cardiff, Wales; signed with Welsh label Crai, released first two singles, 1993; signed with Blanco Y Negro, 1995; released debut album Way Beyond Blues, 1996; released the acclaimed International Velvet, 1998; released Equally Cursed and Blessed, 1999.

Addresses: Record company Blanco Y Negro, 66 Golborne Rd., London, England, phone: (181) 960-9888, fax: (181) 968-6715, e-mail: glen@trade2.de mon.co.uk. Atlantic Records, 1290 Avenue of the Americas, New York City, NY 10104, phone: (212) 707-2533, fax: (212) 405-5665, website: http://www.atlantic-records.com.

Kingdom, which handles marketing, sales, and promotion. Travis had previously cut the song Whale for his Rough Trade Singles Club.

Outshined Other Newcomers

Soon after signing, Catatonia started touring relentlessly with bands like Marion, Salad, and Puressences, acts which at first received greater press attention than the Welsh newcomers. However, Catatonia pressed on, and eventually left the others in their wake. In the meantime, Catatonia set about writing songs and recording a debut album with producers Stephen Streetwho worked with the Smiths and Blur, among othersand Paul Sampson at Maison Rouge Studios in London. With 1996s Way Beyond Blue, Catatonia enjoyed their first taste of success. The album, propelled by singles such as Bleed, Youve Got A Lot To Answer For, and the bands theme tune titled Sweet Catatonia, brought the band major exposure, including extensive airplay, an appearance for the Radio 1 road show, and a place in the United Kingdom top 40. The group became favorites, too, as subjects for Britains gossip columnists, largely for Matthews celebrating the groups success about town.

In addition to performing in the United Kingdom, Catatonia made an attempt to break through in America, crossing the Atlantic to play shows in New York City, Los Angles, and Austin, Texas. But because of record company chaos and bad timing, their debut never saw release in the United States. Nonetheless, back home Catatonias popularity continued to escalate, and by May of 1996, they had completed two national sell-out tours.

Scored Hits with International Velvet

The later months of 1997 brought the band even greater success with two major hit singles. The witty I Am the Mob came first, followed quickly by Mulder and Scully, a song inspired by the X-Files television show that entered the United Kingdom singles chart at number three. Then, in early 1998, Catatonia released a second LP, the critically applauded International Velvet. The new songs are some of the saddest, most righteous, tough/forlorn classics youll hear all year, wrote Whitelaw in his review of the collection. Making its chart debut at number 11 in Britain, International Velvet cemented Catatonias pop-star status, with Q magazine eventually listing the record as one of their 90 Best Albums of the 1990s and Melody Maker naming the outing Album of the Year. The song Road Rage was named best single at the Q Awards. The band also scored three Brit Award nominations that year for best group, best album, and best single for Road Rage, as well as a Mercury Music Prize nomination for the celebrated release.

Right after we finished recording, I think we knew that International Velvet was a special album, said Matthews, as quoted by Atlantic Records. We had stumbled an awful lot until that point and we had been working so hard. There was a desperation about it. Wed been on the road pretty much solid two years. When it came time to record, we were just spilling our guts, really.

Catatonia continued to tour non-stop in support of the album, including a sold-out headlining tour and several music festival appearances. After International Velvets European release, Catatonia landed several high-profile gigs, playing at the Lisbon Expo, the World Cup in Paris, and fashion week in Milan. We did a press conference in Denmark, marveled Powell, as quoted by Mark Jenkins in the Washington Post, and there were people there from Latvia, Lithuania and Poland, all of them saying, Two of your records are in the top 10 in our country. I didnt even know that wed released records in Poland and Latvia. The fact that you can communicate with people in those countries without ever having been there is quite a thing to get your head around.

In the summer of 1998, barely a month after the albums American release, Catatonia came to the United States to participate at the H.O.R.D.E. festival, joining well-known acts like Blues Traveler, the Barenaked Ladies, and Paula Cole. Most of the audience had never heard of them, despite them being one of the biggest-selling acts in their native Great Britain. But the band themselves admitted they knew little of the other bands. People say, Oh yeah, youre playing with Blues Traveler. That must be great, Powell told Jenkins. To be honest with you, none of us know anything about Blues Traveler. What do they sound like?

Topped the British Album Chart

The group concluded 1998 with a British arena tour with another well-known Welsh band, the Manic Street Preachers, then traveled to Australia and New Zealand for the first time to perform. Here, the band tested some of their new material, songsincluding the top ten hit Dead From the Waist Downthat would later appear on their next album, Equally Cursed and Blessed. Produced by Catatonia and Tommy D (who previously worked with the Sugarcubes, A Tribe Called Quest, and the Shamen) and released in Britain in 1999, the album debuted on the United Kingdom chart at number one and showed the groups growing confidence in their songwriting abilities. Its a much more reflective album than International Velvet explained Matthews for Atlantic Records. Its a lot more thoughtful. That sort of made sense at the time because everything was happening so quickly and International Velvet had gone so madly. So yeah, theyre more thoughtful songs altogether darker maybe even.

After switching to Atlantic Records to distribute International Velvet, Catatonia finally began to win over fans in the United States. The album was released in March of 2000, and Matthews appeared on the cover of the April issue of Details magazine, as well as in feature stories in both Interview and Nylon. Ive got absolutely no expectations, Matthews said, however, in an interview with Los Angeles Times writer Marc Weingarten about the group reaching the same level of success in the United States I did two or three years ago. I wanted to come here and mesmerize everybody, but its a big country and youve got a lot of good acts now. I just want to enjoy it.

Selected discography

Way Beyond Blue, (United Kingdom) Blanco Y Negro/WEA, 1995.

Catatonia 1993/1994, (United Kingdom) Crai, 1998.

International Velvet, (United Kingdom) Blanco Y Negro/WEA, 1998; Vapor, 1998.

Equally Cursed and Blessed, (United Kingdom) Blanco Y Negro/WEA, 1999; Atlantic, 2000.

Sources

Periodicals

Billboard, July 4, 1998; November 6, 1999; March 11, 2000.

Los Angeles Times, August 21, 1998; January 27, 2000; January 29, 2000.

Melody Maker, November 8, 1997; January 31, 1998; March 28, 1998; December 15-21, 1999.

Rolling Stone, May 25, 2000.

US Weekly, April 10, 2000

Washington Post, August 9, 1998.

Online

Atlantic Records, http://www.atlantic-records.com (May 24, 2000).

Sonicnet.com, http://www.sonicnet.com (May 24, 2000).

Laura Hightower

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