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Has Kahlbaum Syndrome Disappeared or Is It Underdiagnosed?

Reexamining the Nosology of Catatonia

Article  in  The journal of ECT · March 2012

DOI: 10.1097/YCT.0b013e318223c3f5 · Source: PubMed

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 BRIEF CLINICAL REPORT LETTER

Has Kahlbaum Syndrome Disappeared or

Is It Underdiagnosed?
Reexamining the Nosology of Catatonia
Naren P. Rao, MD, Vishal Kasal, MBBS, Narayan R. Mutalik, MBBS, Rishikesh V. Behere, MD,
Ganesan Venkatasubramanian, MD, Shivarama Varambally, MD, and Bangalore N. Gangadhar, MD

stitute of Mental Health and Neurosciences in the past 2 years.

Abstract: In contemporary psychiatric classification such as the Seventy-seven patients (male-to-female ratio, 31:46) patients were
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, diagnosed as having catatonia. Diagnosis was established using
and International Classification of Diseases, 10th Revision, catatonia ICD-10. Catatonic features were assessed by applying Bush-
is classified as a subtype of schizophrenia and not as an independent Francis Catatonia Rating Scale (n = 44).4 Details regarding
disorder. However, catatonia does not seem to obey nosological boundaries medication and electroconvulsive therapy were noted from the
and is seen with both affective and nonaffective psychoses. We conducted medical records. Those who did not respond to lorazepam within
a chart review of patients to examine the nosological status of catatonia. 48 to 72 hours were given electroconvulsive therapy.5 Mutism
Our data suggest that catatonia is a syndrome of varied manifestation was the most common sign (97.7%) followed by withdrawal
possibly related to both affective and nonaffective psychoses with a sub- (93.2%), stupor (79.5%), staring (75%), and posturing (72.7%).
group independent of both. Further prospective studies examining the Least common were combativeness (0%), verbigeration (2.3%),
natural course are needed, which could have significant implications on echophenomenon (2.3%), perseveration (2.3%), and waxy flexi-
future classificatory systems. bility (9.1%). Catatonia was associated with both affective and
Key Words: catatonia, schizophrenia, affective disorder, nosology, nonaffective psychoses. Interestingly, most patients at admission
Kahlbaum syndrome were diagnosed with catatoniaVcause not knownVwhich was
later changed to acute psychosis or mood disorders as depicted in
(J ECT 2012;28: 62Y63)
Table 1; 29.9% of patients were diagnosed with catatoniaVcause
not known at the time of admissionVbut decreased to 5.2%
during the 24-month follow-up.
Our data indicate that catatonia is related to both schizo-
Dear Editor: phrenia and mood disorders, with substantial number of cases
Kahlbaum syndrome or catatonia was originally described being suggestive of a third psychosis. At admission, most of
as a disorder primarily associated with mood syndromes with them were diagnosed as having catatoniaVcause not knownVbut
characteristic motor abnormalities.1 However, in contemporary the diagnosis was changed to others during follow-up. Most of
psychiatric classification such as the Diagnostic and Statistical them were rediagnosed as having acute psychosis or mood dis-
Manual of Mental Disorders, 4th Edition, and International order. In conclusion, our data suggest that catatonia is a syn-
Classification of Diseases, 10th Revision (ICD-10), catatonia is drome of varied manifestation possibly related to both affective
classified as a subtype of schizophrenia and not as an indepen- and nonaffective psychoses with a subgroup independent of both.
dent disorder.2 However, catatonia does not seem to obey nosol- The current approach of classifying catatonia only as a subtype
ogical boundaries and is seen with both affective and nonaffective of schizophrenia in ICD-10 may be very restrictive, and this issue
psychoses. Moreover, when definitions of both schizophrenia and needs to be addressed in future revisions. Further prospective
mood disorders are most restrictive as in the case of the Leonhard
system, Kahlbaum syndrome seems better accommodated as a
‘‘third psychosis.’’3 Because of these, the diagnostic and thera-
peutic significance of catatonia is lost in contemporary psychiatric
classification. Thus, in this study, we aimed to examine the no- TABLE 1. Diagnosis at Admission and Follow-Up
sological status of catatonia in contemporary psychiatric classifi- Diagnosis Admission, % Follow-Up, %
cation (ICD-10).
We conducted a chart review of patients who were ad- Schizophrenia 11.7 16.9
mitted to the psychiatric intensive care unit at the National In- BPAD 10.4 15.6
Depression 11.7 15.6
Mania 0 1.3
Acute psychosis 14.3 22.1
From the Department of Psychiatry, National Institute of Mental Health & Psychosis NOS 19.5 15.6
Neurosciences, Bangalore, India.
Received for publication April 19, 2011; accepted April 20, 2011. CatatoniaVcause not known 29.9 5.2
Reprints: Naren P. Rao, MD, The Schizophrenia Clinic, Department of Schizoaffective 1.3 1.3
Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Others 1.3 6.5
Rd, Bangalore 560029, India (e-mail: docnaren@gmail.com).
The authors have no conflict of interest to declare. BPAD indicates Bipolar affective disorder; NOS, not otherwise
Copyright * 2012 by Lippincott Williams & Wilkins specified.
DOI: 10.1097/YCT.0b013e318223c3f5

62 www.ectjournal.com Journal of ECT & Volume 28, Number 1, March 2012

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Journal of ECT & Volume 28, Number 1, March 2012
studies examining the natural course are needed, which could
have significant implications on future classificatory systems.
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* 2012 Lippincott Williams & Wilkins
View publication stats Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Reexamining the Nosology of Catatonia
3. Daniels J. Catatonia: clinical aspects and neurobiological correlates.
J Neuropsychiatry Clin Neurosci. 2009;21(4):371Y380.
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