CATATONIA. – A form of abulia (q.v.) characterized by the inability to act, whether spontaneously or upon command, as if the subject’s will encountered insurmountable resistance in translating itself into action, or, for every impulse to act, an automatic counter-impulse arose, so that the action remained blocked from the outset or was checked during its execution. When ordered, for example, to open the eyes, the catatonic does not comply, while the motor apparatus appears inert or seized by simultaneous contractions of the muscles responsible for the commanded movement (elevators of the eyelids) and their antagonists (orbicular muscles of the eyelids). Under such conditions, the individual remains for long periods immobile in uncomfortable or ridiculous postures—attitudes of prayer, ecstasy, menace, fright, etc. The apparent passivity of the catatonic conceals an intense tension that, upon the lifting of the volitional arrest, may discharge in a sudden outburst of activity (“catatonic impulsivity”).
Catatonia may occur alongside disturbances of the affective sphere (melancholia, mania) and occupies a place among a series of pathological motor manifestations such as stupor, catalepsy (q.v.), negativism, stereotyped and repetitive postures, grimaces, mannerisms, hyperkinesias, etc. Catatonia is very frequent and typical in states of heightened tension or in the schizophrenic temperament (q.V. SCHIZOPHRENIA); it may also be observed in toxi-infections, amentia (q.v.), epilepsy (q.v.), cerebral syphilis, general paralysis of the insane (q.v.), senile dementia, and affective psychoses.
As to the mechanism of origin, both a psychogenic and a neurogenic theory are advanced. According to the former, the defect would lie in the representational phase of the voluntary act: absence or simultaneous flooding of opposing representations leading to antagonistic actions; the neurogenic theory rests on the function of the extrapyramidal system (q.V. EXTRAPYRAMIDAL, SYSTEM) and on morbid manifestations similar to catatonia seen in the post-parkinsonian syndrome following epidemic encephalitis. A mixed genesis is probable, linked to abnormal psychic factors unfolding within an extrapyramidal system that is functionally or organically altered.
Certain pharmacological substances (bulbocapnine, mescaline, cannabine, harmine; intravenous soporifics, acetylcholine and high doses of adrenaline) can induce a kind of experimental catatonia (first described by Baruk and Dejong in 1928), though their mechanism of action is in fact different, since the injected substances produce the catatonic picture by acting on the muscular apparatus rather than on the nervous centers.