Catatonia

CATATONIA. - A form of abulia (v.) characterized by an inability to act, whether spontaneously or on command, as if the subject's will encountered insurmountable resistance to translating itself into action, or as if for every impulse to act a corresponding impulse toward the opposite act automatically arose, so that the action remains blocked at the outset or checked during its execution. When commanded to open his eyes, for example, the catatonic does not carry out the order, while the motor apparatus appears inert or in the grip of simultaneous contractions of the muscles assigned to the commanded movement (levator palpebrae) and of their antagonists (orbicularis oculi). In such conditions, the individual remains for a long time motionless in uncomfortable or ridiculous statuesque poses, attitudes of prayer, ecstasy, menace, fright, etc. The apparent apathy of the catatonic conceals an intense tension which, when the volitional arrest gives way, can discharge in a sudden explosion of activity ("catatonic impulsivity").

C. may develop in conjunction with alterations of the affective sphere (melancholia, mania) and takes its place among a series of motor manifestations of a pathological type such as stupor, catalepsy (v.), negativism, stereotyped and repetitive attitudes, grimaces, mannerism, hyperkinesias, etc. C. is very frequent and typical in dementia praecox or schizophrenic atymia (v. SCHIZO-FRENIA); it may also be observed in toxinfections, in amenia (v.), epilepsy (v.), cerebral syphilis, paralytic dementia (v.), senile dementia, affective psychoses.

As regards the mechanism of origin, both a psychogenic and a neurogenic theory are maintained. According to the former, the defect would lie in the representational moment of the voluntary act: absence or simultaneity of opposing representations overflowing into antagonistic actions; the neurogenic theory rests on the function of the extrapyramidal system (v. EXTRAPIRAMIDALE, SISTEMA) and on the morbid manifestations similar to c. present in the picture of the post-parkinsonian syndrome secondary to epidemic encephalitis. A mixed genesis is probable, bound to abnormal psychic factors that unfold within the ambit of an extrapyramidal system altered functionally or organically.

Certain pharmacological substances (bulbocapnine, mescaline, cannabine, harmine; somnifon administered intravenously, acetylcholine and adrenaline in high doses) can provoke a kind of experimental c. (first by Baruk and Dejong in 1928) whose mechanism of action, however, is in reality different, since the inoculated substances provoke the catatonic picture by acting on the muscular apparatus rather than on the nerve centers.

Giuseppe de Ninno