A study on late catatonia--the psychopathological study of its symptoms, courses, subtypes, and treatments

It was discussed at the beginning of this century whether to categorize "late catatonia" in "manic-depressive disorder", in "schizophrenia", or to consider itself as another clinical entity. Sommer was the first to make a clinical report on "late catatonia"; however Kraepelin had reported on cases with very similar symptoms prior to Sommer, and called them "involutional melancholia" or "presenile psychosis". Followed by a couple of decades, Jacobi's clinical report gave "late catatonia" the impressions as having a very poor prognosis. It was then stated by M. Bleuler that approximately 30% of "late schizophrenia" was well-fitted into "late catatonia". According to Huber who carried out a survey utilizing the same criterion for "late schizophrenia" some 30 years later, no such concordance was found. Hence, it may be said that some kind of change in symptoms has occurred. Symptom-transitions of 16 "late catatonia" subjects were analysed in detail. "Late catatonia" is a symptomatic concept with characteristic progressive symptoms: Stage 1 (prodrome and primary depression), Stage 2 (anxiety, irritation), Stage 3 (hallucination, delusion), Stage 4 (catatonia), and the residual stage. "The complete type" which progresses to Stage 4 stepwise, may end up developing "malignant catatonia". In this case, it may be life threatening unless suitable treatment is carried out. This disease may be divided into 2 types of clinical courses; a multi-phasic course with intermittent remission, and a mono-phasic course which is chronic. Transition to the residual stage may occur at any point. In practice, there are 3 other subtypes; these three are called "the abortive types" (anxious/irritated type, depressive/delusional type, residual type). These cases are most typically considered as depression with severe anxiety and irritation, and in case flattening of affect becomes the major symptoms, it is often misdiagnosed as "organic dementia". Considering treatment, the majority was nonrespondent to neuroleptics, especially those at stage 4; however, ECT (electroconvulsive therapy) was observed to be effective in some cases.