"Classics in ECT" brings you this case series from the British Medical Journal in 1977:
The pdf is
here.
And from the text:
We considered the possibility that our patients were in a depressive stupor. Catatonic stupor and the psychomotor retardation seen in severe depressive illnesses may be difficult to distinguish, and the response to ECT was similar to what might be expected in depression.There was, however, a striking lack of evidence of prior psychiatric illness in these patients and their families, and there was no evidence of any primary disturbance of mood. It would be of great theoretical interest if we could document a "symptomatic schizophrenia" related to typhoid. Eugen Bleuler described the condition of his patient, referred to above, as acute schizophrenia, but he included in this category many patients whom other psychiatrists would not call schizophrenic. In some ways our patients resembled schizophrenics: they were young, and their catatonic syndrome was similar to that seen in schizophrenia. There were none of the first-rank symptoms described by Schneider, however, nor were there delusions, hallucinations, or any disorder of thinking or affect that is generally associated with schizophrenia. We were unable to conclude that typhoid catatonia represents a symptomatic schizophrenia or that it represents a true schizophrenic illness precipitated in susceptible people by severe physical illness. Though ECT was dramatically effective, this does not help in defining the psychopathological basis of the syndrome. Good responses to ECT are expected in depressive illnesses and have been reported in schizophrenia. Roth and Rosie reviewed the use of ECT in various symptomatic and exogenous psychoses, including delirium. They pointed out that, because ECT is apparently therapeutic in such a wide variety of psychiatric disorders, its mechanism of action must be non-specific and so does not permit the formulation of any clear aetiological hypotheses in specific mental illnesses. Published data on the catatonic syndrome in typhoid fever may be lacking because typhoid has been most extensively studied by physicians to whom psychiatric complications have been of secondary interest...This is a fascinating case series from a hospital in Punjab. The description of catatonia is classic, although the "aetiological hypotheses" are a bit too closely tied with schizophrenia, given the then-prevalent belief that catatonia was a subtype of schizophrenia. Unfortunately, no details of the ECT are given, except for the number of treatments (3-7) and report of the excellent outcome. There is some medical trivia knowledge to be gained, viz. the Widal test:
(from Wikipedia:)
Widal test. Purpose. serological test for enteric fever. In 1896 and named after its inventor, Georges-Fernand Widal, is an indirect agglutination test for enteric fever or undulant fever whereby bacteria causing typhoid fever is mixed with a serum containing specific antibodies obtained from an infected individual.
This classic paper makes a compelling read, highly recommended (about 10 minutes).
The below comment is from Dr. Max Fink:
ReplyDeleteBreakey and Kala, 1977
This widely cited novel report argued that catatonia was not a component of Kraepelin and Bleuler mythology. With the reports of Morrison in 1973, Abrams and Taylor in 1976 and Gelenberg in 1977, catatonia was extracted from schizophrenia. Next NMS was identified as a treatable form of catatonia.
Catatonia is best recognized as a systemic medical syndrome of many faces, treatable by medical means, not a type of schizophrenia. The neuroleptics touted for schizophrenia are not effective, indeed are toxic, for catatonia.
Max Fink