Catatonic disorder due to general medical condition must be excluded in psychiatric patients presenting with this movement disorder. This report emphasizes the association of catatonia with multiple sclerosis.
Method:
A patient with catatonia, psychotic depression, and the subsequent diagnosis of multiple sclerosis is described and the literature reviewed.
Results:
Mutism, immobility, cataplexy, waxy flexibility, and other aspects of catatonia occur in multiple sclerosis, usually as a consequence of a severe mood disorder and extensive cerebral demyelination. These symptoms may be the presenting manifestations of multiple sclerosis.
Conclusions:
A high index of suspicion for neurological disease is indicated in patients with new-onset catatonia. Neuroimaging and other studies may reveal underlying demyelination requiring specific therapy.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Edition. Washington, DC: American Psychiatric Association, 1994: 196–171.
2.
AbramsRTaylorMA. Catatonia. A prospective clinical study. Archives of General Psychiatry1976;33:579–581.
3.
BarnesMPSaundersMWallsTJSaundersIKirkCA. The syndrome of Karl Ludwig Kahlbaum. Journal of Neurology, Neurosurgery and Psychiatry1986;49:991–996.
4.
TaylorMA. Catatonia: A review of a behavioral neurologic syndrome. Neuropsychiatry, Neuropsychology, and Behavioral Neurology1990;3:48–72.
5.
PopkinMKTuckerGJ. “Secondary” and drug-induced mood, anxiety, psychotic, catatonic, and personality disorders: A review of the literature. Journal of Neuropsychiatry and Clinical Neurosciences1992;4:369–385.
6.
RosebushPIHildebrandAMFurlongBGMazurekMF. Catatonic syndrome in a general psychiatric inpatient population: Frequency, clinical population, and response to lorazepam. Journal of Clinical Psychiatry1990;51:357–362.
7.
AltshulerLLCummingsJLMillsMJ. Mutism: Review, differential diagnosis, and report of 22 cases. American Journal of Psychiatry1996;143:1409–1414.
8.
CarrollBTAnfinsonTJKennedyJCYendrekRBoutrosMBilonA. Catatonic disorder due to general medical conditions. Journal of Neuropsychiatry and Clinical Neurosciences1994;6:122–133.
9.
RodgersJBlandR. Psychiatric manifestations of multiple sclerosis: A review. Canadian Journal of Psychiatry1996;41:441–445.
10.
PineDSDouglasCJCharlesEDaviesMKahnD. Patients with multiple sclerosis presenting to psychiatric hospitals. Journal of Clinical Psychiatry1995;56:297–308.
11.
MathewsWB. Multiple sclerosis presenting with acute remitting psychiatric symptoms. Journal of Neurology, Neurosurgery and Psychiatry1979;42:859–863.
12.
BoernerRJ. Organic catatonic disorder—On the occurrence of a catatonic syndrome in a patient with encephalomyelitis disseminata. Psychiatrische Praxis1996;23:40.
13.
LyooIKSeolHYByunHSRenshawPF. Unsuspected multiple sclerosis in patients with psychiatric disorders: A magnetic resonance imaging study. Journal of Neuropsychiatry and Clinical Neurosciences1996;8:54–59.
14.
Diaz-OlavarrietaCCummingsJLVelazquezJde la CadenaC Garcia. Neuropsychiatric manifestations of multiple sclerosis. Journal of Neuropsychiatry and Clinical Neurosciences1999;11:51–57.
15.
MindenSLSchifferRB. Affective disorders in multiple sclerosis: Review and recommendations for clinical research. Archives of Neurology1990;47:98–104.
16.
SadovnickADRemickRAAllenJSwartzEYeeIMEisenKFarquharRHashimotoSAHoogeJKastrukoffLFMorrisonRNNelsonJOgerJPatyDW. Depression and multiple sclerosis. Neurology1996;46:628–632.
17.
FiskJDMorehouseSABrownMGSkedgelCMurrayTJ. Hospital-based psychiatric service utilization and morbidity in multiple sclerosis. Canadian Journal of Neurological Sciences1998;25:230–235.
18.
TedmanBMYoungCAWilliamsIR. Assessment of depression in patients with motor neuro disease and other neurologically disabling illness. Journal of the Neurological Sciences1997;152:S75–S79.
19.
SurridgeD. An investigation into some psychiatric aspects of multiple sclerosis. British Journal of Psychiatry1969;115:749–764.
20.
WhitlockFASiskindMM. Depression as a major symptom of multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry1980;43:861–865.
21.
RabinsPVBrooksBRO'DonnellPPearlsonGDMobergPJubeltBCoylePDalosNFolsteinMF. Structural brain correlates of emotional disorder in multiple sclerosis. Brain1986;109:585–597.
22.
ScottTFAllenDPriceTRMcConnellHLangD. Characterization of major depression symptoms in multiple sclerosis patients. Journal of Neuropsychiatry and Clinical Neurosciences1996;8:318–323.
23.
FassbenderKSchmidtRMossnerRKischkaUKuhnenJSchwartzAHennericiM. Mood disorders and dysfunction of the hypothalamic-pituitary-adrenal axis in multiple sclerosis: Association with cerebral inflammation. Archives of Neurology1998;55:66–72.
24.
ClarkeTWadhwaULeroiI. Psychotic depression. An atypical initial presentation of multiple sclerosis. Psychosomatics1998;39:72–75.
25.
SchifferRBWeitkampLRWinemanNMGuttormsenS. Multiple sclerosis and affective disorder: Family history, sex, and HLA-DR antigens. Archives of Neurology1988;45:1345–1348.
26.
HeilaHTurpeinenPErkinjunttiT. Case study: Mania associated with multiple sclerosis. Journal of the American Academy of Child and Adolescent Psychiatry1995;34:1591–1595.
27.
HurleyRATaberKHZhangJHaymanLA. Neuropsychiatric presentation of multiple sclerosis. Journal of Neuropsychiatry and Clinical Neurosciences1999;11:5–7.
28.
MollerAWiedemannGRohdeUBackmundHSonntagA. Correlates of cognitive impairment and depressive mood disorder in multiple sclerosis. Acta Psychiatrica Scandinavica1994;89:117–121.
29.
PujolJBelloJDeusJMarti-VilaltaJLCapdevilaA. Lesions in the left arcuate fasciculus region and depressive symptoms in multiple sclerosis. Neurology1997;49:1105–1110.
30.
SabatiniUPozzilliCPantanoPKoudriavtsevaTPadovaniAMillefioriniEDi BiasiCGualdiGFSalvettiMLenziGL. Involvement of the limbic system in multiple sclerosis patients with depressive disorders. Biological Psychiatry1996;39:970–975.
31.
HonerWGHurwitzTLiDKBPalmerMPatyDW. Temporal lobe involvement in multiple sclerosis patients with psychiatric disorders. Archives of Neurology1987;44:187–190.
32.
CasanovaMFKruesiMMannheimG. Multiple sclerosis and bipolar disorder: A case report with autopsy findings. Journal of Neuropsychiatry and Clinical Neurosciences1996;8:206–208.
33.
McNamaraME. ECT and treatment of multiple sclerosis. Journal of Neuropsychiatry and Clinical Neurosciences1995;7:385–386.
34.
MattinglyGBakerKZorumskiCFFigielGS. Multiple sclerosis and ECT: Possible value of gadolinium-enhanced magnetic resonance scans for identifying high-risk patients. Journal of Neuropsychiatry and Clinical Neurosciences1992;4:145–151.
