295.20 Catatonic Type
Introduction
The essential feature of the Catatonic Type of Schizophrenia is a marked psychomotor disturbance that may involve motoric immobility, excessive motor activity, extreme negativism, mutism, peculiarities of voluntary movement, echolalia, or echopraxia. Motoric immobility may be manifested by catalepsy (waxy flexibility) or stupor. The excessive motor activity is apparently purposeless and is not influenced by external stimuli. There may be extreme negativism that is manifested by the maintenance of a rigid posture against attempts to be moved or resistance to all instructions. Peculiarities of voluntary movement are manifested by the voluntary assumption of inappropriate or bizarre postures or by prominent grimacing. Echolalia is the pathological, parrotlike, and apparently senseless repetition of a word or phrase just spoken by another person. Echopraxia is the repetitive imitation of the movements of another person. Additional features include stereotypies, mannerisms, and automatic obedience or mimicry. During severe catatonic stupor or excitement, the person may need careful supervision to avoid self-harm or harming others. There are potential risks from malnutrition, exhaustion, hyperpyrexia, or self-inflicted injury. To diagnose this subtype, the individual's presentation must first meet the full criteria for Schizophrenia and not be better accounted for by another etiology: substance induced (e.g., Neuroleptic-Induced Parkinsonism, see page 792), a general medical condition (see page 185), or a Manic or Major Depressive Episode (see page 417).
Diagnostic criteria for 295.20 Catatonic Type
A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:
(1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
(2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
(3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
(4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
(5) echolalia or echopraxia
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age: 23
dx: bipolar I, ADHD-C, tourette's syndrome, OCD, trichotillomania, GAD, Social Phobia, BPD, RLS
current meds: depakote (divalproex sodium) 1000mg, abilify (aripiprazole) 4mg, cymbalta (duloxetine) 60mg, dexedrine (dexamphetamine) 35mg, ativan (lorazepam) 1mg prn, iron supplements
past meds: ritalin, adderall, risperdal, geodon, paxil, celexa, zoloft
other: individual talk therapy, CBT, group therapy, couple's therapy, hypnosis
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