There are some instructive videos on Catatonia produced by Pathescope Productions in the 1940′s. The videos are displayed below. Catatonia is a disorder of movement and affect that can occur in a number of conditions. The Pathescope films are specifically about people with Schizophrenia although they occur in other mental illnesses such as mood disorders as well as medical conditions including Central Pontine Myelinolysis (see Appendix for other posts on Catatonia). The features of Catatonia vary from one person to another and this condition can improve with treatment. Various lines of evidence suggest that the Basal Ganglia plays an important role in Catatonia. More recently in the work on the new diagnostic manual DSM-V it has been proposed that Catatonia’s direct and circumscribed association with Schizophrenia should be removed and instead that it should be described as occurring or not occurring with a broad range of illnesses such as Schizophrenia and Mood Disorders. Indeed there has been a suggestion that Catatonia has been underrecognised. However Professor Fink in an excellent article in the Indian Journal of Psychiatry argues that Catatonia merits a category of its own in DSM-V. His discussion of Self-Injurious Behaviours in relation to Catatonia are particularly interesting. Below are a number of videos illustrating different features of Catatonia (although there are many remaining features not contained in this selection of videos).
In Echopraxia the person experiences a compulsion to imitate the actions of others. The video above compares Echopraxia with a person who is simply following the actions of the examiner. The differences are fairly subtle although it can be seen that in the lady displaying Echopraxia, the movements are more exaggerated, with a rapid onset perhaps relating to affect. Echopraxia can be accompanied by Echolalia in which the person will echo another person’s speech.
In Catatonia, certain postures can be maintained for extensive periods of time. They may look uncomfortable to the observer particularly as we would expect muscle fatigue. Whilst to the untrained observer it may appear that this is entirely volitional it should be borne in mind that a disorder which affects the delicate interplay of agonists and antagonist muscle groups may make such postures more comfortable. However despite the length of time over which Catatonia has been described a convincing integrated psychophysiological explanation is still needed.
In Negativism the person will display a rigidity in which the examiner’s movements are resisted. In the context of other features of Catatonia this again may relate to the regulation of tone in muscle groups.
Stereotypies and Mannerisms
In Catatonia there are two types of movements which are distinguished from each other by the goal of those movements (sometimes described as adaptive and non-adapative movements). Thus Stereotypies are non-goal directed and Mannerisms are goal-directed. As examples, in Stereotypies a person may continue to draw their hand to their mouth but will not complete the movement. With Mannerisms, the person may brush their coat repeatedly. Although this would be understandable if they were brushing something off the coat on one occasion, the actions start to lose their meaning after multiple repetitions.
In Waxy Flexibility (Latin: Cerea Flexibilitas) when the person is moved into a position by the examiner they will remain in that position for some time. However over time this position will gradually return to the usual resting position.
Appendix – Other Posts on Catatonia
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