Catatonia (Actual Problems of Psychopatology and Clinical Systematics)

Background: the necessity of conceptual understanding of catatonia phenomenon is dictated by a new clinical reality. The matter concerns creating systematics of a wide range of catatonic disorders, based on the data of clinical, neurobiological and psychopharmacological studies. The aim of the study was to present psychopathological systematics of movement disorders, united by the concept of catatonia as transnosological entity (DSM-5, ICD-11 project).

Patients and methods: a total of 38 patients (20 males; 18 females; mean age 24.7 years; average duration of the disease 14.4 years) were studied. The subjects with established diagnoses of schizophrenia (F20), schizophrenic (F21) and schizoaffective (F25) spectrum disorders underwent treatment in the department of borderline psychiatry and psychosomatic disorders of the FSBSI “Mental Health Research Centre”.

Methods: clinical, pathopsychological, psychometric, Bush Fransis Catatonia Rating Scale (BFCRS), The Scale for the Assessment of Negative Symptoms (SANS).

Results: in the range of movement disorders, that combine non-psychotic forms of catatonia, two categories were distinguished, i.e. parakinetic catatonia syndrome (K. Kleist, K. Leonhard) and stereotyped catatonia syndrome (K. Kleist). Manifestations of parakinetic catatonia (polymorphism of motor symptom complexes, covering isolated areas of the body; impulsivity; extreme intensity; expressiveness with the effect of alienation, loss of arbitrariness of sensorimotor acts) are formed according to the mechanism of mental automatism, act as transformers, that modify positive pathocharacterological disorders and complicate the clinical picture of subsequent exacerbations of the process. Symptom complexes of stereotyped catatonia (monotony, general slowness, uniformity of unrelated motor acts/stiffness is out of the scope of patients’ attention/with a feeling of discomfort, alienation of motor sensations) are formed according to the mechanism of evolving dyskinetopathy. In the psychopathology space of the disease they play the role of doublers, amplifiers of negative (abulia, passivity, apathy, emotional fiattening) and cognitive disorders.

Conclusion: the identified non-psychotic catatonic syndromes (parakinetic and stereotyped catatonia) are clinically heterogeneous both in terms of the ways of their formation (mechanism of mental automatism/evolving dyskinetopathy) and functional activity in the psychopathology space of the disease (transformers of positive disorders/doublers of negative changes) and clinical prognosis.

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