Stability and variability of catatonic symptoms in the longitudinal courseof illness. Videotape documentation in catatonic schizophrenia

The symptomatology of a female patient with catatonic schizophrenia is pres ented with respect to its longitudinal course. The stability and variabilit y of catatonic symptoms are investigated using videotape technique. It is d emonstrated that catatonic symptoms are stable in the longitudinal course b ut due to unsteady arousal they severity of the catatonic symptoms varies m arkedly. There are fluctuating symptom patterns that dominate the clinical picture: a hyperkinetic form with prevailing restlessness or excitement, wi th abnormal involuntary movements, stereotypies, and parakinetic movements, and a hypokinetic form with various inhibition phenomena, mutism and stupo r. The clinical impression of the catatonic syndrome changes according to t he dominating symptom patterns at different: times, whereas the less severe symptoms recede into the background and thus, may be overlooked. Consideri ng this finding the problem of a 'diagnostic threshold' is discussed. The a uthors intend to emphasize videotape documentation of catatonic motor distu rbances as most useful. This technique may contribute to differentiating il lness related from neuroleptic induced movement disorders.