IS CATATONIA A SEPARATE NOSOLOGICAL ENTITY RELATED TO AFFECTIVE-DISORDERS - PSYCHOPATHOLOGICAL OBSERVATIONS AND BIOLOGICAL CORRELATES IN 7 CLINICAL CASES

Whether catatonia (C) is a subtype of schizophrenia, an affective illn ess or an autonomous syndrome is still under debate. A rare, particula r form of C, the so-called ''acute lethal catatonia'' or ''catatonia p eniciosa'' (CP), is a life-threatening organic condition characterized by hyperthermia, increased muscular tone and stupor alternated with e xcitement. After a short review of the literature, the purpose of this study of 7 cases of C (2 of CP) was to evaluate: a) the validity of a diagnosis within the boundaries of either schizphrenic or mood disord ers; b) the relationships between some psychoneuroendocrinological par ameters and the psychopathological picture. Determination of prolactin (PRL) levels and 24-hr profile of plasma cortisol, after and before d examethasone suppression test (DST), were performed in 4 cases, both a t the acute catatonic stage (CS) and after remission (R). PRL was neve r significantly altered as to values and rhythm; cortisol showed highe r levels and a more disrupted rhythm at CS than at R; DST was positive at CS in all 4 cases switching to negative in 2 cases at R(1 undeterm ined). Premorbid characteristics, a severe mood disturbance with or wi thout delusions in the acute stage, and a post-psychotic dysthymic or cyclothymic disorder are common elements in most cases. Taken together with psychoneuroendocrinological data, clinical features seem in favo ur of the Kahlbaum's affective hypothesis of C.