Catatonia is a syndrome characterized by psychomotor abnormalities.

Definition

Catatonia is a syndrome characterized by psychomotor abnormalities, often presenting as a state of apparent unresponsiveness to external stimuli or inability to move normally in a person who is awake. Classically associated with schizophrenia, but may also present in bipolar, PTSD, autism, encephalitis, and other neurologic disorders. If left untreated, can progress into malignant catatonia (20% mortality).

A man is sitting with catatonia, making a strange gesture

Classification of Catatonia

There are several proposed classifications of catatonia, which are outside the scope of this article.

Taylor and Fink proposed that catatonia should be classified as an independent entity with three subtypes:

Non-malignant (Kahlbaum syndrome): The most frequent form of catatonia which has a positive response to treatment with benzodiazepines (lorazepam 6-20 mg IV)

Delirious catatonia: Defined by the presence of excitement, altered states of consciousness, and delirium requiring higher doses of BZDs, worsens with antipsychotics (APs) and often requires adjunctive ECT.

Malignant catatonia: Acute onset, fever, autonomic instability, leucocytosis, increased CK. This type responds to ECT. Due to the similarity with the presentation of neuroleptic malignant syndrome, Fink suggested that malignant catatonia and NMS should be considered the same disorder.

One key difference highlighted between NMS and catatonia is that malignant catatonia starts with psychotic excitement while NMS starts with severe extrapyramidal muscular rigidity.

The alternative clinical classification includes:

Retarded catatonia: A characterized by immobility, mutism, staring, rigidity.

Excited catatonia: A less common presentation in which patients develop prolonged periods of psychomotor agitation.

Catatonia pathophysiology

The pathophysiology of catatonia is not fully understood, but as imaging studies have improved more structures and pathways have been implicated in the pathogenesis of this syndrome. Using FMRI imaging, dysfunction has been seen in the right medial orbitofrontal and lateral orbitofrontal prefrontal cortex.

The right motor cortex has shown atypical lateralization after patients who were suffering from catatonia were given lorazepam. Dysfunction in GABA, glutamate, serotonin, and dopamine transmissions have been implicated in the initiation and progression of catatonia symptoms through clinical findings of catatonia as a result of agents that disrupt these pathways or agents that affect these pathways relieving the symptoms of catatonia.

Causes of Catatonia

The DSM-5 doesn’t identify a specific cause of catatonia but it associates it with symptoms of other conditions.

Mental health conditions that may include catatonia include:

Depression

Bipolar disorder

Conditions that involve psychosis, such as schizophrenia

Neurodevelopmental disorders, such as ADHD or autism

Substance use disorders

Catatonia can also happen with certain medical conditions, including:

Head trauma

Cerebral folate deficiency

Certain autoimmune disorders

Diabetic ketoacidosis

Catatonia symptoms

It includes different signs and symptoms. The following are possible signs noted in patients with catatonia.

Automatic obedience – The patient automatically obeys all instructions given by the doctor.

Ambitendency – The patient alternates between cooperating with the doctor’s instructions and resisting them.

Aversion – The patient turns away when he or she is being spoken to.

Echopraxia – The patient imitates the activities of the person speaking with him or her.

Excitement – The patient engages in excessive and purposeless action that is not driven by outside stimuli.

Negativism – The person is always having negative thoughts and feels sad every day.

Stupor – This is one of the common signs of catatonia. It is characterized by a lack of mobility and speech.

Posturing – The person remains in the same posture for a long period of time.

Mutism – The person is verbally unresponsive and refuses to speak.

Staring – The individual’s eye is fixed on a particular space and open for long periods of time.

Risk factors

The following are the risk factors:

Prior episodes of catatonia

Current or past extrapyramidal symptoms

Mood disorders with psychomotor changes

Autism spectrum disorder

Psychotropic medications (antipsychotics, antidepressants)

Substances (cocaine use, or alcohol/benzodiazepine withdrawal)

Withdrawal of long-term anticholinergic use

Electrolyte disturbances (hyponatremia, hypomagnesemia, and low serum iron)

Additional risk factors include:

Central nervous system disease (frontal, basal ganglia, brainstem, pontine, or cerebellar)

Epilepsy

Dehydration

Weight loss

Medications that lower seizure threshold.

Complications

It can put your safety in jeopardy, especially when it involves:

Stupor

Refusal of food or water

Fever

Repeated movements that lead to injury or self-injury, such as kicking or head-banging

It often requires hospitalization until symptoms improve, especially when the person with catatonia:

Has other serious medical or mental health symptoms

Can’t eat or drink

Can’t take care of basic needs

A healthcare team can treat catatonia while also monitoring vital signs and providing hydration and nutrients.

Severe or untreated catatonia can have severe health effects, including:

High blood pressure

Blood clots in the lungs

Severe swelling

Muscle tissue breakdown

High fever

Eye infection

Kidney failure

If you believe a loved one may have catatonia, you may want to get medical support for them.

Diagnosis of Catatonia

There are different tests a doctor might do to find out if someone has catatonia and what is causing it. Finding out what might have caused catatonia can help a doctor to treat the catatonia itself.

If it is thought you might have catatonia, your doctor will consider the following things:

History – The doctor will talk to you or the person caring for you to find out about your history. They will also want to know how you have been feeling recently. You or the person caring for you should let them know about any drugs you are taking, any head injuries you might have had and any other health problems.

Observation – The doctor might observe your behaviour during an appointment or when you are on a hospital ward.

Examination – The doctor might choose to examine you to make sure that your body is working properly. This should be a full physical examination of your heart, lungs, abdomen and nervous system.

Blood tests – The doctor might take some blood tests. These will look to see if you have any infections or any problems with how your body is working.

Brain scan – After doing an examination and taking blood tests, the doctor might do a brain scan if they need more information. The scan will let your doctor see your brain in more detail.

Electroencephalogram (EEG) – This test monitors the electrical activity in your brain. It can be used to see if you have a neurological condition. EEGs are performed by attaching small sensors to your head and using a machine to pick up the electrical signals produced by your brain. You can find out more about EEGs

Treatment

Electroconvulsive therapy (ECT) and medications are the only two clinically proven treatment methods to treat catatonia. Common treatment approaches are mentioned below.

Medications

The first approach is usually using medications to treat the symptoms. The medications can include benzodiazepines, muscle relaxants, and in some cases tricyclic antidepressants. The first medication that is usually prescribed is benzodiazepines 9.

This medication includes clonazepam (Klonopin), lorazepam (Ativan), and diazepam (valium). This medication helps to increase gamma-aminobutyric acid (GABA) in the brain. People with a high ranking on Bush Francis Catatonia Rating Scale (BFCRS) usually respond well to benzodiazepines treatment.

There are other medications that are prescribed to the patient suffering from this disorder. They include:

Amobarbital (barbiturate)

Bromocriptine (Cycloset, Parlodel)

Carbamazepine (Carbatrol, Epitol, Tegretol)

Lithium Carbonate

Thyroid hormone

Zolpidem

The duration of medication is usually 5 days. If the symptoms don’t start to get better after 5 days the doctor may resort to other methods of treatment.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy 10 is found to be effective in treating patients suffering from this disorder. This therapy takes place in a hospital under medical supervision. The procedure is completely painless. At first, the person is sedated and a special machine is connected to deliver an electric shock to the brain. This procedure causes a one-minute seizure in the individual. This seizure is believed to cause changes in the neurotransmitters of the brain. This method has been found helpful to ease the symptoms.

Prevention

Even when compared to other patients with mental illnesses, patients with catatonia have a significantly increased mortality. Rates of certain medical complications are high, notably infections, rhabdomyolysis, pressure sores, dehydration, venous thromboembolism, cardiac arrhythmia, renal failure, and neuroleptic malignant syndrome.ComplicationPrevention and managementInfection

If not passing urine, consider catheterization to avoid urinary stasis

If pneumonia occurs, aspiration pneumonia is a possibility, so ensure that antibodies cover Gram-negative organisms

Rhabdomyolysis & pressure sores

Daily skin assessment

Frequent repositioning

Pressure mattress

Emollients

Dehydration

Monitor fluid intake

Frequently prompt drinking

Consider intravenous fluids

Venous thromboembolism

Consider thromboembolism deterrent stockings or prophylactic low molecular weight heparin

Malnutrition

Give lorazepam 30-60 minutes before meals

Consider nasogastric feeding if 5-7 days of inadequate intake

India warship arrives Lagos port.

Indian Naval warship INS Tarkash reached Port Lagos in Nigeria on Thursday.

Continuing with her deployment in the Gulf of Guinea, the naval vessel was welcomed by officials of the Nigerian Navy, the High Commission of India and children of the Indian Language School at the largest port of Nigeria, the Indian Navy said in an official statement.

Alongside conducting professional interactions with the Nigerian Navy, the ship will also participate in ports fixtures and social engagements, the Indian Navy said.

Both sides will interact to enhance interoperability, and best practices will be shared between the two nations’ navies.

Subsequently, the ship will also be open to visitors, providing an opportunity for the Indian diaspora and locals to interact with her crew.

Earlier on August 15, INS Tarkash hoisted the tiranga at Rio De Janeiro, as part of Azadi Ka Amrit Mahotsav celebrations.

Notably, Indian and French navies conducted a Maritime Partnership Exercise (MPX) with French naval ships in the North Atlantic Ocean on July 29 and 30 in which INS Tarkash and French Fleet Tanker FNS Somme carried out a replenishment at sea, followed by cooperative air operations with the maritime surveillance aircraft Falcon 50, taking part in several mock missile engagements and air defence drills.

Earlier on July 29, INS Tarkash completed her Mediterranean deployment and entered the Atlantic to continue with her long-range voyage.

According to the Indian Navy, the ship participated in a Maritime Partnership Exercise in the Atlantic with Royal Morocco Naval Ship Hassan 2, a Floreal Class Corvette on July 26.

Exercises conducted included man overboard drills, visit board Search and seizure operations, approaches for replenishment at sea, tactical manoeuvres and helicopter cross deck landings.

Homepage News..

Bitcoin rose more than 7 per cent to $20,796, a two-week high.

Bitcoin surged past the $20,000 barrier and was eyeing its best day in six weeks on Friday as the U.S. dollar fell broadly and markets found reasons to be cheerful at the end of a dour week.

Bitcoin, the biggest cryptocurrency by market value, rose more than 7 per cent to $20,796, a two-week high. Ether, the second-biggest, rose 5 per cent to also hit a two-week peak at $1,717. Bitcoin had been as low as $18,540 on Wednesday.

Market participants said there was no particular trigger for the gains beyond a broad upbeat mood in evidence across asset classes on Friday, led by a drop in the safe-haven dollar and a rally in Chinese stocks.

If the cryptocurrencies can hold their gains until Sunday’s close, Bitcoin could log a second weekly rise in a row, and its best week in about a month.

Ether’s weekend volatility may be heightened by a looming software upgrade known as the merge, due sometime between Sept. 10 and 20, with the exact timing uncertain.

The shift will radically change how transactions are processed and is supposed to slash energy consumption. Some exchanges plan to pause deposits and withdrawals while the upgrade occurs.

Homepage News..

North korea to begin Covid-19 vaccination.

North Korean leader Kim Jong Un has suggested that the isolated country could begin COVID-19 vaccinations in November, state media reported on Friday (Sep 9).

In a speech on Thursday to the North Korean national assembly, Kim cited World Health Organization (WHO) warnings that the winter could see a resurgence in coronavirus infections.

Therefore, along with responsible vaccination, we should recommend that all residents wear masks to protect their health from November, he said, without elaborating.

North Korea has not confirmed administering any COVID-19 vaccinations, although customs records show that it has imported some unspecified vaccines from China this year.

Last month Kim declared victory over COVID-19 and ordered the lifting of maximum anti-epidemic measures imposed in May though adding that North Korea must maintain a steel-strong anti-epidemic barrier.

Therefore, along with responsible vaccination, we should recommend that all residents wear masks to protect their health from November, he said, without elaborating.

North Korea has not confirmed administering any COVID-19 vaccinations, although customs records show that it has imported some unspecified vaccines from China this year.

Last month Kim declared victory over COVID-19 and ordered the lifting of maximum anti-epidemic measures imposed in May though adding that North Korea must maintain a steel-strong anti-epidemic barrier.

North Korea has never confirmed how many people caught COVID-19, apparently because it lacks the means to conduct widespread testing.

Instead, it has reported daily numbers of patients with fever, a tally that rose to about 4.77 million, out of an estimated population of about 25 million. But it has registered no new such cases since Jul 29, and says its death toll stands at 74.

Homepage News..

Australian Republic Movement offered condolences to the Queen’s family.

Australians on Friday (Sep 9) mourned the death of Queen Elizabeth, but Republicans also revived a longstanding debate on ending the country’s association with the 1,000-year-old monarchy.

The British monarch is the head of state in Australia, among 14 realms outside the United Kingdom, although the role is largely ceremonial.

Australia has long debated the need to keep a distant monarch. A 1999 referendum in Australia on becoming a republic lost with 55 per cent of voters opposed.

Our thoughts are with her family and all who loved her. Now Australia must move forward”, said Australian Greens Party leader Adam Bandt, a prominent Republican.

We need Treaty with First Nations people, and we need to become a Republic, he wrote on Twitter.

Bandt was accused, even by some fellow Republicans, of being disrespectful by bringing up the issue just hours after the queen’s death.

Not the right time to call for a republic irrespective of where you sit on the monarchy/republic spectrum. Not respectful after her long life of service, one of Bandt’s followers said in response to the tweet.

Bandt’s office did not immediately respond to an email seeking comment.

The Australian Republic Movement also offered condolences while noting that the queen had backed Australia’s right to become a fully independent nation during the 1999 referendum, saying she had affirmed it was an issue for the Australian people and them alone to decide.

Australian Prime Minister Anthony Albanese has spoken in support of moving toward a republic. But on Friday he said: Today’s a day for one issue and one issue only, which is to pay tribute to Queen Elizabeth II.

Similar debates are occurring in the Caribbean, where Jamaica has signalled it may soon follow Barbados in ditching royal rule.

Homepage News..

Sharp currency moves are undesirable as they destabilise corporate business plans and heighten uncertainty, Kuroda Japan Central Bank Governor.

Bank of Japan Governor Haruhiko Kuroda said rapid yen moves were undesirable after a meeting with Prime Minister Fumio Kishida on Friday, joining a chorus of policymakers lobbing verbal warnings over the currency’s recent sharp drop to 24-year lows.

Sharp currency moves are undesirable as they destabilise corporate business plans and heighten uncertainty, Kuroda told reporters after the meeting, which he described as an occasional catch-up by the two sides to discuss broad economic and financial matters.

When the yen is moving 2 to 3 yen per day, that’s a rapid move,” Kuroda said, when asked about the Japanese currency’s recent fluctuations.

The dollar jumped more than 2 yen on both Tuesday and Wednesday, reaching 144.99 per dollar – its highest since August 1998 – before stabilising.

“We will watch exchange rate moves carefully,” Kuroda told reporters after Friday’s meeting with Kishida.

He added that, while the two discussed market developments including currency moves, he did not receive any specific policy requests from the premier.

The dollar fell to 143.10 yen following Kuroda’s remarks and extended that drop as far as 142.43. It was last down about 1 per cent at 142.75, marking its largest one-day drop in about a month.

Kuroda’s remarks came after Finance Minister Shunichi Suzuki said on Friday that the government would not rule out any options on foreign exchange moves, repeating a warning by the country’s top currency diplomat, vice finance minister for international affairs Masato Kanda, on Thursday.

We’ve seen a rapid heightening of market volatility against the background of speculative moves, Suzuki told reporters, adding that authorities were very concerned about such moves.

Homepage News..

22 years old man hacked to death for chewing tobacco near golden temple in India.

Indian police said on Friday (Sep 9) they had arrested three members of a radical Sikh sect accused of hacking to death a young man for chewing tobacco near the Golden Temple, the faith’s holiest shrine.

Harmanjeet Singh, 22, was killed after an altercation with three Nihangs – a radical Sikh warrior sect known for dressing in blue robes, carrying swords, and a puritanical moral code.

The trio had accused Singh of being drunk and consuming tobacco – both prohibited under the religion’s codes of conduct.

The incident occurred in full public view, Amritsar police commissioner Arun Pal Singh told reporters on Thursday, a day after the murder.

Onlookers watched the entire episode at Kahia Wala Bazar on Wednesday night and did not come forward to prevent it.

Police had arrested all three men by Friday afternoon, officers told AFP.

The protection of shrines is a highly sensitive issue for the Sikh faith, and the consumption of tobacco, liquor or drugs on a holy site is considered an act of desecration.

The killing took place in a market just a few minutes’ walk from the Golden Temple, the headquarters of the religion’s most senior clergy and home of its holy book of scripture, the Guru Granth Sahib.

Former Indian prime minister Indira Gandhi was assassinated by her Sikh bodyguards in 1984 after she ordered a brutal army assault on the Golden Temple to flush out separatists.

Her killing sparked a bloody pogrom in the capital New Delhi which left nearly 3,000 Sikhs dead.

Last year a crowd beat a man to death on the grounds of the Golden Temple after he jumped over a railing and approached the holy book with a sword.

Homepage News..

South Korea fisherman shot dead and body set ablaze by North Korea military.

When North Korean soldiers found a South Korean fisheries official in their territorial waters, they shot him dead and burned the body an incident so shocking it later prompted Kim Jong Un to apologise.

Details are sketchy – and mostly classified – but exactly how and why the official came to be floating in a life jacket above the sea border known as the Northern Limit Line in September 2020 has become a bitter political debate in the South.

Was the 47-year-old official, Lee Dae-jun, a would-be defector fleeing gambling debts, as the government of then-president Moon Jae-in said, citing intelligence it then sealed for 30 years?

Or is that version of events actually a high-level smear campaign and cover-up, as the new government of Yoon Suk-yeol has claimed in raiding an ex-spy master’s house and launching legal action over the former administration’s handling of the case?

The intelligence services claim that their former chief, Park Jie-won, destroyed evidence showing Lee had no plans to move to Pyongyang.

Homepage News..

China’s vehicle exports increased to 65 per cent from a year ago, CAAM added, with electric vehicles accounting for 27 per cent of them.

China’s auto sales reached 2.38 million units in August, increasing 32.1 per cent from a year ago, as they extended a recovery led by electric vehicles (EV) whose sales have been boosted by government incentives.

Sales for the first eight months were 1.7 per cent higher than the same period in 2021, data from the China Association of Automobile Manufacturers (CAAM) showed on Friday.

August sales of new energy vehicles, which include pure electric vehicles, plug-in hybrids and hydrogen fuel-cell vehicles, increased 100 per cent from the previous year.

CAAM tracks broader auto sales including passenger vehicles, buses and trucks while the China Passenger Car Association, which reported July sales on Thursday, focuses on retail sales of cars.

China’s vehicle exports also increased 65 per cent from a year ago, CAAM added, with electric vehicles accounting for 27 per cent of them.

August sales, however, were 1.5 per cent lower than July, as power restrictions affected production of automakers and China’s longest and most intense heatwave since records began in 1961 reduced customer visits to showrooms.

With the economy sputtering, China has tried to revive auto demand with incentives such as a lower sales tax for small-engine vehicles and subsidies to spur trade-ins of gasoline vehicles for electric ones.

But more cities including Shenzhen and Chengdu have imposed fresh lockdowns as Beijing sticks to its “dynamic zero” COVID policy to stamp out every infection chain.

Those measures are weighing on the industry again with automakers such as Volvo, Toyota and Volkswagen either suspending production or putting their factories into closed-loop systems, which generally still impacts output.

The sector was hit hard earlier in the year, with months of stringent lockdowns in the major manufacturing hubs of Shanghai and Changchun.

Homepage News..