FATAL CATATONIA
OTTO BILLIG M. D.1, and
W. T. FREEMAN M. D.1
1 Highland Hospital, Asheville, N. C., and the Neuropsychiatric Department, School of Medicine, Duke University, Durham, N. C.
Fatal catatonia is considered a complication to the usual schizophrenic course. The syndrome may occur in cases of apparent health or show itself as an exacerbation during any form of schizophrenia. The heredobiologic and pathophysiologic mechanisms, and the clinical course prove that this syndrome does not represent a separate schizophrenic group but merely a complication.
The symptoms are: A prodromal phase which lasts from 2 weeks to a few months and shows the usual schizophrenic pattern.
First Phase.—Increasing perplexity and intense anxiety; incoherence; extreme restlessness; a "blind drive for annihilation" and suicidal tendencies; acrocyanosis, increased blood-pressure.
Second Phase.—Motor restlessness changing to a more primitive pattern; consciousness becomes increasingly clouded; unusual hematopoietic changes of the blood; blood pressure falls; pulse is rapid and weak; pupils are dilated and react sluggishly to light; reflexes are decreased; high elevation of temperature; pronounced cyanosis; petechial hemorrhages into the tissue; sudden respiratory death or vasomotor collapse.
Autopsy Findings.—Negative except for petechial hemorrhages into the tissues, and transformation of the fatty bone marrow to the erythropoietic state.
A theory of possible "asthenic metabolic changes" due to disturbances in the hormonal-vegetative system, and its practical application were discussed.
