Abnormal Psychology - Catatonia Disorder - Coursework Example

Catatonic Catch I. Introduction The movie, Awakenings, is set sometime in the late 1969 in which a caring and dedicated physician, Dr. Malcolm Sayer got a job at a local hospital in the Bronx of New York. He was assigned to handle psychologically challenged patients which include catatonic ones who survived encephalitis lethargic from 1917 to 1928. Encephalitis is a CNS Disorder that manifests with lethargy sleep cycle disturbances, extrapyramidal symptomatology, neuropsychiatric manifestations, ocular features and cardio respiratory abnormalities (Lopez-Alberola et al., 2009). One of his patients was a certain Leonard Lowe, the character in the movie who displayed symptoms of catatonia. Leonard lost the ability to write and to move when he was 11 years old. At that early age, he showed rigidity of movements and auditory hallucinations as one of the symptoms of this so-called chronic catatonic state. It is rare, chronic, progressive, encephalitis that affects primarily children and young adults and is caused by a persistent infection of immune resistant measles virus (Stalberg & Punga, 2008). One time, Dr. Sayer was able to realize a very important discovery: one catatonic patient was able to move his hand while he was trying to catch a ball that was thrown at him. That discovery lead to even more surprising discoveries one after the other. It seemed that catatonic patients react to a certain stimuli and somehow, those stimuli could reach beyond their state of immobility. These stimuli can be in the form of hearing specific genres of music, human touch, reacting when a television was moved or just by simply walking on consistent floor tiles and yes, by the simple mention of their names. The only one patient who remained elusive of these activities was Leonard Lowe but then soon found his own way to react and communicate – by the means of a Quija board. It was after Dr. Sayer attended a lecture on Parkinsons Disease and on the subject of the L-Dopa drug that he arrived at one unconventional idea of treating catatonic patients. He thought outside of the box like he normally does and wanted to test his theory by using L-Dopa as a treatment to save his patients from their trance-like states. He first did the experiment on Leonard Lowe – starting on low doses of L-Dopa until he eventually got the astounding result by doubling the said dose. And because the experiment produced a breakthrough, L-Dopa was given to the rest of the catatonic patients as well. This led to more “Awakenings” – patients who stopped speaking and moving for years all got a second chance at life. As Leonard began to appreciate being alive after so many years, he then too, found himself in another phase of freedom: the joy of being physically and romantically interested in someone by the name of Paula, whose father is also a patient in the said hospital. This sense of freedom somehow made Leonard want for more. He wanted to come and go as he pleases – take an outside walk all by himself. He requested the doctors to give him the chance to be completely free and when this was denied, he started to show hostility and agitation. The worst part was that he was starting to manifest a number of uncontrollable facial and body tics. Later on, he showed a symptom of paranoia and anxiety. It turned out that the effect of L-Dopa was just temporary – and this limited measure of cure made the other patients realize that they too, would one day, be like Leonard. As the movie was nearing to the end, Leonard began to show more serious adverse effects of the L-Dopa drug: full body spasms and the inability to move again. As the character tried to put up with the pain he was feeling, he requested Dr. Sayer to film him so that he can be a part of the research that will help save others in the future. He returned back to the state of catatonia after he had his last lunch with Paula where he told her that he just could not see her anymore. That’s when the rest of the “awakened” patients fully accepted the truth that no matter how much their L-Dopa drug would be increased in dosage, they will still eventually return to their state of being catatonic. The movie clearly depicts not on how long the patients enjoyed the luxury of being alive, but how they were given that glimpse to live and enjoy their moments of joy and freedom in a borrowed, limited sense of time. II. Symptoms and Criteria Catatonia as medically defined by a German psychiatrist, Dr. Karl Kahlbaum, is a brain disorder with a cyclical and sequential course of melancholia, mania, stupor, delirium and dementia (Stompe, Ritter, & Schanda, 2007). It is a distinct psychomotor disease with motor, affective and behavioral symptoms (Caroff, et al, 2006). Symptoms of catatonia are as follows: Motoric immobility – this can be manifested due to catalepsy or waxy flexibility and/or stupor. Excessive motor activity – which is apparently purposeless and is not influenced by the external stimuli. Extreme negativism – the tendency to do the opposite of what one is requested to do or to just stubbornly resist for no apparent reason whatsoever. Peculiarities of voluntary movements – inappropriate movements and actions. Echophenomena – otherwise known as Echolalia or the meaningless, involuntary repetition of a recently heard word or phrase which is associated with Schizophrenia and other mental disorders. From the American Journal of Psychotherapy, catatonia was moreover defined as a neuropsychiatric syndrome with a unique combination of mental, motor, vegetative and behavioral signs (Yongue, 2006). In the movie, all these symptoms were manifested by all 30 catatonic patients. All of them remained “dead outside-but-alive-inside” for almost forty years. The character Leonard Lowe in particular stopped speaking and just disappeared from the real world in November of 1939 that all he could ever do was read. When he lost the ability to write, his mother found him in a state of a trance sitting on a desk with his arms reaching out. He also showed symptom of auditory hallucinations, which is prevalent in most psychological disorders. III. Diagnosis As defined in the Diagnostic & Statistical Manual of Mental Disoders (DSM-IV): “Catatonia is not only a subtype of Schizophrenia but also a disorder due to medical conditions and as a specifier of mood disorders” – that to be able to call a patient catatonic, he or she has to show the five symptoms or criteria for Catatonia with eleven single catatonic symptoms (Stompe, Ritter, Schanda 2007). The International Classification of Diseases (ICD-10) however, defines Catatonia as a subtype of Schizophrenia. Researches were done by Emil Kraepelin, Bleuler and Schneider to name a few and hence, it was then that Catatonia became Catatonic Schizophrenia. In one of their studies, it turned out that 50% with prominent catatonic features do not have schizophrenia and yet, 15-30% of those diagnosed with schizophrenia show prominent catatonic features (S. Heckers et al., 2010). Accordingly, if I were to diagnose the patients in the movie, specifically Mr. Leonard Lowe, I must say that his condition can be attributed to Chronic Catatonia. However, since not all of the DSM IV-TR criteria for schizophrenia is met, then catatonia can be considered a subtype of Schizophrenia. For instance, when Mr. Lowe was not granted the total freedom to walk outside by himself, he started to show signs of hostility and a great deal of anxiety. But moving on with this diagnosis, I would like to state what Schizophrenia is – a chronic, severe and disabling brain disorder that has affected at least 1% of the population all throughout history. It is a mental disorder that shows symptoms of hallucination, both auditory and visual, agitation and paranoia. There are three broad symptoms of this disorder: The Positive, The Negative and The Cognitive Symptoms (“Schizophrenia”, n.d.). The Positive Symptoms are manifested when a patient or a person begins to lose touch of reality. One of the symptoms include hallucinations which is manifested when a patient begins to see, hear or feel what others cannot; delusions, which are false beliefs that are not part of the person’s logic. Delusions are usually bizaare and one example is the delusion of grandeur that makes a person believe he is a famous historical figure meant to do something great. Another one is the delusions of persecution in which a person believes that someone is out to hurt him, harass him or plot something bad against him or to those people he cares about. Meanwhile, a thought disorder is manifested when a person is having a hard time organizing his thoughts and neither does he have the ability to connect those thoughts. Finally, movement disorders is a repetition of movements which shows agitation and could soon lead to being catatonic. On the other had, the Negative Symptoms include Flat Affect or when the face does not move and a person talks in a monotonous voice. Other symptoms under this category are the lack of pleasure in everyday life; the lack of the ability to begin and sustain activities that were planned beforehand; and starting to talk little even when he is encouraged to talk. The Cognitive Symptoms are the ones that are usually difficult to recognize. They are usually detected when a specific test is performed. These symptoms show when a person is having trouble focusing his attention; when he shows poor ability to understand and make decisions and lastly, when he’s having problem with his memory. I believe that some of the above-mentioned symptoms of Schizophrenia were seen and were manifested by the character Leonard Lowe. In specific, when he was not granted the privilege to walk outside on his own, he had this delusion that those doctors do not want him to enjoy life and freedom. He walked out on Dr. Sayer when he told him of the sad news and got physically violent when the guard refused for him to leave the hospital all alone and without the doctors’ permission. He then started to think that everyone was out to stop him from being happy and thus, started a revolt inside the hospital. His paranoia somehow made him anxious of being kept inside. He had facial and body tics which also is a sign of uncontrolled, repetitive movements. He pushed Dr. Sayer on the floor when he tried to talk sensible things into his head – which sadly, he no longer has control over. The Flat Affect symptom was shown when he talked to Dr. Sayer after he found him helplessly sitting on the floor in an empty room. He then could no longer speak that well which was also shown in the later part of the movie. Therefore, with the symptoms shown by Leonard Lowe – some Schizophrenic Symptoms that somehow in the end, led him again to a state of Catatonia, I diagnose Mr. Lowe as having Catatonia as a subtype manifestation of Schizophrenia. IV. Recommended Treatment In the movie, L-Dopa or levodopa was used on catatonic patients, though the said drug is used to treat another kind of disorder: Parkinson’s disease. The drug is supposed to help alleviate symptoms of Parkinson’s disease such as rigidity, trembling and slow movements. Parkinson’s disease results when there is a low supply of dopamine in the brain (“L-Dopa”, n.d.). It can alleviate in a way that it is able to cross the blood-brain barrier whereas dopamine cannot. The moment L-Dopa enters the Central Nervous System, it then metabolizes into dopamine by aromatic-L-amino-acid-decarboxylase. However, such conversion can cause adverse effects while decreasing more dopamine in the CNS. Some of the adverse affects of L-Dopa are hallucinations and depression. And since in the past, scientific breakthroughs are not as compelling and as effective as the ones we have today, patients then had smaller chances of being cured. In any case, catatonic patients should be partly treated the way schizophrenics are treated and that is through anti-psychotic medications and psychosocial treatments. Some of the famous anti-psychotic brands are Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Aripriprazole (Abilify) and Paliperidone (Invega). These are the second generation or called the “atypical” anti-psychotics. Though these antipsychotics help treat hallucinations and make the patients break with reality, they too have side effects. However, these side affects go away after a few days and yes, they can be managed well including drowsiness, blurred vision, sun sensitivity, skin rashes, problem with menstruation for women, dizziness after a sudden change in position and weight gain (“Anti-psychotic Drugs”, n.d.). With anti-psychotic drugs, hallucinations can go away in days and delusions will be gone after a week – after continuous medication, patients will see and feel a lot of improvement. But people react differently to certain drugs, so it is only advisable that to try several medication for him or her to find the perfect drug (“Antipsychotic Drugs”, n.d.). Psychosocial treatments then can be given once a patient has stabilized with the anti-psychotic drug. Through this, patients will be given some support as they deal with their everyday illness and the challenges that go with it. This can include difficulties in communicating with significant others and eventually in forming and maintaining intimate relationships with people around them. Moreover, psychosocial treatments can help them adjust with their weaknesses and to bank on their strengths to become functional and productive citizens of their respective communities (“Psychosocial Treatments”, n.d.). Accordingly, those who undergo intense psychosocial treatment will be less likely to undergo a relapse. On the other hand, the therapist can likewise provide more in-depth education to patients with regards to their illness with the goal of understanding themselves in view of their illness. This way, they will be able to take a proactive stance to it and do everything in their power to manage it independently which is the most important part of psychosocial treatment. References Abbott, E. (Producer), Marshal, P. (Director). (1990). Awakenings [Motion picture]. United States: Columbia Pictures. Ahuja, N. & Lloyd, A. J. (2008). On catatonia, seizures and bradycardia. Psychosomatics. Pro Quest Health and Medical Complete, 86. Anti-psychotic Drugs. (n.d.) Retrieved April 20, 2010 from https://mail.google.com/mail/?ui=2&ik=3ccdb0a2ca&view=att&th=12811a1a19a1f533& attid=0.10&disp=vah&realattid=f_g858h0hw9&zw Fawcett, J, M.D. (2007). Catatonia, past and present. Psychiatric Annals, 6. Freudenreich, M.D., McEvoy, M.D., Goff, M.D. & Fricchione, M.D. (2007). Catatonic coma with profound bradycardia. Psychosomatics, 74-78. Heckers, Tandon & Bustillo (2010). Catatonia in the DSM – Shall we move or not? Schizophrenia Bulletin. Volume 36, 205-207. How is Schizoprenia Treated (n.d.). Retrieved April 20, 2010 https://mail.google.com/mail/?ui=2&ik=3ccdb0a2ca&view=att&th=12811a1a19a1f533& attid=0.10&disp=vah&realattid=f_g858h0hw9&zw L-Dopa. (n.d.) Retrieved April 20, 2010 from http://www.encyclopedia.com/topic/l-dopa.aspx Levodopa and Carbidopa (n.d.). Why is this medication prescribed? Retrieved April 20, 2010 from https://mail.google.com/mail/?ui=2&ik=3ccdb0a2ca&view=att&th=12811a1a19a1f533&attid=0.12&disp=vah&realattid=f_g858h64511&zw Lopez-Alberola, Georgiou, Sfakianakis, Singer & Papapetropolous (2009). Contemporary encephalitis lethargica: Phenotype, laboratory findings and treatment outcomes. Original Communication, 396-404. Prowler, M. L., Weiss, D. & Caroff, S. N. (2010). Treatment of catatonia with methylphenidate in an elderly patient with depression. Psychosomatics. Pro Quest Health and Medical Complete, 74-76. Schizophrenia. (n.d.) Retrieved April 20, 2010 from http://www.medicinenet.com/schizophrenia/article.htm Schreurs, Stalberg & Punga (2008). Indication of peripheral nerve hyperexcitability in adult- onset subacute sclerosing panencephalitis (SSPE), Neurol Sci. Case Report, 121-124. Stompe, M.D., Ritter, M.D. & Schanda, M.D. (2007). Catatonia as subtype of schizophrenia. Psychiatric Annals, 31-36. Yongue, J.S (2006). From psychopathology to neurobiology. American Journal of Psychotherapy, 320. Read More