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Inicio Psiquiatría Biológica Diagnóstico y tratamiento de la catatonia: a propósito de un caso
Journal Information
Vol. 20. Issue 3.
Pages 40-43 (July - September 2013)
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19892
Vol. 20. Issue 3.
Pages 40-43 (July - September 2013)
Caso clínico
Diagnóstico y tratamiento de la catatonia: a propósito de un caso
Diagnosis and treatment of catatonia: Presentation of a case
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19892
Raquel Cecilia Costaa,
Corresponding author
raquelceciliacosta@gmail.com

Autor para correspondencia.
, Carolina Caicedo di Filippoa, Fernando Boatas Enjuanesb
a Unidad de Agudos de Psiquiatría, Hospital Sagrat Cor, Martorell, Barcelona, España
b Centro de Salud Mental y Hospital de Día de Martorell, Martorell, Barcelona, España
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Tabla 1. Escala de valoración para catatonia
Tabla 2. Algunas causas no psiquiátricas de catatonia
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Resumen

La catatonia es un síndrome de alteraciones motoras que se puede observar en varias patologías psiquiátricas y, también, médicas. En las últimas décadas la incidencia de catatonia se ha visto reducida, y se cree que ello se debe en parte a un infradiagnóstico. Es muy importante realizar un diagnóstico precoz para aplicar lo antes posible el tratamiento adecuado.

Presentamos el caso de un paciente varón de 19años que ingresa para tratamiento de un síndrome psicótico al que se le inicia tratamiento con antipsicóticos con respuesta parcial. En la exploración destaca clínica compatible con catatonia, por lo que se descarta causa médica y se inician benzodiacepinas y terapia electroconvulsiva (TEC). Progresivamente disminuyen los signos catatónicos, lo que permite reducir las benzodiacepinas hasta su retirada. Al alta se mantienen los antipsicóticos y la TEC.

Para realizar el diagnóstico de catatonia, según el DSMIV solo es necesaria la presencia de 2 de los signos asumidos como cardinales: inmovilidad motora, actividad motora excesiva, negativismo extremo, peculiaridades del movimiento voluntario y/o ecolalia o ecopraxia.

La aplicación de escalas clínicas resulta útil como guía para la exploración completa y para cuantificar su gravedad. Existen varias, pero la Bush-Francis Catatonia Screening Instrument (BFCSI) es la preferida para el empleo rutinario, debido a su validez, fiabilidad y fácil administración.

Respecto el tratamiento, se ha visto que tanto las benzodiacepinas como la TEC son tratamientos efectivos para la catatonia, y que los antipsicóticos atípicos, en algunos casos, también pueden ser útiles.

Palabras clave:
Esquizofrenia
Catatonia
Diagnóstico
Tratamiento
Abstract

Catatonia is a syndrome with motor alterations that can be found in several psychiatric and medical pathologies. The incidence of catatonia has decreased in the last few decades, partly due to its under-diagnosis. An early diagnosis is essential in order to start an effective treatment as soon as possible.

We present the case of a 19 year-old male patient who was admitted due to a psychotic syndrome in order to receive treatment with antipsychotics, to which he showed a poor response. A diagnosis of catatonia was made in the psychopathological assessment, and benzodiazepines treatment and ECT were started, after excluding other medical reasons. The catatonic symptoms gradually decreased, and the benzodiazepines dose was reduced and withdrawn as a consequence. The patient was discharged with antipsychotic drugs and ECT treatment.

A catatonia diagnosis based on DSMIV requires the presence of at least two of the cardinal signs such as: motor immobility, excessive motor activity, extreme negativism, peculiarities of voluntary movement, and/or echolalia or echopraxia.

The administration of clinical scales is useful as a guide to make a complete exploration, and for quantifying its severity. There are several scales, but the Bush-Francis Catatonia Screening Instrument (BFCSI) is preferred for routine use, due to its validity, reliability and ease of administration.

Regarding the treatment, it has been shown as both ECT and benzodiazepines are effective treatments for catatonia. The atypical antipsychotics may also be useful in some cases.

Keywords:
Schizophrenia
Catatonia
Diagnosis
Treatment

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