Catatonia and telephone use. (2007)

Saxby Pridmore, University of Tasmania and Mariusz Rybak, Royal Hobart Ho(>pital, Hobart, Tasmania, Australia: The seminal descriptions of psychopathology antedated general availability of the telephone (particularly, the user-friendly mobile telephone). Over the last year we have observed four patients with stuporous catatonia (absence of movement and speech) who have, unexpectedly, been able to communicate with family members and friends (when they have called) on a mobile telephone. A 35-year-old mother with a recent history of bipolar disorder had become progressively slower and finally immobile and incontinent of urine over a 4 day period prior to being brought to hospital. On admission she was mute. Her limbs had markedly increased tone (assessed by palpating her muscles) with resistance to passive movement and some cogwheeling. There was forced grasping [1]; she grasped sheets and examiners and did not release her grasp on request. Careful examination revealed changing symptoms over a half-hour period. At one point there was gegenhalten [2]; she resisted movements with the same degree of pressure exerted by the examiner. At another point there was less resistance, and when placed in a position she would retain that posture despite being told that she could return to a resting position. One example of this was when her hip and knee were flexed so that her heel was 30 em above the bed; this position was retained for 5 min although she was invited to return her leg to the bed. Computed tomography was normal and she made progress with electroconvulsive therapy. The father was a senior, reliable health professional. He reported that in the hour before he brought the patient to hospital, her brother had telephoned from overseas, to wish her well. The patient took the telephone and conducted an apparently normal conversation, quite different to that which she had been conducting with the rest of her family, or subsequently conducted with her medical attendants. There was nothing to suggest an episode of catatonic excitement. The other three patients mentioned here had been in the psychiatric intensive care ward and were observed by nursing staff when they had taken telephone calls from relatives and responded tolerably well. One of these was a middle-aged former teacher with a well-established pattern of stuporous catatonia (including occasional incontinence of urine and faeces), but uncertain diagnosis. The other two were young men, both of whom suffered schizophrenia and had been mute and immobile. All four patients showed temporary but unsustained mild improvement on i.v. diazepam (20 mg over 5 min). The inconsistency of being able to converse with close relatives on the telephone but not with other close relatives or medical or nursing staff can raise questions about the patient being selective or manipulative, and call the diagnosis into question. However, we are in no doubt about the diagnosis in any of these cases. Hamilton states that (n)egativism depends to some degree on the environment, and continues, fellow patients evoke the negativistic reaction much less easily than doctors and nurses [1 ]. Catatonic stupor may result from excessive cerebral excitatory processes [3]. It may follow that face-to-face interactions increase pathological excitation, thereby increasing the difficulties of responding. The telephone (an inanimate object) may allow communication of support by others, without the arousing effect of their physical presence.