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Catatonia: a clinician’s guide to diagnosis and treatment
  1. M R Trimble

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    Max Fink, Michael Alan Taylor. Cambridge: Cambridge University Press 2003, pp 210, £50.00 (hardback). ISBN 0-521-82226-2.

    This nicely produced book reviews one of the historically most interesting, but clinically still very important, disorders of neuropsychiatry. Catatonia, described by Kahlbaum in the latter half of the 19th century, was hijacked by Kraepelin to be incorporated into his concept of dementia praecox, and almost disappeared from the literature in the first half of the 20th century, being finally eclipsed by the introduction of effective psychotropic drugs thereafter. But, as Fink and Taylor explore here, catatonia as a diagnosis is still a diagnostic challenge, with causes far beyond schizophrenia and a syndrome with effective treatment, notably, but not exclusively electroconvulsive therapy (ECT).

    For those interested in the cerebral basis of psychiatry, a condition with the main presenting signs of mutism, immobility, negativism, posturing, stereotypy, and echophenomena cannot fail to attract attention, and the many faces of catatonia (title, chapter 3) are an olla podrida of neuropsychiatry. It is refreshing to find reference to Leonhard’s work and the cycloid psychoses in a text from American authors, who are thoroughly appreciative of the European literature on their subject, and shyly critical of DSM-IV. Their overall conclusions are clear. Catatonia is a common stable syndrome, neuroleptic malignant syndrome is malignant catatonia, catatonia is not usually associated with schizophrenia, and it is a syndrome of motor dysregulation with a good prognosis—if identified and treated early. This book is a pleasure to read, but should be on the imperative reading list for all psychiatric trainees to inform them about the history of their discipline, the importance of neuropsychiatry, and how to write clearly.

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