Talk:Catatonia

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 4 January 2021 and 29 January 2021. Further details are available on the course page. Student editor(s): Gonzalezmabit. Peer reviewers: Jbobet830.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 16:57, 16 January 2022 (UTC)

Untitled

Firstly, the link to Percy Wetmore leads to 'The Green Mile' page. Secondly, John Coffey leads to a baseball player of the same name. I think that after these problems are corrected I'd advise adding a section for old barbaric forms of treatment for catatonia, such as the infamous ice-water dunking idea and others. Just my thoughts, Mr. Tachyon.

This is not my field at all, but I thought it might interesting to mention that Richard Bandler of NLP fame claims to have helped many people in catatonic states. --Jens Schriver 14:27, 2005 Apr 22 (UTC)

Borrowed information and merger proposal

Catatonia, Catatonic stupor, and Catatonic excitement borrow heavily from Catatonia - Health A to Z. These three articles definitely do not need to remain separate. Catatonic stupor and catatonic excitement can be expanded and not plagiarized to become sections of Catatonia.

Merge. Catatonic stupor and catatonic excitement clearly belong on this page, as they are both directly related to this article. Also, if all three pages were merged, I think that the article would no longer be a stub. I'm going to go ahead and merge the pages.

Fuzzform 17:38, 30 January 2006 (UTC)

Ok, I've merged the three pages, although the article now looks a bit sloppy. I wonder if it still qualifies as a stub? I'll do some more research and try to bulk up the article a bit, so I can remove the stub tag. As for the plagiarism, I've tried to reword as heavily as possible.

Fuzzform 18:12, 30 January 2006 (UTC)

Treatment dosage

This part seems a little odd to me, suggesting a typo: "Benzodiazepines are the first line of treatment and high doses are often required. A test dose of 1-2 mg intramuscular lorazepam will often result in marked improvement within half an hour." I'm not a doctor, but I know 2 mg is not very much. --Snaxe920 16:39, 8 October 2006 (UTC)

Article with Extensive Clinical Information on Catatonia

If anyone feels like bulking up the article, I found a fantastic source of medical information on catatonia at eMedicine.

Here's a link: http://www.emedicine.com/neuro/topic708.htm -- 03:47, 26 October 2006 (UTC)

I have seen a good response in a patient with dosage of 2mg BID —Preceding unsigned comment added by 142.21.15.116 (talk) 08:32, 22 November 2009 (UTC)

Is geggenhalten a word?

In the first paragraph i read the following:

They may show specific types of movement known as "waxy flexibility" in which they maintain positions after being placed in them by someone else or geggenhalten, in which they resist movement in proportion to the force applied by the examiner.

There is a german word "gegenhalten" (holding against) but I'm not sure what is meant in the article. —The preceding unsigned comment was added by Jemocri (talk • contribs) 06:42, 10 February 2007 (UTC).

"Gegenhalten" is the original German term for what can be partially Latinised as "oppositional paratonia." Michael JG Harrison explains it thus, in comparison to both spastic and lead-pipe rigidity: "A more diffuse increase in the tone in antagonists may be felt in the presence of frontal lobe lesions. This phenomenon (gegenhalten) feels as though the patient is deliberately counteracting all imposed movements." See "Neurological Skills" London: Butterworths 1987. ISBN 978-040701360-5. This word is not to be found in most English language textbooks of neurology, but was popularised in the UK, along with "mitgehen" and "astasia-abasia," by the smallest available textbook of geriatrics, JC Brocklehurst & T Hanley's "Geriatrics for Students" London: Churchill Livingstone 1976. ISBN 978 044391470-3. These were described there as features of dementia. NRPanikker (talk) 17:13, 5 June 2022 (UTC)

Links

I deleted links to a private hypnotherapist's web page. I don't think the links are appropriate, although they do discuss catatonia. Let me know if I'm wrong on this one.

GB77 18:50, 29 March 2007 (UTC)

derren brown

Derren Brown claims to have put people into a catatonic state in at least two instances ("zombie" and "trick or treat - marrakesch"). if that is true, should it be mentioned? isn't that harmful? i know they have to sign contracts and stuff, but you can't really put someone into what is described in this article and get away with it, can you?--ExplicitImplicity 23:33, 13 June 2007 (UTC)

A catatonic state is not one associated with hypnotism nor is it a coma. I doubt very much whether the catatonic state he claims has anything to do with the medical term.cheers, Cas Liber | talk | contribs 23:59, 13 June 2007 (UTC)

Karl Kleist's classification

Karl Kleist described at least eight types of catatonia, differing in symptoms, family history and outcome. An account of this work was published by Frank Fish in the Journal of Mental Science of July 1957. A summary might be worth adding to the main article. Karl Leonhard and Helmut Beckmann carried on with this line of study. NRPanikker (talk) 22:55, 17 December 2008 (UTC)

Detailed reference: Fish FJ (1957) "The Classification of schizophrenia. The views of Kleist and his co-workers." Journal of Mental Science (103) 443 - 463. NRPanikker (talk) 16:38, 18 December 2008 (UTC)

Acute assessment

Catatonia can be caused by medical illness, and it can cause medical complications. Emerg Med J doi:10.1136/emermed-2011-200896 JFW | T@lk 18:18, 24 October 2012 (UTC)

Temporary catatonic state

I have three times found myself in a situational catatonic state that lasted until the situation changed. Without giving too much detail, each instance involved distress due to feeling emotionally threatened. Not knowing how to deal with the threat (consisting essentially of input from other people who were present), I withdrew inside and became rigid and unable to move or to speak.

The position was very tense and quite tiring. What I wanted while I was in that state, and what the people around me didn't know to provide (nor could they have, I imagine), was "safety" from the things that had been said. Fortunately, rather than trying to get me out, they decided to leave me on my own. In leaving, they took the "danger" with them and I was able to I was relax and emerge.

The experience strikes a chord with descriptions of " tharn", the fear-based freezing in a car's headlights that rabbits do, as named by Richard Adams in Watership Down. As nobody tried to touch me or persist in getting me to respond, let alone get anybody medical involved, I don't know how the situation would have progressed. My feeling is that I'd only have responded to someone who knew that the key to unlock me was the provision of safety.

Although there are similarities, I couldn't say that it's anything like the catatonia that the article talks about. 92.29.18.107 (talk) 23:15, 15 August 2013 (UTC)

Catatonic Excitment

This section is missing some information in that individuals in this state usually experience delusions or hallucinations. I believe this is an important aspect of this condition and should not be overlooked. Cweiner1993 (talk) 23:52, 18 April 2014 (UTC)

Good addition! Like Lova Falk talk 08:50, 14 May 2014 (UTC)

Assessment comment

The comment(s) below were originally left at Talk:Catatonia/Comments, and are posted here for posterity. Following several discussions in past years, these subpages are now deprecated. The comments may be irrelevant or outdated; if so, please feel free to remove this section.

I just removed small amount of vandalism, it may be pertinent to keep an eye on this page: straight black haired, brown eyed, half-korean, slightly obese women with tendencies to wear goofy scarves,are likely canidates for this disorder. P.S. Elise is really dumb and ugly Mylittlestarcar (talk) 22:45, 18 December 2007 (UTC)

Last edited at 03:32, 16 August 2014 (UTC). Substituted at 11:03, 29 April 2016 (UTC)

subtypes: acute/periodic vs. chronic catatonia

Although the most recent definitions of catatonia differ significantly from earlier definitions in terms of it no longer being a type of schizophrenia, there is probably still some merit in looking at different forms of catatonia as they were defined e.g. by Karl Leonhard. Especially there is a lack of mention of chronic forms of catatonia in the article.

This is apparently not only a problem in Wikipedia, but the medical literature in general. Whereas acute (either monophasic or relapsing) presentations of catatonia are now widely seen as a general phenomenon distinct from schizophrenia (though the two can be co-morbid of course), chronic catatonia is rarely mentioned, and - apart from anecdotal reports of it occuring in autism - it is still widely considered a "rare" form of schizophrenia. It seems there hasn't been a lot of re-thinking concepts in terms of chronic catatonia.

However, Leonhard's original descriptions also keep placing emphasis on catatonia's relation to schizophrenia: In most forms there is a "blunting of affect" to some degree, and sluggish catatonia causes permanent "hallucinations", inferred from the indistractable self-talk of affected individuals.

And then there is motility psychosis: Is this distinct from catatonia, or not? And is it appropriately called "psychosis"? (I think there was literature about that, but now I lack time for a more lengthy research. What I remember is that there is a controversy about that.)

There are also several similar diagnoses, like "pervasive refusal syndrome" and "Ganser syndrome", which are considered by some psychiatrists to be No True Scotsman variants of catatonia. --2003:E7:772E:5A06:6896:4CCD:72B8:32B (talk) 05:31, 30 December 2020 (UTC)

Catatonia is a symptom of depression which is a symptom of schizophrenia. The person becomes "frozen". Just granpa (talk) 13:58, 30 December 2020 (UTC)

Opinions about catatonia and what it actually is are controversial in general. Plus, during the time where catatonia was considered a form of schizophrenia, many alternative diagnoses were created to desribe catatonia-like behavior outside the context of schizophrenia. Such as "catatonia-like phenomena" in affective disorders, autism spectrum disorders and dementias, or the many culturally-bound syndromes which include catatonic features, such as Latah, lycanthropism or (already mentioned) Ganser syndrome. Today this distinction is questioned, and catatonia is diagnosed (or not diagnosed) by the presence (or absence) of certain behaviors in acute settings. There is still controversy about catatonia in neurologic disorders with overlapping symptoms (such as strokes and dementias), or its relationship to aforementioned culture-bound syndromes. This is probably the result of catatonia being ill-defined on a neurological and psychological level since its separation from the schizophrenia spectrum.

These problems seem to be even more pronounced for chronic catatonia-like conditions, as they can overlap with a plethora of other diagnoses, like severe OCD, Tourette syndrome, severe forms of ADHD, sensory processing problems in autism, certain dissociative disorders and forms of PTSD, chronic hospitalism etc. Nearly a century ago when the Wernicke-Kleist-Leonhard system of endogenous psychoses was created, there was a much lower number of possible differential diagnoses that could alternatively fit the described behaviors. Also the term "psychosis" was used more broadly, including mental states that would not be seen as psychotic today (depression is not generally psychosis, hallucination and pseudohallucination were not consistently distinguished, and some of Karl Leonhard's "system paraphrenias" and "hebephrenias" come closer to present diagnoses of "severe personality disorder" rather than schizophrenia.)

That doesn't mean today's classification systems are necessarily "better" or "more accurate", though. Anyway, diagnostic manuals are always a work-in-process and also influenced by culture and society. But it may be worth mentioning in our article that catatonic features can be either acute or chronic in nature.

And by the way, even with catatonia being a condition on its own, it's still possible for somebody to suffer from catatonic schizophrenia by means of a dual diagnosis of schizophrenia + catatonia. There still seem to be qualitative differences between catatonia in schizophrenia vs. other conditions (especially mood disorders) regarding the prevalence of particular symptoms. (Which is a final reference to your edit.)

Concerning culturally bound syndromes with catatonia-like features, I could add them to the list of associative links at the end of the article. That could be a sufficient mention; descibing them and all their connections to catatonia will only deteriorate the article into a coatrack.

TL;DR: Catatonia is a complex and rather ill-defined subject, especially when it comes to chronic states. Current diagnostic manuals clash with the descriptions of the Wernicke-Kleist-Leonhard school which linked catatonia intimately with schizophrenia. "Catatonic schizophrenia" still exists but the treatments for catatonia will not alleviate schizophrenia and vice versa. This leaves the chronic catatonic states described by Leonhard's "system catatonias" hanging in the air. Today there are many similar non-schizophrenic (and non-catatonic) diagnoses which could be given to a patient showing such symptoms. And no, catatonia is not depression, neither is it characterized by just "freezing" - this is catatonic stupor, which is one of many possible symptoms of catatonia. Catatonia-like culture-bound illnesses could be added to the list of associative links, when not done already. The possibility of periodic and chronic courses of catatonia may be worth mentioning in the article. Concerning motility psychosis, a link to its own article might be enough. --2003:E7:772E:5A24:14F6:7E62:E92C:7E (talk) 22:40, 30 December 2020 (UTC)

(P.S. Don't feel pressed to do what I said here. It's just a personal idea, and maybe I will do that myself sometime later.)

I didn't want to finish this verbal diarrhea without giving a few potentially useful sources about the topic:

https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/catatonia/D08B59DDBC43D5AF807321AA5A1A43D4

https://mhttcnetwork.org/sites/default/files/2019-07/catatonia.pdf - about chronification and prognosis

https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.12.1.16 - about schizophrenia-catatonia-OCD link and "manneristic catatonia"

https://www.wjgnet.com/2220-3206/full/v7/i3/177.htm - this is what I mentioned at the beginning

http://www.cercle-d-excellence-psy.org/fileadmin/Cours/WKL_STB/Periodic_and_Systematic_Catatonias_20-11-2015.pdf (not sure if that one is appropriate, but it gives some information on Leonhard's concept)

Just to prove that I'm trying to summarize the stuff I have read about this topic. Otherwise this may look like some random nonsense written just to get attention - it's not.

Also, my intention is not to bash against DSM-V, ICD-10 or the Wernicke-Kleist-Leonhard school. I just wanted to emphasize that they are quite contradictory about the nature of catatonia. All in all, a good degree of scientific progress has been made, but culture and society always influences the view on psychiatric 'disorders' and even what is considered normal. Leonhard's specific catatonias are probably "rare" as he proposed a distinct cause of the abnormal behavior - in systematic catatonias, this is the loss or disinhibition of certain 'will forces'. Current consensus is, catatonia is complex (I repeat myself), and very similar behaviors can probably result from a variety of different causes or combinations of them. If all other causes apart from those proposed by Karl Leonhard are excluded, this will narrow down the diagnostic criteria and thus render the diagnosis rare. If only the behavior is rated regardless of possible causes, this will make the diagnosis more common, but also more heterogenous. --2003:E7:772E:5A26:391F:277F:110D:62FA (talk) 02:14, 1 January 2021 (UTC)

Wikiproject Medicine; UCF College of Medicine

Hello, I am a 4th year medical student participating in a Wikiproject Medicine course. The purpose of this course is to chose one article related to medicine and edit, update, and expand the current article. A general outline of my work plan is below:

Lead -Will edit the current lead, shorten some of what has already been written as it is a bit verbose, and add some high-yield information.

Etiology/Causes -I will add this section to the beginning as I believe the article will flow better if we start by understanding the disease, and then moving on to clinical features, assessment and diagnosis, treatment, and differential diagnosis.

Epidemiology

Pathogenesis/Mechanism -I will add this section to the current article as this is an important feature that could help readers better understand catatonia.

Clinical Features -Subtypes: including signs and symptoms for each -Associated disorders

Assessment/Diagnosis -Current article has a pretty complete DSM-V diagnosis criteria.

Treatment -Will make some edits and expand on the treatments of both malignant and none-malignant catatonia. Will include an algorithm.

Outcomes/Prognosis/Recurrence -Will add this section as well.

Differential Diagnoses -I will include differential diagnosis and links providing information about each.

Additional Images -Although the article already has some great images, it is my goal to find a couple more to add to the article.

During this 4-week course I will try my best to be as complete as possible with this article and accomplish everything listed above. It is my goal to make this article complete but also succinct, providing the most important information for readers to know in order to educate and empower them with knowledge. Please feel free to comment on my edits and offer suggestions. Gonzalezmabit (talk) 22:08, 7 January 2021 (UTC)

-Just wanted to let you know I did the peer review below!! Jbobet830 (talk) 19:44, 25 January 2021 (UTC)

WikiProject Medicine UCF Peer Review

@GonzalezMabit

Overall the changes to this article are fantastic and make it completely brand new. I believe that a regrading would be in order. Going section by section:

Introduction: The overall content is well explored with a quick definition, disease associations, and treatment. However, it does read a little choppy to me and I believe that a reorganization would help with clarity. Just as an example:

"Catatonia is a neuropsychiatric behavioral syndrome that is characterized by abnormal movements, immobility, abnormal behaviors, and withdrawal. Onset can be acute or subtle with symptoms waxing, waning, and changing during episodes. There are several subtypes of catatonia: retarded catatonia, excited catatonia, malignant catatonia, and other forms."

I personally believe that while the content is the same, combining small paragraphs when possible and linking them can help retain information better.

Citations appear to be appropriate.

Etiology: I appreciate the DSM definition as it provides direct clinical ideas about catatonia. Overall content is excellent. I would recommend organizing into a list the different causes and expanding on them individually. Sub-heading with "psychiatric causes", "infectious/autoimmune", and "withdrawal" might allow for more information in an organized way. Please feel free to disagree.

Link to review article for benzo withdrawal inducing catatonia - doi: 10.1038/s41398-018-0192-9

I have been unable to find one for alcohol. Other citations appear appropriate

Epidemiology: Information and citations seems appropriate. Expansion on prevalence and incidence and comorbidity with other illness would be great if numbers exist. Citations appear to be appropriate. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319219/ - This resource seems promising in their prevalence section however I did not read it in depth.

Pathogenesis/Mechanism: I feel a picture of a brain pointing to the implicated areas might help for explanation. Citations appear appropriate.

Signs and Symptoms: Excellent in-depth review. I appreciate how the subtypes are separated and explained individually. Citations appear appropriate.

Diagnosis: DSM-5 diagnosis included. Assessment/Physical accurate and thorough. Would it be possible to include the Bush-Francis Catatonia Rating Scale? Citations appear appropriate.

Treatment: Seems correct and well summarized. I like how each class of drugs is sectioned off and explained individually. Citations appear appropriate.

Complications, Outcomes, and Recurrence: I feel there is an over-reliance on statpearls as a single resource here. While the information may not be inherently wrong it might be worthwhile to gather other resources. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319219/ - This link has some discussion on complications.

Differential diagnosis: Highlight of the article! Truly amazing job walking through each one and discussing the differences between them. Citations appear appropriate.

GREAT JOB OVERALL!!!

Jbobet830 (talk) 19:41, 25 January 2021 (UTC)

Hi Josh! Thanks for the review! I'll get to work on making some changes! Gonzalezmabit (talk) 16:39, 27 January 2021 (UTC)

An important missing citation

Whilst I agree this is almost certainly true, the sentence "Catatonic excitement is commonly cited as one of the most dangerous mental states in psychiatry" in the "Excited Catatonia" section requires a citation which explicitly says. The sentence literally states 'commonly cited' without providing any. — Preceding unsigned comment added by 103.106.90.52 (talk) 12:36, 15 December 2021 (UTC)

That would be "lethal catatonia" or "malignant catatonia," or possibly "mania" or "hypermania." The latter two are concepts which have been excluded from the DSM classification and are therefore no longer mentioned in peer-reviewed American psychiatric literature. NRPanikker (talk) 19:27, 6 June 2022 (UTC)

Perhaps a rephrasing is in order. Rather than seek out-of-date citation, consider changing the phrasing to "Due to the potential for a patient to injure others during a period of hyperactivity and hallucination, catatonic excitement is considered one of the more dangerous conditions in psychiatry." Phrasing such as this might communicate the idea as a logical conclusion based on the previously mentioned information in the paragraph. Knighthsilgne (talk) 00:08, 31 October 2022 (UTC)

This isn’t the most common risk tho? And in my opinion is a bit judgmental and based in stereotypes from movies. People who experience catatonic excitement(more commonly called positive symptoms or psychomotor agitation)are more likely to get assaulted by others then to assault others, this is a proven fact and is usually because they are seen as “annoying”, “weird” or “crazy”, and they are even more likely to seriously hurt themselves then anything else, people who experience catatonic excitement are commonly viewed as dangerous and scary, so saying it’s dangerous because they are likely to hurt others, well not entirely wrong, gives the wrong idea in my opinion, people with psychotic disorders are at a high risk for suicide and self harm, and that is mostly regarded as the reason this is dangerous, I don’t have links but please do some research on your own. I recommend checking out Mayo Clinic’s website on schizophrenia and schizoaffective disorder along with psychotic disorders in general. 2601:249:C00:2B50:9455:9560:B3FA:9881 (talk) 21:10, 28 June 2024 (UTC)

Wiki Education assignment: WikiMed Fall 2024

This article was the subject of a Wiki Education Foundation-supported course assignment, between 28 October 2024 and 22 November 2024. Further details are available on the course page. Student editor(s): ChristopherHuebner (article contribs). Peer reviewers: Alexb406.

— Assignment last updated by Wendyxieyang (talk) 06:55, 22 November 2024 (UTC)

WikiMed Fall 2024 Workplan

Introduction/Opening Section: Improve readability and fluency Make more concise points Explain unexplained points Cut out extraneous detail

Plan to follow the suggested headings from the wikiproject medicine style guide so after the introduction I’ll start with classification rather than the existing signs and symptoms section.

Classification: Move some of the information from the diagnosis section to classification and edit the presentation of the information for clarity and relevance.

Signs and symptoms: Remove what appears to be a clinical pearl in malignant catatonia vs NMS section Remove other forms section and place periodic catatonia under subtypes Move information from complications section to outcomes/prognosis section

Causes: Cut the psychodynamic sentence include psychoactive substances that can contribute to catatonia Improve fluency Improve readability of some sentences

Mechanism: Improve organization More or less rewrite the section divided into explanation of neurotransmitter dysregulation hypotheses and connectivity difference hypotheses

Diagnosis: Put more emphasis on ICD-11 criteria as international standard Move the definitions of the 12 psychomotor symptoms to the signs and symptoms section Delete “other disorders” section, make classification descriptions shorter since there is a classification section elsewhere Put the use of rating scales and benzodiazepine challenge into diagnosis Be specific that the diagnosis of delirium precludes the diagnosis of catatonia due to overlap in diagnostic criteria

Prevention or Screening: Add this section

Treatment: Too much detail about dosing strategies Remove france sentence Improve fluency and readability

Outcomes or Prognosis: Insert mortality rate

Epidemiology: Breakdown of general numbers Breakdown by underlying disorder or category of disorders Demographic differences

History Expand significantly

Society and Culture Write this section from scratch

— Assignment last updated by ChristopherHuebner (talk) 20:22, 12 November 2024 (UTC)

Peer review comments added below! Alexb406 (talk) 18:56, 17 November 2024 (UTC)

WikiMed 2024 Peer Review

@ChristopherHuebner

Great start to improving this long and important page! Section by section comments below. Many of the changes proposed in the workplan have not been implemented yet but I think they would be fantastic in improving this resource!

Introduction: Introduction reads very well, easy to understand and provides a good brief overview of the topic. Can consider moving treatment earlier in the introduction and removing the sentence about delirium.

Classification: Consider bullet points when listing symptoms to improve readability. Consider a sentence differentiating between ICD-11 and DSM-5. Consider switching order and historical and modern classifications. Historical classifications could even be an independent section on the history of the condition.

Signs and symptoms: Great table that is succinct and easy to read. Small grammar mistakes throughout text in this section that can be edited to improve readability. Good breakdown of the different subtypes. The link to the Wernicke-Kleist-Leonhard school site does not work.

Causes: Excellent section on psychiatric conditions but need citation for second paragraph (connection between type of psychiatric disorder and type of catatonia). Good list of medical conditions. Subheaders in the medical conditions have no text, unsure if that is meant to be filled in later or if those are just bullet points that should be reformatted. Need citations for ketamine/PCP substance use section.

Mechanism/Pathogenesis: Section is appropriately short given the lack of established pathophysiology. Good number of citations. Proposed changes sound great if there is information available from reputable sources.

Diagnosis: This section is very long and redundant at times (such as details that are repeated from the signs and symptoms above). Symptoms are again listed in the ICD-11 classification section without much new info added. ICD-11 section is missing citations. Assessment/physical section jumps between physical exam, EEG, imaging studies, and laboratory tests that do not align with the section title. A link for the BFCRS is mentioned but is not easily found. Second paragraph of the rating scale section appears out of place. Citations needed for lab findings section but is helpful information. Differential diagnosis section is very thorough, arguably too long and should be compressed to the most important points. Some links do not work (such as obsessional slowness).

Prevention or Screening: Proposed section has not been added yet but sounds like it would be helpful!

Treatment: Opening paragraph needs citation. Benzodiazapene discussion needs citations. Consider different paragraphs for benzos, ECT, underlying causes and including subheaders for these sections.

Outcomes or Prognosis: Agree with proposed change that mortality rate would be helpful here given discussion of mortality and malignant catatonia discussed above. Section is otherwise well-written.

Epidemiology: Good brief overview of epidemiology, does not appear like the proposed changes have been made. Would benefit from demographic data and breakdown by subtypes mentioned throughout article.

History: Section is very brief, looks like proposed changes have yet to be made. Consider adding information from the historical classification above.

Society and Culture: Looks like this section has not been added yet but would be a welcome addition to this page! Alexb406 (talk) 18:56, 17 November 2024 (UTC)