An imperforate anus or anorectal malformations (ARMs) are birth defects in which the rectum is malformed. ARMs are a spectrum of different congenital anomalies which vary from fairly minor lesions to complex anomalies. The cause of ARMs is unknown; the genetic basis of these anomalies is very complex because of their anatomical variability. In 8% of patients, genetic factors are clearly associated with ARMs. Anorectal malformation in Currarino syndrome represents the only association for which the gene HLXB9 has been identified. Types
There are other forms of anorectal malformations though imperforate anus is most common. Other variants include anterior ectopic anus. This form is more commonly seen in females and presents with constipation. Presentation
There are several forms of imperforate anus and anorectal malformations. The new classification is in relation of the type of associated fistula.The classical Wingspread classification was in low and high anomalies:
A low lesion, in which the colon remains close to the skin. In this case, there may be a stenosis (narrowing) of the anus, or the anus may be missing altogether, with the rectum ending in a blind pouch. A high lesion, in which the colon is higher up in the pelvis and there is a fistula connecting the rectum and the bladder, urethra or the vagina.
Treatment response for patients with catatonia is 50–70% and these patients have a good prognosis. However, failure to respond to medication is a very poor prognosis. Many of these patients will require long-term and continuous mental health care. For patients with catatonia with underlying schizophrenia, the prognosis is much poorer. Epidemiology
Catatonia has been mostly studied in acutely ill psychiatric patients. Catatonia frequently goes unrecognized, leading to the belief that the syndrome is rare; however, this is not true and prevalence has been reported to be as high as 10% in patients with acute psychiatric illnesses. One large population estimate has suggested that the incidence of catatonia is 10.6 episodes per 100 000 person-years. It occurs in males and females in approximately equal numbers. 21-46% of all catatonia cases can be attributed to a general medical condition. History
It was first described in 1874 by Karl Ludwig Kahlbaum as Die Katatonie oder das Spannungsirresein (Catatonia or Tension Insanity). See also
References
External links
Catatonia in DSM-5
Encyclopedia of Mental Disorders – Catatonic Disorders
"Schizophrenia: Catatonic Type" video by Heinz Edgar Lehmann, 1952
Bush-Francis Catatonia Rating Scale