Catatonic Schizophrenia (A brief Guide)

In this blog post, we will discuss Catatonic schizophrenia, causes, symptoms, treatments, and complications.

Catatonic Schizophrenia: How to recognize it

Catatonic schizophrenia was considered to be a subtype of schizophrenia, characterized by stupor (a state close to unconsciousness), catalepsy (trance seizure with rigidity), waxy flexibility (limbs stay in the position another person puts them in), mutism (lack of verbal response)

The first observations of psychiatric patients with schizophrenia helped to identify catatonic behavior.

In addition, Catatonic Schizophrenia was considered a rare condition, now, catatonia can occur in a broad spectrum of psychiatric and medical conditions without schizophrenia being present. 

Although catatonia and schizophrenia can occur as separate conditions, they are closely related. 

Schizophrenia

Symptoms related to schizophrenia often affect thoughts, emotions, and causes atypical or abnormal behaviors.

The symptoms are divided into “positive symptoms” and “negative symptoms” but they are not termed this way because they are considered good or bad but in terms of adding or removing a behavior. 

Delusions

People suffering from schizophrenia cannot differentiate between what is real and what it is not.

Delusions firm or fixed beliefs that do not have rational arguments or real evidence to support them. 

Hallucinations

During hallucinations, people tend to see, hear or smell things that are not really there. 

Hearing voices is the most reported and common type of hallucination. 

Disorganized speech and thoughts

When communicating with others, the speech of people with schizophrenia does not follow a logical and normal sequence (not making any sense).

Also, they may give answers that are not really related to the initial question and their sentences may seem meaningless for other people.

Abnormal or atypical behavior

The behavior of people with schizophrenia can become unpredictable, exhibiting child-like behaviors or strange postures.

Schizophrenia with catatonia

In a previous version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), schizophrenia with catatonia was considered one of the five main subtypes of schizophrenia.

Catatonic symptoms in people with schizophrenia tend to be present as mimicry of body movements or speech.

They can go from completely motionless to extremely energetic, this can go on for minutes or even days and can happen suddenly. 

If it is left untreated it can, in some cases, have serious health consequences.

In addition, symptoms of schizophrenia with catatonia can vary which makes it difficult to diagnose, especially because catatonia can be present in other disorders such as depression, bipolar disorder, and even autism.

Diagnosis

As mentioned previously, it diagnosing schizophrenia with catatonia can be quite challenging due to symptom overlap with other conditions. 

Dr. Stephen Rush, assistant professor of clinical psychiatry at the University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience describes the three forms of catatonia as follows:

  • Akinetic or retarded: the individual might be mute with slow movements and can resist movements of a body part by another person, or even respond doing the opposite of what was requested. This type may also include urinary incontinence, a decreased or absence need to eat or drink and may appear to be in a state of stupor.
  • Excited catatonia: the person appears as restless and often combative and may be swirling his/her arms around for no apparent reason (also known as hyperkinesis which means excessive and purposeless motor activity in the arms and legs). 
  • Malignant catatonia: in this type the person may have unstable vital signs with fast breathing, an increased heart rate, fever, delirium and rigidity of the muscles might also tend to happen.  This type is considered to be potentially fatal and life-threatening. 

Michael Bengston, M.D from PsychCentral explains that “the general criteria for a diagnosis of schizophrenia must be satisfied.

Temporary and isolated catatonic symptoms may occur in the context of any other subtype of schizophrenia, but for a diagnosis of catatonic schizophrenia one or more of the following behaviors should dominate the clinical picture…”

These are the behaviors should be present:

  • Stupor or mutism: meaning not responding to other people or the environment. 
  • Excitement or agitation 
  • Posturing: holding their body in an unusual position.
  • Negativism
  • Rigidity: resisting people who try to adjust their body 
  • Waxy flexibility
  • Perseveration of words and phrases

Causes or risk factors

There is still an ongoing debate on the causes of this type of condition, they are still not well established as facts since they lack more evidence.

However, some researchers support the idea it could be a mix of environmental factors, genetic and stress-related conditions or situations.

Brain Structure and function

Functional Magnetic Resonance Imaging is an imaging technique used by neuroscientists to check brain function.

They have found in their research that there are brain abnormalities in people with schizophrenia-related to the general population.

Triggers have been associated with brain chemistry imbalances (dopamine or serotonin) or dysfunction, stressful situations or traumatic events. 

Environmental

It has been reported that the impact of substance abuse (drugs and alcohol) combined with the imbalance in the brain increases the risk of developing the condition.

Also, suffering from stressful situations or a traumatic experience during childhood can help trigger the disorder.

Hereditary/genetic

There is a widely accepted theory based on extensive research that schizophrenia could have a hereditary component, meaning having a first-degree relative increase the probability of developing the condition.

Additionally, the age of your parents at birth or fetal malnutrition have been proposed to increase the risk of developing schizophrenia.

Treatment 

Medication is typically prescribed to treat catatonic schizophrenia. Some of the most common drugs prescribed are lorazepam (Ativan), which is classed as a benzodiazepine and is usually injected either intramuscularly or intravenously. Other benzodiazepines that could be prescribed are alprazolam (Xanax), diazepam (Valium) and clorazepate (Tranxene).

Other related drugs that can get prescribed are known as Barbiturates, often referred to as depressants or sedatives.

They can have mild sedation to total anesthetic effect and they are believed to rapidly relieve the symptoms of catatonia. 

Additionally, psychotherapy is combined with medication to teach a set of coping skills and problem-solving techniques to deal with stressful situations.

Also, it is necessary for the family, friends or significant others to be involved so they can contribute to help the person suffering from this condition to handle it more effectively. 

When patients seem to be unresponsive to medication or other treatments, then they can be advised of getting Electroconvulsive therapy.

This procedure consists of sending electrical currents through the brain to produce controlled seizures or convulsions.

Side effects can include short-term memory loss.

Hospitalization may be necessary when someone is experiencing a severe catatonic episode.

They are safer in a hospital setting and they may even get better nutrition, better sleep, and hygiene, as well as the right treatment.

Complications of catatonic schizophrenia

Untreated catatonic schizophrenia can cause other health concerns, financial instability or problems with the law.

Some of the complications can include being depressed, having suicidal thoughts or even suicidal attempts, Malnutrition, Hygiene problems, substance abuse (which may include alcohol, prescription medications, and illegal drugs), Inability to find or maintain employment, resulting in financial problems, among others. 

Why is this blog about catatonic schizophrenia important?

This blog is important to understand and raise awareness about Catatonic Schizophrenia (even though, it is not included in the accepted diagnostic manuals as a disorder).

Additionally, it is important to understand how it can be misdiagnosed due to symptom overlap with other conditions such as bipolar disorder.

This is why it is advised to seek professional clinical assistance, if you know someone that is battling with this condition, for the proper assessment, diagnosis, and treatment.

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Frequently Asked Questions (FAQ’s) for Catatonic Schizophrenia

What is catatonic behavior in schizophrenia?

Catatonic behavior in schizophrenia can be described as a significant decrease in someone’s responsivity to their environment.

This can involve behaviors such as stupor, mutism, negativism or motor rigidity and even over-excitement without a clear or specific purpose.

What is catatonic Behavior?

Catatonic behavior is considered a group of symptoms that are characterized by disturbances in movement that can have a psychological or physiological root cause.

One of the most common symptoms would be muscular rigidity.

How do you get catatonic schizophrenia?

You can develop catatonic schizophrenia due to a combination of factors like genetics and environmental triggers, like stressful situations or events.

Some experts believe that a certain brain imbalance in some chemicals (neurotransmitters) like dopamine or serotonin is one of the main key risk factors that can cause catatonic schizophrenia, but there is still an ongoing debate on this matter.

Can you die from catatonia?

You can’t die from catatonia but you can certainly die from certain medical complications due to prolonged immobility or dehydration.

This syndrome comprises symptoms such as motor immobility, excessive activity, extreme negativism, and stereotyped movements. 

How can you tell if someone is catatonic?

Mental health professionals can diagnose someone as catatonic if they display three of the following signs:

– Not responding to other people or their environment.

– Not speaking (mutism)

– Having an unusual body posture.

– Resistant to people trying to adjust their body.

– They are agitated.

– They have repetitive and seemingly meaningless movements.

– Mimicking someone else’s speech.

– Mimicking someone else’s movements.

Recommended reading

  1. SCHIZOPHRENIA :FUNCTIONAL PSYCHOSIS: severe Mental Health Problem
  2. Catatonic Schizophrenia – A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References
  3. Schizophrenia and Related Syndromes
  4. The Madness of Fear: A History of Catatonia
  5. Heartbeats of Hope: The Empowerment Way to Recover

What we recommend for Schizophrenia

Professional counselling

If you have Schizophrenia, then ongoing professional counselling may be your ideal first point of call. Counselling will allow you to practice various habits that improve your overall quality of life.

References

WebMD

Mentalhealth UK

NHS

Psycom

PsychCentral

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