Catatonic Schizophrenia

Definition

Catatonic schizophrenia is a form of schizophrenia, in which the patient presents abnormal behavior (taken to the extreme). On one hand, the patient can enter into a state of catatonic stupor, in which he/she is unable to move, speak or respond. This is the stage in which all the movement is suspended. On the other hand, the patient can enter into a state of hyperexcitability, marked by agitation. When in the state of catatonic excitement, the patient can mimic the sounds or movements of other people, in an excessive manner.

Apart from the already mentioned changes, the patients diagnosed with catatonic schizophrenia might also present stereotypic behaviors. The assuming of bizarre positions is possible, as well as the abnormal movements of the limbs or the contortions that may occur at the level of the face. During the period of catatonic stupor, the patient might stay immobilized for a long period of time, resisting any attempt to be moved or re-positioned. This condition is considered a rare affliction nowadays, given the improvement in the available treatments.

Signs and Symptoms

These are the most common signs and symptoms of catatonic schizophrenia:

• Lack of mobility
  • This appears in the catatonic stupor stage
  • The patient is unable to speak or move
  • The position might be assumed for prolonged periods of time, with the patient staring
  • The patient appears to be unaware of his/her surroundings
• During the catatonic stupor stage, if any of the limbs of the patient are moved, they may remain in that respective position for a number of hours
• In the catatonic excitement phase, the patient might exhibit excessive mobility
  • Energetic pacing
  • Walking in a circle
  • Speaking loud
• Lack of cooperation
  • This appears in the catatonic stupor stage as well
  • The patient might resist any attempts of being moved or re-positioned
  • Lack of speech or unresponsive patient
  • May not pay attention or seem unaware of the given instructions
• Abnormal movement
  • The patient might assume strange postures or perform abnormal movements
  • Among these, expect to see unusual grimaces or bizarre mannerisms
• Abnormal behavior
  • Constantly repeating words
  • Obsession with lining things or other similar routines
• The patient might mimic words or movements coming from other persons
  • Echolalia – word mimicking
  • Echopraxia – movement mimicking
• Delusion
  • False belief of percussion
  • Guilt of grandeur
  • Belief to possess extraordinary powers
  • Someone plotting against them
  • Desire to hide in order to feel protected from potential persecutors
• Hallucinations
  • Hearing voices
• Thought disorder
  • Incoherent line of thinking and speech
• Lack of motivation (this is also known as avolition)
  • Loss of drive
  • Abandonment of daily activities
• Inappropriate expression of emotions – in situations that are either happy or sad
• Social withdrawal
  • Reason – fear of being hurt
  • Poor social skills – reduced interest for human interaction
• Unaware of illness
  • May refuse to take the medication
• Cognitive difficulties
  • Lack of concentration
  • Memory is affected
  • Ability to organize compromised
  • Difficult communication
  • Incoherent speech
• Inadequate hygiene
• Angry outbursts
• The patient’s coordination can be affected as well (often described as clumsy).

What Causes Catatonic Schizophrenia?

The exact cause that leads to the appearance of catatonic schizophrenia has yet to be identified. Recent research has found a connection between brain dysfunctions and catatonic schizophrenia. However, it is believed that genetic factors, as well as environmental triggers, contribute to this diagnosis. The dopamine imbalance, for example, is considered to play a part in the appearance of this condition. Other studies have shown that serotonin, another neurotransmitter at the level of the brain, might also be involved. A recent study, published in psychiatry journals, has revealed inadequate signals at the level of the brain, in patients who are diagnosed with catatonic schizophrenia.

How is Catatonic Schizophrenia Diagnosed?

These are the most common measures used for the diagnosis of catatonic schizophrenia:

• Physical examination
  • Height, weight and heart rate
  • Blood pressure and temperature
  • Heart and lungs auscultation
  • Abdomen examination
• CBC (complete blood count)
  • Identification of drugs or other medication in the blood
  • Thyroid hormones (check the functioning of the thyroid hormone)
• Imaging studies – allow for the identification of brain abnormalities or different lesions that might cause the above-mentioned symptoms
  • MRI (magnetic resonance imaging)
  • CT (computed tomography)
• EEG (electroencephalogram) – assessment of brain waves (brain function evaluation)
• Psychological assessment
  • Behavior pattern
  • Thoughts and feelings
  • Symptoms, severity, interference with personal life and daily activities
  • Frequency and duration of the episodes
  • Suicide attempts or thoughts
  • Catatonic signs
  • Discussion with the other members of the family.

There are also specific diagnostic criteria for catatonic schizophrenia (DSM – Diagnostic and Statistical Manual of Mental Disorders, by the American Psychiatric Association):

• Patient unable to move or to speak
• Maintaining the same position for a prolonged period of time
• Entering into a state of excessive agitation, with abnormal behaviors
• Lack of cooperation, failure to respond to instructions or resisting attempts to be re-positioned
• Abnormal postures or movements, grimaces or mannerisms
• Mimicking different sounds (echolalia) and movements (echopraxia).

Risk factors

These are the risk factors commonly associated with catatonic schizophrenia:

• Genetics
  • Family history of schizophrenia (schizophrenia gene)
• Viral infection
  • Fetus exposed to different viruses – higher risk of developing schizophrenia later on in life
• Fetal malnutrition
  • If the fetus does not get the necessary nutrients during the pregnancy phase, the risk of developing schizophrenia is higher
• Severe stress (early stage of life)
• Childhood abuse or trauma
• Being born from parents who are older (in comparison to having younger parents)
• Drugs (especially if those have been used during adolescence, affecting the development of the brain).

Treatment

These are the most common treatment measures taken for catatonic schizophrenia:

Medication

• Benzodiazepines
  • Medication with sedative properties, commonly recommended for anxiety
  • May be administered intravenously (patients in catatonic state)
  • Long-time treatment leads to addiction
• Barbiturates
  • Depressants of the central nervous system
  • They can have a wide range of effects, going from mild sedation to complete anesthesia
  • Not the routine choice for catatonic schizophrenia (can cause addiction as well)
• Antidepressants
  • These are also known as mood stabilizers
  • May help with additional problems, such as depression or anger

Electroconvulsive therapy

• Used in patients who do not respond to medication or in those with a high risk of suicide (immediate release of neurotransmitters into the brain)
• Electric current is sent to the brain, in order to produce what is known as a controlled seizure
• Short memory loss might occur as a side-effect

Other possible treatment approaches

• Hospitalization – especially recommended during severe episodes
• Psychotherapy – development of coping skills
• Training of social and vocational skills (increasing the level of independence for the patient)
• Support therapy – ensures that the patient follows the established treatment plan (lack of compliance – often a big problem).