Treatment Options For Catatonic Schizophrenia
Schizophrenia is a condition that lasts throughout life, although the catatonic symptoms may not persist. Patients with schizophrenia require treatment on a permanent basis even when symptoms seem to have disappeared and the patient believes they are better. Treatment is essentially the same for all forms of schizophrenia.
Methods vary depending on a number of factors, including the severity and types of symptoms, the health of the patient, and their age.
What Is An Example Of Catatonic Behavior
Characteristics of Catatonic Behavior For example, a person might pace in a repeated pattern and make loud exclamations for no reason at all . Parrot-like repetition or echoing of words, known as echolalia, is also a common catatonic behavior.
What is fully catatonic mean?
Use the adjective catatonic to describe someone who is in an unresponsive stupor, as if suffering from a mental disorder. Sometimes in the summer it gets so hot that people lose all their energy and get catatonic. Catatonic can also be used to describe something that is related to psychiatric problems.
How does catatonia occur?
Neurotransmitters are brain chemicals that carry messages from one neuron to the next. One theory is that a sudden reduction in dopamine, a neurotransmitter, causes catatonia. Another theory is that a reduction in gamma-aminobutyric acid , another neurotransmitter, leads to the condition.
What does catatonia look like?
The most common signs of catatonia are immobility, mutism, withdrawal and refusal to eat, staring, negativism, posturing , rigidity, waxy flexibility/catalepsy, stereotypy , echolalia or echopraxia, verbigeration .
Pearls And Other Issues
- Catatonia was traditionally associated with schizophrenia. In the latest version of the DSM V , it has its own category.
- When prominent negative symptoms and psychomotor symptoms are noted in a patient with schizophrenia, consider catatonic schizophrenia.
- Catatonic schizophrenia can be a medical emergency the BFCRS must be used for early detection. Medical support is often warranted and necessary. Underlying medical and neurological causes must be ruled out.
- Treat medical complications first.
- A benzodiazepine challenge is warranted. Treat aggressively with IV benzodiazepines for at least 3-7 days. Clinical trials have shown the use of up to 24 mg IV lorazepam.
- Catatonic schizophrenia has a poor response to benzodiazepines and often responds better to ECT.
- These patients have a poor prognosis, and relapse and remission of symptoms are usually seen. Maintenance ECT is considered helpful.
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Definition Of Undifferentiated Schizophrenia
Schizophrenia is a mental health condition that interferes with a person’s perception of reality. Previously, schizophrenia was divided into five subtypes as defined in the Diagnostic and Statistical Manual of Mental Disorders , which is published by the American Psychiatric Association.
The five subtypes of schizophrenia:
- Paranoid: Positive symptoms like delusions and hallucinations are most dominant.
- Hebephrenic/disorganized: Cognitive and negative symptoms, such as disorganized thought, disorganized speech, and flat affect are most dominant.
- Residual: A person meets the criteria for a diagnosis of schizophrenia, but the symptoms are in a milder form.
- Catatonic: A person meets the criteria for schizophrenia and has additional symptoms of catatonia .
- Undifferentiated: A person exhibits the symptoms of more than one subtype of schizophrenia, but does not exhibit enough symptoms of one subtype to be classified as that subtype.
The most recent edition of the DSM no longer includes these subtypes as distinct conditions because they were believed to have low validity and reliability in terms of diagnosis.
The five subtypes are still used by some clinicians as a way to understand how an individual’s experience with schizophrenia is manifesting, and as a guide for discussing prognosis and tailoring treatment for each person.
What Are Schizophrenia Disorders
Schizophrenia disorders are mental health disorders that interfere with a persons perception of reality. They are often characterized by delusions and hallucinations. These disorders are usually severe and require mental health care in order for the person to manage their symptoms and lead a more normal life.
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Rehabilitation And Living With Schizophrenia
Treatment can help many people with schizophrenia lead highly productive and rewarding lives. As with other chronic illnesses, some patients do extremely well while others continue to be symptomatic and need support and assistance.
After the symptoms of schizophrenia are controlled, various types of therapy can continue to help people manage the illness and improve their lives. Therapy and psychosocial supports can help people learn social skills, cope with stress, identify early warning signs of relapse and prolong periods of remission. Because schizophrenia typically strikes in early adulthood, individuals with the disorder often benefit from rehabilitation to help develop life-management skills, complete vocational or educational training, and hold a job. For example, supported-employment programs have been found to help people with schizophrenia obtain self-sufficiency. These programs provide people with severe mental illness competitive jobs in the community.
For many people living with schizophrenia family support is particularly important to their health and well-being. It is also essential for families to be informed and supported themselves. Organizations such as the Schizophrenia and Related Disorders Alliance of America , Mental Health America and the National Alliance on Mental Illness offer resources and support to individuals with schizophrenia and other mental illnesses and their families .
Examples Of Catatonia In Schizophrenia
The DSM-5-TR further classifies catatonia in schizophrenia under three types: akinetic, hyperkinetic, and malignant catatonia.1 Some symptoms of each catatonic schizophrenia type include:1
- Akinetic: Also known as stuporous catatonia, this condition causes immobility, problems following commands, and echolalia .
- Hyperkinetic: Also known as excited catatonia, a person may have symptoms such as bizzare, hyperactive behavior and pacing. This type is less common than akinetic.
- Malignant: Also known as Stauders lethal catatonia, this type causes extreme excitability that can be deadly.
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What Can I Do If A Loved One Shows Signs Of Schizophrenia Or A Similar Condition
Because people with schizophrenia frequently cant recognize their symptoms or condition, they often dont believe they need medical care or treatment. That can be frustrating or frightening for both the person with the symptoms and those who care about them.
Schizophrenia with catatonia can also cause you to feel worried or frightened if you have it, or if you have a loved one who has it. If you notice a loved one showing signs of schizophrenia, especially with symptoms like catatonia, its important to seek medical treatment for them. Thats because people with catatonia and schizophrenia may develop malignant catatonia, and are prone to agitation or dangerous behavior and other complications in some cases.
How to help a loved one who has schizophrenia
If you notice a loved one showing signs of schizophrenia or a related condition, you can try to help them by doing the following:
A note from Cleveland Clinic
Last reviewed by a Cleveland Clinic medical professional on 07/18/2022.
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What Is The History Of Catatonia
Catatonia was previously considered a subtype of schizophrenia. Therefore patients diagnosed with catatonia were also diagnosed with schizophrenia. However, researchers and clinicians have since come to understand that catatonia has distinct features and actually occurs more frequently in patients with mood disorders than schizophrenia. It is now diagnosed as its own entity in the DSM-5, unspecified or associated with another mental disorder or medical condition.
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The Different Types Of Schizophrenia
Mental health disorders are complicated and can be hard to diagnose. Often, people have overlapping symptoms or more than one disorder at the same time. Because of these variations, mental health disorders are often classified by broad term first and then broken down into more specific disorders. One such example is with schizophrenia.
How Do I Take Care Of Myself Or Manage The Symptoms
You should never try to diagnose schizophrenia in yourself or a loved one because it takes training and experience to diagnose it accurately. This condition also involves symptoms that can happen with other conditions or substance use. Lastly, the medications necessary to treat schizophrenia require a prescription from your healthcare provider. Because of all these factors, your healthcare provider should be the one to diagnose this condition and recommend treatments.
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Is Catatonia A Symptom Or A Condition
Catatonia can be both a symptom and a condition.
Formally, the DSM-5 doesnt classify catatonia as a standalone condition, though. But it does recognize three different subtypes:
- catatonia with another mental health condition
- catatonia with another medical condition
- unspecified catatonia
In the past, medical and mental health experts recognized three types of catatonia:
- excited catatonia, which involved fast, agitated movement
- akinetic catatonia, which involved slow movement and often, loss of speech
- malignant catatonia, which involved delirium and fever
Some care providers still use these terms although its no longer the rule.
You might also hear it called catatonic schizophrenia or catatonic depression. That said, most clinicians will now diagnose these conditions as schizophrenia with catatonia or depression with catatonia.
The DSM-5 doesnt identify a specific cause of catatonia but it associates it with symptoms of other conditions.
Mental health conditions that may include catatonia include:
The signs and symptoms of catatonia can vary from person to person, based on what caused it.
The DSM-5 lists 12 key symptoms.
To reach a diagnosis, a health professional will try to identify three or more of these:
Coping With Catatonic Behavior
Witnessing someone experience catatonic behavior with schizophrenia is certainly scary. Steps people can take to help cope:
- Stay informed: Perhaps the best thing friends and family members can do is to stay educated about diagnosis, symptoms, and effective treatment. By staying informed, loved ones can get help immediately if they notice any signs of catatonia like rigidity or stupor, or erratic extreme movements.
- Be prepared to describe symptoms: Depending on the severity and type of symptoms, people may need to step in to describe the catatonic behaviors to their loved one’s doctor.
- Offer encouragement and support: People can also help by doing their best to encourage someone experiencing catatonic behavior to work with their mental health professionals. Sticking to the treatment plan will help ensure that schizophrenia is well managed and controlled.
Self-care is also essential for sustaining the mental energy required to support someone with a mental illness. Caregivers should try to get ample sleep, eat right, exercise, and make time for relaxation and fun.
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The Potential Physical Social And Mental Complications Of Catatonic Schizophrenia
The risks of catatonic schizophrenia are many. There are physical and mental health risks that are associated with schizophrenia, complications that arise from behavior and moods. There are also social risks that are borne from the cultural stereotype that the schizophrenic is dangerous.
- Malnutrition. Withdrawal and the internal desire to maintain unusual movements or positions can overwhelm the need to eat, which can lead to dangerous states of hunger, dehydration, and malnutrition.
- Depression. People with schizophrenia have a 5% chance of attempting suicide in their lifetimes. While it isnt known if this is higher or lower with catatonia, it is a clear and present risk.
- Social repercussions. These can include a higher chance of being institutionalized or imprisoned, shunned at school, sent to detention instead of educated, difficulty finding or keeping employment, and more.
- Isolation. Increased isolation is often a complication of an undiagnosed and untreated mental health condition.
- Substance abuse. Increased substance abuse is often associated with mental disorders, often as a result of many other factors.
In fact, many of these factors feed into each other. Lack of viable employment can lead to poverty and homelessness, which can cause depression and make substance abuse more likely. All of these make the chances of treatment even less likely.
Its a cruel, society-wrought cycle. But it doesnt have to be this way.
Is Catatonia A Mental Illness
In this Article Catatonic schizophrenia is one feature of a serious mental illness called schizophrenia. Schizophrenia prevents you from separating whats real from whats not, a state of mind called a psychosis. Catatonic schizophrenia affects the way you move in extreme ways. You might stay totally still and mute.
Can catatonia be fatal?
Recognizing and treating catatonia usually results in rapid resolution of the syndrome, whereas failing to recognize it may lead to potentially fatal complications including infection, neuroleptic malignant syndrome, and pulmonary embolism.
Can catatonia be caused by trauma?
For example, a traumatic event or losing a loved one can cause mental trauma. As an outcome, the individual encounters extreme emotional stress, which causes him or her to enter a catatonic state.
What is agitated catatonia?
Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders.
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Negative Symptoms Of Schizophrenia
The negative symptoms of schizophrenia can often appear several years before somebody experiences their first acute schizophrenic episode.
These initial negative symptoms are often referred to as the prodromal period of schizophrenia.
Symptoms during the prodromal period usually appear gradually and slowly get worse.
They include the person becoming more socially withdrawn and increasingly not caring about their appearance and personal hygiene.
It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else.
Negative symptoms experienced by people living with schizophrenia include:
- losing interest and motivation in life and activities, including relationships and sex
- lack of concentration, not wanting to leave the house, and changes in sleeping patterns
- being less likely to initiate conversations and feeling uncomfortable with people, or feeling there’s nothing to say
The negative symptoms of schizophrenia can often lead to relationship problems with friends and family as they can sometimes be mistaken for deliberate laziness or rudeness.
Signs And Symptoms Of Catatonic Schizophrenia
Catatonic schizophrenia is rare and used to only be diagnosed in individuals who are schizophrenic. Now, it has been noted that the condition can occur in association with other mental illnesses including bipolar disorder, depressive disorders, and neurodevelopmental disorders.
Individuals with catatonic schizophrenia can display their symptoms in different ways. Either the individual will be unexplainably hyperactive, or they may be completely still and unresponsive. The state can last anywhere from a few minutes to a number of days.
The symptoms of catatonic schizophrenia include:
- A lack of responsiveness
- Inability to control facial movements
- Repeating someone elses words without reason
- Copying someone elses movements without reason
For an individual to be diagnosed as catatonic they have to exhibit three or more of the symptoms listed above. The state can be interrupted by times of completely opposite behaviors, such as hyperactivity. Catatonia is most commonly diagnosed in individuals who are schizophrenic.
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Changes In Behaviour And Thoughts
A person’s behaviour may become more disorganised and unpredictable.
Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else.
Another feeling is that thoughts are disappearing, as though someone is removing them from their mind.
Some people feel their body is being taken over and someone else is directing their movements and actions.
Catatonic Schizophrenia Diagnosis And Treatment
As stated above, a trained psychiatrist will be able to diagnose catatonic schizophrenia, however, there is no cure. First-line treatment typically involve medications that can help to regulate the neurological processes. These medications are typically psychotropic medications, such as benzodiazepines and n-methyl-d-aspartic acid.
Antipsychotics are also used to help treat patients with schizophrenia. However, there are risks to taking antipsychotics, such as neuroleptic malignant syndrome, which is a life-threatening reaction to atypical antipsychotic drugs. The good news is this reaction is relatively rare. Treatment of catatonia goes way beyond medication. In many cases, electro-convulsive therapy is also necessary.
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Deterrence And Patient Education
The most important aspect includes early detection and treatment. When schizophrenia is traditionally discussed, the focus is usually on the positive symptoms of schizophrenia and less on the negative symptoms. Catatonic schizophrenia is a small percentage of the larger spectrum of a chronic psychotic disorder. However, given its poor prognosis, patients and families would benefit from understanding the nature of symptoms such as stereotypy, automated mannerisms, and immobility to better identify its manifestations.
Fast Facts On Catatonic Schizophrenia
Here are some key points about catatonic schizophrenia. More detail and supporting information is in the main article.
- Catatonia only occurs in some individuals with schizophrenia
- Symptoms can involve flipping between hyperactivity and under activity
- Risk factors for catatonic schizophrenia are the same as those for schizophrenia in general
- There are now a number of effective treatments for the symptoms of catatonic schizophrenia
Catatonic schizophrenia is much rarer than it used to be thanks to improved treatments. Catatonic states are now more likely to be found in types of mental illness other than schizophrenia, such as neurodevelopmental , psychotic bipolar, or depressive disorders.
Individuals with catatonia may flip between decreased and excessive motor activity.
With modern treatments, patients with catatonic schizophrenia can manage their symptoms easier, making the likelihood of leading a happier and healthier life much greater.
The clinical picture of catatonia is dominated by at least three of the following symptoms:
- Stupor no psychomotor activity, no interaction with the environment
- Catalepsy includes adopting unusual postures
- Waxy flexibility if an examiner places the patients arm in a position, they will maintain this position until it is moved again
- Mutism limited verbal responses
- Echolalia mimicking another persons speech
- Echopraxia mimicking another persons movements
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