Catatonic Schizophrenia is a rare form of schizophrenia that causes various psychiatric and medical symptoms. A study suggests1Francis, A., Fink, M., Appiani, F., Bertelsen, A., Bolwig, T. G., Bräunig, P., Caroff, S. N., Carroll, B. T., Cavanna, A. E., Cohen, D., Cottencin, O., Cuesta, M. J., Daniels, J., Dhossche, D., Fricchione, G. L., Gazdag, G., Ghaziuddin, N., Healy, D., Klein, D., … Wachtel, L. (2010). Catatonia in Diagnostic and statistical manual of mental disorders, fifth edition. The Journal of ECT, 26(4), 246–247. that 10% of individuals having psychiatric illnesses have shown signs of catatonic schizophrenia.
Individuals suffering from this type of schizophrenia have episodes of irresponsive or purposeless activity, depending on the severity of the condition.
Also, people facing this psychiatric illness tend to have many behavioral and psychomotor disturbances that impair their overall well-being.
However, once the condition is timely diagnosed, effective treatment is possible.
What Is Catatonic Schizophrenia?
Catatonic schizophrenia2Jain, A., & Mitra, P. (2022). Catatonic Schizophrenia. StatPearls Publishing. is one of the rarest types of schizophrenia. “Catatonic” refers to a state of altered motor behavior marked by unusual and often extreme movements or immobility, typically observed in individuals with certain mental disorders. Whereas “Schizophrenia” is a severe mental disorder characterized by disruptions in thinking, emotions, and behaviors. It involves symptoms like distorted perceptions, disorganized thinking, delusions, and impaired social functioning.
Therefore, this severe mental disorder is characterized by extreme changes in the affected individual’s thoughts, behavior, and emotions, leading to paranoia. A paranoid person finds it hard to perceive reality and often misjudges intrusive thoughts as real.
Furthermore, it involves disturbed motor responses and various abnormal physical movements and social behaviors.
What Causes Catatonic Schizophrenia?
The exact cause of catatonic schizophrenia is still unknown. However, scientists suggest that genetic, environmental, and neurological factors altogether play a role in the prevalence of this form of schizophrenia.
Family History and Genetics
Positive family history has a key role in developing many types of schizophrenia, including catatonic schizophrenia. Individuals having schizophrenics in their first-degree relatives are likely to get affected by this psychiatric illness.
People with schizophrenia tend to have structure and functional abnormalities within their nervous system. These disturbances include irregularities in brain connectivity, volume, and activity patterns. Also, marked structural changes are seen in brain parts associated with motor control, cognition, and emotion regulation.
A study suggests3Ellul, P., & Choucha, W. (2015). Neurobiological approach of catatonia and treatment perspectives. Frontiers in Psychiatry, 6, 182. that neurotransmitter imbalance plays a vital role in the prevalence of catatonic schizophrenia. Abnormal release of neurotransmitters such as GABA, dopamine, and glutamate contributes to the progression of this disease. Moreover, neurotransmitter imbalance disturbs adequate brain communication, which results in the development of key symptoms of catatonic schizophrenia.
Congenial complication such as exposure to infections before birth and difficulties during delivery puts the individual at a higher risk of having schizophrenia.
Furthermore, substance abuse and childhood trauma are also among the risk factors of catatonic schizophrenia.
What are the Symptoms of Catatonic Schizophrenia?
Numerous characteristics are seen in individuals suffering from catatonic schizophrenia. But catatonia is the first and foremost symptom of this psychiatric illness which often differentiate the condition from childhood and bipolar schizophrenia.
Additionally, a study defines catatonia4Kleinhaus, K., Harlap, S., Perrin, M. C., Manor, O., Weiser, M., Harkavy-Friedman, J. M., Lichtenberg, P., & Malaspina, D. (2012). Catatonic schizophrenia: a cohort prospective study. Schizophrenia Bulletin, 38(2), 331–337. as a spectrum of psychomotor irregularities which includes:
Individuals facing catatonic stupor may experience episodes of motionlessness or a statue-like appearance. During this phase, affected individuals may go completely mute or show no response to their external surroundings. Despite suffering from these episodes, individuals with catatonic stupor have their cognitive functions intact that are unlikely to cause coma or other stages of unconsciousness.
Catatonic excitement refers to the mental state of extreme and agitated motor activity. Individuals with this condition often show uncontrolled, repetitive, and purposeless movements. This state is also associated with intense emotional responses that can be debilitating for both the affected individuals and their caretakers.
Waxy flexibility is a significant characteristic of catatonic. The dysregulation of neuromotor responses leads to this phenomenon. Individuals with waxy flexibility fix themselves in a position another person places them in.
Individuals diagnosed with catatonic schizophrenia may also show signs of echopraxia which includes mimicking the movements of other persons.
People with catatonic schizophrenia also exhibit characteristics of echolalia which include mimicking phrases or words spoken by other individuals.5Hamlin D, Mahgoub Y. A unique presentation of echo phenomena in a patient with catatonia: a case report and literature review. BMC Psychiatry. 2023 May 24;23(1):364. doi: 10.1186/s12888-023-04821-w. PMID: 37226149; PMCID: PMC10210441.
Individuals diagnosed with catatonic schizophrenia tend to form a posture that works against gravity.
Catatonic schizophrenics are more likely to perform odd and absurd movements known as mannerisms.
Individuals with catatonic schizophrenia also have these symptoms:
- Smiling for no particular reason
- Repetitive movements without having any purpose
- Feelings of being persecuted or having supernatural powers
- Hearing voices that are not present (auditory hallucinations)
- Seeing things that are unreal (visual hallucinations)
- Jumping from one thought to another thought without having a logical connection between them
- Lack of motivation while performing everyday tasks such as cooking or bathing
- Withdrawal from social events due to fear of getting harmed
- Inability to express both positive and negative emotions
- Show unawareness towards their illness
- Difficulty while memorizing, planning, or organizing any activity
- Reduced attention span
- Decreased ability to hold proper conversations
People who experience these symptoms tend to have schizophrenia in most cases. Although to diagnose it clinically, the family or caretaker of that individual must consult a healthcare professional on an urgent basis.
How to Get Catatonic Schizophrenia Diagnosed?
Catatonic schizophrenia diagnosis involves a precise evaluation of both the physical and mental status of the affected individuals. Although the diagnostic criteria of this type of schizophrenia include:
The clinician will run a comprehensive medical assessment by evaluating the vitals of the affected person. This includes checking the patient’s heart rate, blood pressure, temperature, height, and weight. Also, healthcare professionals will listen to the patient’s chest and abdomen sounds for further evaluation.
A psychiatrist will evaluate the patient’s mental health by discussing their symptoms, including when they started, how severe they are, and what effects they brought on the patient’s life. Moreover, a mental health professional will assess the patient’s thoughts, feelings, and behavioral patterns. Furthermore, questions related to suicidal thoughts and attempts are also a part of psychological assessments.
DSM-5 Diagnostic Criterion
As per the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition6Britannica, T. Editors of Encyclopaedia (2023, May 26). Diagnostic and Statistical Manual of Mental Disorders. Encyclopedia Britannica. https://www.britannica.com/topic/Diagnostic-and-Statistical-Manual-of-Mental-Disorders); Schizophrenia is a condition characterized by significant impairments in discerning reality. This is evident through the presence of at least two or more of the subsequent symptoms, which need to persist for a minimum of one month (unless treatment leads to a reduction in symptoms):
There should be a minimum of one symptom from the category known as positive symptoms, which include:
- Delusions: These encompass peculiar beliefs that are resistant to logical reasoning or contradiction from others.
- Hallucinations: These are usually auditory, though occasionally visual in nature.
- Disorganized Speech: This involves incoherent and irrational expression.
- Disorganized or Catatonic Behavior: This manifests as repetitive, nonsensical movements or adopting and maintaining a particular pose for extended periods. The individual may show resistance to attempts to alter their posture or may adopt a new posture when positioned differently.
In addition to these positive symptoms, there are negative symptoms, which include:
- Flat Affect: A lack of emotional expressiveness.
- Amotivation: A diminished drive to engage in activities.
- Anergia: Reduced energy and enthusiasm.
- Failure to Maintain Hygiene: Neglect of personal cleanliness and grooming.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)7Walther, S., & Strik, W. (2016). Catatonia. CNS Spectrums, 21(4), 341–348., the prevalence of three or more catatonic characteristics besides other schizophrenia symptoms, including hallucinations and delusions, is the key to a catatonic schizophrenia diagnosis.
Despite physical and mental evaluation, there are certain diagnostic schizophrenia tests that healthcare professionals might ask the affected individuals to look into. It includes:
- CBC (complete blood count) –to identify whether the patient’s blood contains alcohol or drugs. It also helps to assess thyroid function.
- MRI or CT scan – to assess any structural abnormalities of the brain
- EEG (electroencephalogram) – to diagnose irregularities in brain function
The symptoms of catatonic schizophrenia correlate with other psychiatric illnesses, including mania, severe depression, seizure disorder, substance abuse, and neurological disorders. Thereby, prompt identification of this condition might take some time.
How to Get Catatonic Schizophrenia Treated?
Once catatonic schizophrenia is diagnosed, treatment should be initiated to control symptoms and prevent further complications of this disease. Although the treatment of catatonic schizophrenia8Sienaert, P., Dhossche, D. M., Vancampfort, D., De Hert, M., & Gazdag, G. (2014). A clinical review of the treatment of catatonia. Frontiers in Psychiatry, 5, 181. is multidisciplinary; it’s a combination of medications, psychotherapy, and supportive care.
Pharmacological Management For Catatonic Schizophrenia
Clinician injects these medications intravenously or orally, depending on the severity of the condition to deal with symptoms of catatonic schizophrenia:
- Benzodiazepines – A study suggests9Narayanaswamy, J. C., Tibrewal, P., Zutshi, A., Srinivasaraju, R., & Math, S. B. (2012). Clinical predictors of response to treatment in catatonia. General Hospital Psychiatry, 34(3), 312–316. that benzodiazepines are the first choice of treatment while managing individuals with catatonic schizophrenia. This class of drugs induces sedation in the affected person and injects intravenously. Additionally, two-thirds of the patients diagnosed with catatonic schizophrenia respond to this medication. Although, the healthcare professional may induce benzodiazepines for a few days or weeks. However, its continuous use may cause dependency in the longer run.
- Barbiturates – Often less prescribed than benzodiazepines, barbiturates work as depressors of the central nervous system. These drugs induce mild to severe sedation and relieve the symptoms of catatonia. However, continuous intake of barbiturates can cause a high risk of dependency.
- Antidepressants – Besides other mental health issues, depression coexists with catatonic schizophrenia. Therefore, antidepressants are given to handle its symptoms.
Electroconvulsive Therapy (ECT) For Catatonic Schizophrenia
Individuals with severe catatonic schizophrenia don’t respond to pharmacological intervention in many cases. Whereas in certain patients, medications can be harmful. In both conditions, electroconvulsive therapy (ECT) may be considered as the treatment of choice.
The procedure of ECT involves the usage of electric current to induce controlled seizures in schizophrenic individuals. The application of ECT is safe and well-tolerated when given under strict medical supervision. Even a study claims10Morrison, J. R. (1974). Catatonia: prediction of outcome. Comprehensive Psychiatry, 15(4), 317–324. that ECT is successful in 53% of individuals with severe catatonia schizophrenia where medications didn’t respond previously.
Psychotherapy For Catatonic Schizophrenia
Psychotherapy, including cognitive behavioral therapy (CBT) and supportive therapy, helps to manage symptoms of catatonic schizophrenia effectively. These therapies aid in developing the copying and socializing skills of schizophrenic individuals that increase their quality of life.
Furthermore, supportive therapy offers a non-judgmental and secure atmosphere to affected individuals where they can express their concerns and feelings easily. Whereas cognitive behavioral therapy (CBT) reframes distorted beliefs and thoughts patterns related to catatonic schizophrenia.
Lastly, psychotherapy also improves compliance with treatment by increasing the medication adherence of affected individuals.
Hospitalization For Catatonic Schizophrenia
During the acute phase of catatonic schizophrenia, hospitalization is sometimes necessary. Hospitals provide a safe atmosphere and intensive care that helps in patients’ recovery.
Additionally, hospitals do offer supportive care, a team of multidisciplinary healthcare professionals that work together to improvise patients’ overall well-being.
Outlook – Can Schizophrenia be Cured?
Catatonic schizophrenia is a rare mental disorder that affects both the physical and mental well-being of an affected individual. Although catatonia is a lifelong condition, its symptoms can be successfully managed by taking prompt medications. Moreover, psychotherapy also helps individuals with this disease to continue their tasks of daily living.
- 1Francis, A., Fink, M., Appiani, F., Bertelsen, A., Bolwig, T. G., Bräunig, P., Caroff, S. N., Carroll, B. T., Cavanna, A. E., Cohen, D., Cottencin, O., Cuesta, M. J., Daniels, J., Dhossche, D., Fricchione, G. L., Gazdag, G., Ghaziuddin, N., Healy, D., Klein, D., … Wachtel, L. (2010). Catatonia in Diagnostic and statistical manual of mental disorders, fifth edition. The Journal of ECT, 26(4), 246–247.
- 2Jain, A., & Mitra, P. (2022). Catatonic Schizophrenia. StatPearls Publishing.
- 3Ellul, P., & Choucha, W. (2015). Neurobiological approach of catatonia and treatment perspectives. Frontiers in Psychiatry, 6, 182.
- 4Kleinhaus, K., Harlap, S., Perrin, M. C., Manor, O., Weiser, M., Harkavy-Friedman, J. M., Lichtenberg, P., & Malaspina, D. (2012). Catatonic schizophrenia: a cohort prospective study. Schizophrenia Bulletin, 38(2), 331–337.
- 5Hamlin D, Mahgoub Y. A unique presentation of echo phenomena in a patient with catatonia: a case report and literature review. BMC Psychiatry. 2023 May 24;23(1):364. doi: 10.1186/s12888-023-04821-w. PMID: 37226149; PMCID: PMC10210441.
- 6Britannica, T. Editors of Encyclopaedia (2023, May 26). Diagnostic and Statistical Manual of Mental Disorders. Encyclopedia Britannica. https://www.britannica.com/topic/Diagnostic-and-Statistical-Manual-of-Mental-Disorders
- 7Walther, S., & Strik, W. (2016). Catatonia. CNS Spectrums, 21(4), 341–348.
- 8Sienaert, P., Dhossche, D. M., Vancampfort, D., De Hert, M., & Gazdag, G. (2014). A clinical review of the treatment of catatonia. Frontiers in Psychiatry, 5, 181.
- 9Narayanaswamy, J. C., Tibrewal, P., Zutshi, A., Srinivasaraju, R., & Math, S. B. (2012). Clinical predictors of response to treatment in catatonia. General Hospital Psychiatry, 34(3), 312–316.
- 10Morrison, J. R. (1974). Catatonia: prediction of outcome. Comprehensive Psychiatry, 15(4), 317–324.