Catatonic Behavior Symptoms and Complications

Pensive woman looking into distance
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Catatonia is a psychomotor disturbance since it involves psychiatric and physical or motor manifestations. It may be characterized by a marked decrease in, increase in, or peculiar motor activity. Mentally, its expression can range from unresponsiveness to agitation.

Catatonic behavior can be scary for people with bipolar disorder to experience. For those witnessing an episode, it's important to understand what catatonia is, and how to respond to catatonic symptoms.

Diagnosis and Prevalence

Catatonic features occur most often in schizophrenia, schizoaffective disorder, and similar conditions, but can occur with bipolar spectrum disorders and major depressive disorder. In some cases, catatonia may also be an extreme side effect of a medication or manifestation of another medical condition.

Research shows over 50% of people who experience catatonic episodes have bipolar disorder, and about 28% of bipolar individuals experiencing catatonia had them in mixed mood states of depression and mania at the same time.

For this reason, scientists believe anywhere from 20% to 30% of bipolar patients will experience catatonia during their illness.

Behavior rating scales are used to diagnose the condition. These include Bräunig-Catatonia Rating Scale, Bush-Francis Catatonia Screening Instrument, Bush-Francis Catatonia Rating Scale, Rogers Scale, Northroff Scale, and Catatonia Rating Scale. Additionally, patients being screened for catatonia may be asked about their family medical history, have their vital signs checked, and be subject to a neurological exam.

Benzodiazepines, which are often used in the treatment of catatonia, can also be helpful for confirming a clinical diagnosis. A doctor may administer doses of benzodiazepines and then reassess the individual to see if there has been a marked reduction in their symptoms. However, this method is not totally reliable because some individuals are resistant to benzodiazepines. 

Types

Catatonia presents in two forms: one of excited delirium and one of stuporous behavior marked by unresponsive behavior that renders the individual mute, immobile, and responsive only to pain or visual stimuli.

Symptoms

These are possible symptoms of catatonia:

  • Stupor, which involves a lack of response to external stimuli — e.g., no response to being spoken to or prodded.
  • Catalepsy, which involves muscular rigidity so that the limbs remain in whatever position they are placed.
  • Excessive motor activity with no purpose.
  • Extreme negativism, or resistance to movement or instruction.
  • Mutism, which involves being unable or unwilling to speak.
  • Inappropriate postures and grimacing.
  • Echolalia, which is a parrotlike repetition of a word or phrase just spoken by another person.
  • Echopraxia, which is a repetitive imitation of the movements of another person.

Complications of Catatonia

Untreated severe catatonia can be fatal. Some of the complications may be:

  • Blood clots
  • Exhaustion
  • Malnutrition
  • Muscle breakdown
  • Self-inflicted injury

Treatment

There is no cure for catatonia, however, pharmaceuticals and electroconvulsive treatment (ECT) may be employed to treat symptoms of catatonia. Drugs such as benzodiazepines, muscle relaxants, antidepressants, and neuroleptics have all been used to treat catatonic symptoms.

ECT may be helpful for individuals who are resistant to benzodiazepines. ECT has also been shown to be effective for the treatment of bipolar disorder with catatonia presentation.

Case reports also suggest that amantadine may be helpful for treating catatonia. Further research is needed to explore the use of this medication to treat symptoms of the condition.

People who experience catatonic symptoms may also be admitted to psychiatric, medical, or neurological inpatient observation and treatment. Regular follow-up visits may be urged to stay ahead of catatonic episodes or to ensure re-admittance is not warranted for the patient.

In severe cases, catatonia patients may be placed in an intensive care unit (ICU). The ICU might be suggested as a restrictive environment where intravenous nutrition can be provided, as well as protecting the patient from self-injury and others from possible physical violence during the catatonic episode.

If you are bipolar, be sure you educate your close friends and loved ones about how catatonia may affect you.

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