What Is Catatonia?

confused woman

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What Is Catatonia?

Catatonia is a psychomotor disorder that affects both speech and behavior functions. It can manifest as a state of stupor and unresponsiveness or as restlessness, agitation, and confusion. 

Catatonia was first identified as a discrete syndrome in 1874 by Karl Kahlbaum. The early description of the condition was focused on motor symptoms, and treatment was focused on supportive care rather than medical interventions. 

Currently, the incidence of catatonia is a little more than 10 percent of patients with acute psychiatric illnesses, particularly affective disorders. However, some experts believe that many cases go unreported. 

There are three main forms of catatonia: akinetic, hyperkinetic, and malignant catatonia.

  • Akinetic: The most common type of catatonia that features a lack of movement, staring, and non-responsive behavior. 
  • Hyperkinetic: This is the excited type of catatonia that involves impulsive movement. 
  • Malignant: This causes the most severe symptoms and can lead to other health problems, and in some instances, it can result in death. 

Catatonia used to be closely linked to schizophrenia. In fact, until recently, it was considered a subtype of schizophrenia. But it’s now more commonly associated with a broad spectrum of medical and psychiatric illnesses, particularly mood disorders. 

Symptoms

The symptoms of catatonia will vary depending on the severity and type. However, there are some signs and symptoms that will be common across cases of catatonia. 

  • Stupor: Lack of physical movement or speech
  • Mutism: Non-verbal or very little verbal communication
  • Posturing: Active maintenance of a posture against gravity
  • Waxy flexibility: Appearance of being stuck in the same position
  • Negativism: Resistance to passive manipulation of the limbs or turning away when addressed
  • Stereotypy: Involuntary, rhythmic movement repeatedly performed over time, including body rocking, hand waving, shoulder shrugging, and more 
  • Echolalia: Repeating words said by other people
  • Echopraxia: Mimicking movements done by other people
  • Automatic obedience: Exaggerated cooperation on the patient’s part when interacting with another person
  • Ambitendency: Alternating between compliance and resistance to another person’s requests
  • Forced grasping: Repeated handshake despite being asked not to do so

Some signs occur more frequently. One study involving more than 230 catatonic patients found that staring, immobility, mutism, and withdrawal were reported with a greater frequency than other symptoms.

Causes

The exact cause of catatonia is not clear. However, experts say a catatonic state can be triggered by a range of conditions, including psychiatric causes to those related to neurological and other medical illnesses.

Some common theories include a deficiency in gamma-aminobutyric acid (GABA), which is the primary inhibitory neurotransmitter in the brain, a dysregulation in glutamate, which is the primary excitatory neurotransmitter a massive blockade of dopamine, or abnormalities of metabolism in the thalamus and frontal lobes.

Other common hypotheses for catatonia include the following:

  • Psychiatric disorders: Schizophrenia, mood disorders such as depression and bipolar disorder, and affective disorder are all underlying conditions that can cause catatonia.
  • Neurological disorders: Catatonia can be caused by brain disorders like neurodegenerative disease and encephalitis. It can also be triggered by strokes, neoplasms, or other diseases. 
  • Anxiety: One theory about the cause of catatonia stems from an outward manifestation of anxiety. Researchers report patients experiencing severe anxiety before and during catatonic episodes. 
  • Medical conditions: Although psychiatric conditions are the most common underlying cause, some medical conditions can also cause catatonia. Dystonia, renal failure, progressive multifocal leukoencephalopathy, autoimmune, paraneoplastic, infectious, metabolic, and certain drug exposures, and poisonings can lead to the development of catatonia.

It's important to note that the majority of cases will have a detectable underlying cause, but some catatonic cases can also arise from an unknown cause. 

Diagnosis

Diagnosing catatonia is based on clinical observations. Practitioners can use a scale to diagnose catatonia. One of the most commonly used scales is the Bush-Francis Catatonia Rating Scale. Other tools include the Rogers Catatonia Scale, the Northoff Catatonia Rating Scale, and the Braunig Catatonia Rating Scale. 

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a patient must present (either during an examination or observed) with three or more of the following symptoms to be diagnosed with catatonia. 

  • Catalepsy 
  • Waxy flexibility
  • Stupor
  • Agitation
  • Mutism
  • Negativism 
  • Posturing
  • Mannerisms 
  • Stereotypy
  • Grimacing 
  • Echolalia
  • Echopraxia

Separating catatonia from schizophrenia in the DSM-5 allowed catatonia syndrome to be diagnosed as a specifier to major mood disorders, psychotic disorders, general medical conditions, and catatonia not otherwise specified. This has made it easier for practitioners to diagnose the condition. 

Treatment

The treatment of catatonia generally falls under one of two categories: pharmaceutical or electroconvulsive therapy (ECT). 

  • Benzodiazepines: In general, the first line of defense for treating catatonia are medications, with benzodiazepines being the top pick. Lorazepam, which belongs to the benzodiazepines, is often administered in doses ranging from 8 to 23 milligrams per day. At this dosage, patients typically see a response in three to seven days.
  • Zolpidem: When benzodiazepines aren’t effective, some practitioners will choose to use zolpidem, which belongs to a class of medications called sedative-hypnotics. 
  • Glutamate Antagonists: While not used very often, glutamate antagonists, and more specifically, amantadine, has shown some success in treating catatonia. 
  • Electroconvulsive Therapy. In cases where a patient does not respond to low-dose benzodiazepines, a doctor may recommend electroconvulsive therapy (ECT). During ECT, a medical professional will administer a brief electrical stimulation through the brain while the patient is under anesthesia. The purpose is to trigger a brief seizure with the goal of causing changes in brain chemistry. In patients demonstrating symptoms of malignant catatonia, ECT is often recommended as the first treatment option since this type of catatonia has a high rate of mortality if not treated immediately.

In many cases, mental health experts or doctors need to treat catatonia before they can accurately diagnose and address any underlying conditions.

Coping

Catatonia is a serious medical condition that requires treatment from a doctor. Because of this, there are no coping strategies for a patient to implement. That said, if a caregiver or loved one is in need of support, information, or other services, reaching out to an expert can help them cope with the physical and emotional aspects of caring and living with someone with catatonia. 

A Word From Verywell

If you suspect someone you know is experiencing catatonia, contact a doctor or call 911 right away. In some cases, catatonia can be serious and life-threatening. However, with a proper diagnosis and the right treatment plan, the prognosis is good. 

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