What Is Catatonic Behavior in Schizophrenia?

Common catatonic behaviors

Verywell / Chelsea Damraksa 

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What Is Catatonic Schizophrenia?

Although you may have heard the term "catatonic schizophrenia," this diagnosis no longer officially exists in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It was previously one of the subtypes of schizophrenia. Currently, it is used to describe someone who is diagnosed with schizophrenia who also meets the diagnostic criteria for catatonia.

Catatonia is marked by a significant decrease in someone's reactivity to their environment. This can involve stupor, mutism, negativism, or motor rigidity, and even purposeless excitement. While these symptoms can be scary and extremely debilitating, knowing more about them (and what treatments are available) can help you better manage them or help a loved one.

Characteristics of Catatonic Behavior

Someone with this condition might experience rigidity or stupor, or be unable to speak, respond, or even move—and this can last for hours or even days if left untreated. Catatonia can also cause a person to perform strange movements and stay in uncomfortable-looking positions without attempting to shift into more comfortable or natural ones.

In addition to a lack of mobility, erratic and extreme movement is possible in catatonic behavior. For example, a person might pace in a repeated pattern and make loud exclamations for no reason at all (i.e., not in response to an environmental stimulus or event).​ Parrot-like repetition or echoing of words, known as echolalia, is also a common catatonic behavior.

Common Schizophrenia Symptoms

People with this disorder may also display signs of schizophrenia, including:

  • Cognitive problems
  • Decreased ability to express emotions
  • Delusions
  • Disorganization
  • Hallucinations
  • Poor self-care
  • Social difficulties
  • Social withdrawal

Diagnosis

There are no labs or tests to diagnose catatonic symptoms in schizophrenia. Catatonic behavior can also occur in other conditions such as autism and mood disorders, so a doctor will evaluate symptoms to determine what is causing them. 

A doctor will perform a series of medical exams and psychological evaluations to assess the individual's physical and mental health, as well as rule out other conditions.

Depending on the results, a doctor may order a magnetic resonance imaging (MRI) scan or an electroencephalogram (EEG) to check for any lesions or unusual brain wave patterns. A test may also be given to check for the presence of drugs and alcohol.

During the psychiatric evaluation, the individual will be asked questions about their thoughts and behaviors. A psychiatrist will attempt to discover how long they have been experiencing the symptoms in question.

If a patient is in a catatonic stupor and unable to talk, their family may be called in to provide information about the catatonic behavior.

Causes

The exact causes of catatonic behavior are not clear and there is no single cause of schizophrenia.

Causes of Catatonic Behavior

  • Brain abnormalities: These include unusual activity in the brain including irregularities in neurotransmitter systems involving dopamine, glutamate, and gamma-aminobutyric acid (GABA). 
  • Psychiatric conditions: Catatonia or catatonic behavior is a serious psychiatric condition that has historically been associated with schizophrenia, but it can be present in a variety of psychiatric conditions, including schizoaffective disorderbipolar disorder, and major depressive disorder.
  • Substances and other medications: Catatonic behavior may also result from drugs, alcohol, and certain medications.
  • Medical conditions: Some other medical conditions can cause catatonic behavior or behaviors that can be mistaken for catatonia. Dystonia, encephalopathy, HIV, and renal failure are conditions that can potentially cause catatonia.

Catatonic symptoms like facial contortions, strange limb movements, or unusual body positions can lead to a misdiagnosis of tardive dyskinesia or other movement disorders. Similarly, Tourette's syndrome may be confused for catatonia due to some of the vocalizations that can be part of the syndrome.

Causes of Schizophrenia

While the exact causes of schizophrenia are not fully understood, it is believed that a combination of genetic and environmental influences may play a role. Genetics appear to make people more vulnerable to the condition, but other factors including viral infections, exposure to toxins, neurochemical irregularities, stress, and trauma can also play a role. 

Treatment of Catatonic Schizophrenia

Schizophrenia is a lifelong, chronic condition, which means you'll need to take steps to stay ahead of and manage your catatonic behaviors and your schizophrenia. While there's no cure, there are treatment methods that can help you to better manage your symptoms.

Medication

Benzodiazepines like Ativan (lorazepam) are perhaps the most common approach to treatment. These drugs act as depressants on the central nervous system, which is why they are often used to treat anxiety.

Because these drugs are fast-acting, they can often relieve catatonic symptoms quite quickly. However, they can be habit-forming when used as a long-term treatment.

There is some debate around the use of antipsychotics in catatonia. In some cases, antipsychotics can worsen catatonia and are often discontinued in its acute management. However, they are generally reintroduced to treat and prevent the symptoms of schizophrenia.

Electroconvulsive Therapy (ECT)

ECT, formerly known as electroshock therapy, is increasingly used to effectively treat catatonia in schizophrenia and other psychiatric conditions.

Coping With Catatonic Behavior in Schizophrenia

Witnessing someone you care about experience catatonic behavior with schizophrenia is certainly scary. Perhaps the best thing you can do is to stay educated—about diagnosis, symptoms, and effective treatment—so you can get help right away if you notice any signs of catatonia like rigidity or stupor or erratic and extreme movements.

Depending on the severity and type of symptoms, you may need to step in to describe the catatonic behaviors to your loved one's doctor. Doing your best to encourage your loved one to work with their mental health professional and stick with the treatment plan will help ensure that schizophrenia is being well managed and controlled.

And don't forget self-care, which is essential for sustaining the mental energy required to support someone with a mental illness. Try to get ample sleep, eat right, exercise, and make time for relaxation and fun in your life.

A Word From Verywell

Getting a proper diagnosis and complying with treatment is key to coping with catatonic behavior. While schizophrenia is a lifelong disease, catatonia can be controlled. With appropriate treatment, people suffering from catatonic symptoms as part of schizophrenia and other psychiatric conditions can find significant relief from their symptoms.

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