A Brief Guide to Catatonic Schizophrenia

Catatonic schizophrenia is a mental illness that falls within the scope of the mental disorder known as schizophrenia (schizophreniform disorder). There are several different types of schizophrenia. Catatonic schizophrenia is a type of schizophrenia with overlapping symptoms of other types of schizophrenia. Catatonic schizophrenia at times can resemble bipolar disorder; however, there are critical differences between the two, which is why it is critical for experienced clinicians to diagnose the mental illness.

Read on to learn more about what catatonic schizophrenia is, the common clinical signs and symptoms of schizophrenia, and first-line treatment options.

What is Catatonic Schizophrenia?

Catatonic schizophrenia is a specific type of schizophrenia that is characterized by disruptions in a person’s movement. Catatonic schizophrenia, like other variations of the mental disorder, has no cure and people are born with it. Schizophrenia isn’t a gradual mental disorder; there is no “development” phase. Risk factors are higher especially in people whose parents have been diagnosed with schizophrenia. 

Those who are affected with schizophrenia are inundated with delusions and hallucinations, which are as real to a schizophrenic as the actual world around them. Simply put, for a person with schizophrenia, there is no distinguishing the reality of their hallucinations and delusions from actual events of the real world surrounding them.

Patients with catatonic schizophrenia have the same neurological and psychotic symptoms as other types of schizophrenia. However, the physical reactions in those with catatonic schizophrenia are significantly different from other types of schizophrenics. 

Schizophrenia Definition

Schizophrenia is one of the most misunderstood mental disorders. The stereotype of schizophrenics in our collective psyche has some basis in reality. At the same time this particular strain of mental illness has much more to it. Characterized by a broad range of unusual behaviors causing a disruption in their own lives and the lives of others, schizophrenia famously is understood to involve delusions and hallucinations. 

Schizophrenia is typically diagnosed in people in their 20s, as the DSM-V and the Bush-Francis catatonia rating scale doesn’t acknowledge schizophrenia existing in those under 18. Many times those under 18 who display schizophrenic symptoms are classified as having bipolar disorder instead of schizophrenia. Furthermore, most clinicians will rule out substance-induced psychotic disorder prior to diagnosing the catatonic type of schizophrenia.

Since schizophrenia is a neurological disorder, the issues resulting from this disorder are entirely mental responses to stimuli, or in many cases, stimuli created by entirely within the confines of an individual’s brain.

Catatonic Definition

When it comes to catatonic schizophrenia, this particular disorder has a few wrinkles that are otherwise not found in other types of schizophrenia, including paranoid schizophrenia. The most noticeable aspect of catatonic schizophrenia is the physical manifestations of the mental illness. Similar to bipolar disorder, the catatonic syndrome has periods of mania and catatonic behavior as well as periods of abject listlessness. 

For example, when patients with catatonic schizophrenia are in a down cycle, their bodies can be positioned in an assortment of ways. This is known as waxy flexibility, and if you have ever worked with models or mannequins then it is a similar type of listlessness. This listlessness is known as a stupor and results in a variety of weird, unnatural positions. Many of these positions are quite unnatural yet do not cause patients suffering through the mental disorder to feel physical pain. 

During periods of catatonic mania, there is a quite an increase in activity as the stimuli is causing a greater reaction. When thinking of catatonic mania, the best way to conceptualize this particular aspect of catatonic schizophrenia is thinking of bipolar disorder.

Symptoms of Catatonic Schizophrenia

The symptoms of catatonic schizophrenia are very easy to notice. That said, avoid trying to diagnose this particular disorder without the help of a trained psychiatrist specializing in abnormal psychiatric disorders. Because there is much to consider in terms of treatment—along with the actual clinical nature of the disorder—finding a trained psychiatrist is critical. 

The reality is treatment of catatonic schizophrenia is not something that can be done with traditional talk therapy. Therefore, getting a firm diagnosis of schizophrenia from a licensed clinician is the best and most reliable course of action. 

The licensed clinician will look for key symptoms of catatonic schizophrenia. If present, then he or she will make a firm diagnosis. Here are some of the most common catatonic symptoms:

  • Catatonic Stupor
  • Catatonic Excitement
  • Posturing
  • Negativism
  • Rigidity
  • Waxy Flexibility
  • Disorganized speech

Here is an in-depth look at each catatonic symptom:


Characterized in some cases by mutism, stupor is most apparent when there is noticeably less interaction with the environment while spontaneous movements and activity abound. In these situations, the person suffering from catatonic schizophrenia is deep into the hallucinations. The real world is no longer existing to them but instead they are reacting to the delusions occurring within.

Catatonic Excitement

When not influenced by external stimuli, this purposeless motor activity is again symptomatic of the internal prioritization of the hallucinations and delusions plaguing patients with catatonic schizophrenia. In these cases, it is incredibly important to understand that patients are typically not in the same world as everyone else.


The unnatural positioning and maintenance of these positions is undertaken by those with catatonic schizophrenia. In many cases, these positions look quite uncomfortable. Posturing can be affected by catatonic mania or a deep stupor. Ultimately, this is a patient responding to the internal stimuli that is blocking out the actual real world environment they would otherwise react to.


It is important to understand the machinations of the mind of patients suffering from catatonic schizophrenia. This symptom is characterized by the motivation-less resistance to instructions and attempts to move a person. Sometimes, this even results in a person moving in diametric opposition to what the instructions are. Again, this showcases the break between the person suffering from catatonic schizophrenia with the surrounding environment while being immersed in their own environment.


Just as the word implies, rigidity is the resistance to being moved from a current physical position. A patient’s posture is stiff, and there is little that one can do to move the person out of position. Despite all efforts, the rigid posture will remain and moving or manipulating the person will prove to be a very difficult endeavor.

Waxy Flexibility

This symptom is the complete opposite of rigidity. In these cases, the person is in the downswing of activity, and the waxy flexibility is similar to positioning a dummy or mannequin.

Other Symptoms

Catatonic symptoms can be broken into two categories: positive symptoms and negative symptoms. Most notable of the symptoms not covered above is disorganized speech along with command automatism. Patients with schizophrenia are either repeating the same words and phrases without any purpose except to repeat them. In cases of command automatism, there is an almost robotic-like nature to how patients follow instructions. 

Additionally, nonconvulsive status epilepticus is another possible medical condition associated with schizophrenic patients.

Other Types of Schizophrenia

Besides catatonic schizophrenia, there are other types of schizophrenia. The most famous is the paranoid schizophrenia, which is a subtype of schizophrenia, but also one that is equally debilitating. Though patients with mental disorders are more often a threat to themselves than others, the paranoid schizophrenia subtype is the most notorious. Auditory hallucinations are one of the most common symptoms of paranoid schizophrenia. This is often described as “the voices.” 

Paranoid schizophrenia is often difficult to diagnose because they lack the same physical manifestations as those with catatonic schizophrenia. Additionally, the behaviors and responses to situations are often unpredictable. For example, the voices are never calming; instead they often make patients feel like something or someone is out to get them. 

Unfortunately, the inability to distinguish between a hallucination and reality can have tragic effects on patients with paranoid schizophrenia. Patients with disorganized schizophrenia appear to lead chaotic lives and the hallucinations and delusions cause them to ping-pong between different activities and tasks. 

Additionally, patients with the disorganized schizophrenia subtype have difficulty processing their emotions.

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.

Catatonic Schizophrenia Diagnosis and Treatment

Unfortunately, catatonic schizophrenia is a mental disorder that no only affects patients’ lives, but also those around them. In addition to providing the patient with the level of care that he or she needs, empathy is another effective way to cope with the disorder and ensure overall mental health.

By understanding how people with schizophrenia are affected, it is easier to manage which is a benefit to all affected.











author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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