Catatonic Schizophrenia: Symptoms and Treatment

What is Catatonic Schizophrenia?

Catatonic schizophrenia is a serious mental disorder. Characterized by a person’s physical movements, it has been one of the subtypes of schizophrenia. However, not all people diagnosed with schizophrenia may display catatonic symptoms. Catatonic schizophrenia’ affects a person’s physical movement in particular. This can be to the extent that they cannot move at all. Or, they may have limited repetitive movements. Or their movement may seem excited and over exaggerated. It is a chronic, lifelong condition, but a manageable and treatable one.

Schizophrenia Definition

Schizophrenia is a serious mental illness. It distorts and affects all aspects of the way a person functions. For someone diagnosed with schizophrenia, how they think and process information can be very disorganized. Emotions may be erratic, and their behavior may seem odd to other people. They experience psychotic symptoms. It can affect a person’s ability to understand what is real

They may have visual and auditory hallucinations, hearing and seeing things that others do not. They may be delusional and paranoid. They may believe that other people are persecuting them, or out to get them. That everything around them is a conspiracy. They may withdraw away from others because of these beliefs. They may neglect their personal self-care and fail to maintain personal hygiene and nutrition. People with schizophrenia are often unable to recognize when they are unwell.

It unknown what the exact cause of schizophrenia is. However, it considered both a neurological and psychological condition. Causes of schizophrenia may be a combination of genetics, family history, and environmental situations. Most diagnoses of schizophrenia are in adults. Symptoms do not usually become apparent until early adulthood. However, there are cases of the onset of schizophrenia in younger children.

Catatonic Definition

The term catatonic describes a type of movement and overall mobility. Catatonia can range from being completely immobile to excessive. Someone experiencing catatonia may seem dazed and in a stupor. They may be unresponsive, unable to speak, and unaware of anything going on around them. Their muscles may be rigid and they may be completely immobile. Or, they may have limited slow movement and a lack of awareness of their surroundings. With excited catatonia, someone’s movements and speech may be manic, excited and repetitive.

It is important to note that catatonic type symptoms affect a range of health conditions. These include other mental health issues such as clinical depression, bipolar disorder, and catatonic syndrome. People can also experience catatonic behavior and symptoms in reaction to different types of drugs and excessive alcohol consumption. Medical conditions such as brain lesions and anti-NMDAR encephalitis can also result in catatonic symptoms. Treatment of catatonia can also use similar methods.

Symptoms of Catatonic Schizophrenia

It is important that diagnosis of any type of schizophrenia is undertaken by a qualified health professional. They will consider the catatonic symptoms in combination with other schizophrenic traits. The common symptoms or negative symptoms of catatonic schizophrenia include:

Stupor

The symptoms of catatonic stupor are very low to zero physical activity and movement. A person may stay in one position for hours. They may be verbally unresponsive and unable to make eye contact. Someone with catatonic stupor may be very rigid or seem as if they are in a trance. They may not seem to hear or understand anything spoken to them. They may be completely mute and unable to speak, or only be able to give very limited verbal responses.

Agitation

Symptoms of catatonic excitement are excitability and manic/agitated movements. The movement may be repetitive such as walking back and forth, in circles or other patterns. Arm and leg movements may be odd. A person may have outbursts of speech, often loudly. They may repeat the same word or phrases over, and over again.

Posturing

The posture of someone with catatonic schizophrenia may be unusual and awkward whether they are sitting, lying or standing. They may be able to hold different positions that seem to defy gravity. They may stay in rigid or uncomfortable positions for long periods. Facial expressions may be unusual or grimaced.

Waxy Flexibility

This term refers to when someone else can move a catatonic person into other positions. Once moved, they will usually remain in a new position and not revert to their previous posture or movements. The term relates to the person being flexible enough to be moved, but to the person moving them they feel like wax.

Mimicking

Someone experiencing catatonic schizophrenia may mimic the speech and/or physical movements and mannerisms of others. This is involuntary. Called echolalia, the mirroring of someone’s speech is also found in other disorders. Single words, phrases, or the tail end of sentences are repeated and said back to the other person as they say them. Mirroring or mimicking someone’s physical movements is known as echopraxia.

Other Types of Schizophrenia

To diagnose mental disorders, including schizophrenia, clinicians usually use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The American Psychiatric Association (APA) publishes the DSM. Under the current edition, the DSM-5, there are no subtypes. The previous subtypes are symptoms of an overall diagnosis of schizophrenia.

Many health professionals may refer to one of the subtypes referred to in previous editions of the DSM. Diagnosis of a subtype depends on the predominant symptoms present at the time of diagnosis. The symptoms are in combination with other signs of schizophrenia. Aside from catatonic schizophrenia, the other subtypes have included:

Paranoid Schizophrenia: As the name implies, the predominant symptom in someone who diagnosed this subtype is paranoia. Someone with paranoid schizophrenia is likely to have delusions and a distorted sense of reality. They are likely to experience visual and auditory hallucinations. They may believe things to be true, even if faced with evidence to show they are not.

Disorganized or hebephrenic schizophrenia: This subtype has predominant symptoms of disorganized thinking, speech, and behavior. A person with this diagnosis may have difficulty with speaking coherently and finding words to say phrases that make sense. They may have difficulty coping with basic tasks such as dressing, eating, and bathing. They may seem to have flat emotional responses or react inappropriately such as laughing during a serious situation.

Undifferentiated Schizophrenia: This is when a patient has presented a range of schizophrenic symptoms. However, none are more predominant than the others are. They may experience a range of schizophrenic symptoms including disorganized speech, thinking, behavior, catatonia, and delusions.

Residual Schizophrenia: If a person has a diagnosis of residual schizophrenia, they have reduced symptoms. They have recovered from significant symptoms they have displayed during a schizophrenic episode.

Other psychotic disorders can present with similar symptoms to schizophrenia. These include schizoaffective disorder, schizophreniform disorder, and substance-induced psychotic disorder. Symptoms and treatment methods can also overlap with overlap with associated disorders.

Catatonic Schizophrenia Diagnosis and Treatment

Because of the complexity of symptoms, it is important for a health professional to make a formal diagnosis of schizophrenia and treatment methods. They will consider both positive and negative symptoms. Positive symptoms are those not normally seen in healthy people. These include symptoms such as hallucinations, unusual physical movements, delusions and dysfunctional thinking. Negative symptoms are those that can be present in others under certain conditions. These include showing a lack of emotion, ability to speak, and withdrawal from everyday activities.

Diagnosis

Diagnosis can take time. There is not one simple test used to make a diagnosis of catatonic schizophrenia in patients. A clinician is likely to begin first with ruling out any other medical or psychological conditions with similar symptoms. They will likely use different medical tests and criteria from the DSM and the Bush-Francis Catatonia Rating Scale.

Treatment

Health professionals use a range of treatment methods to manage catatonic schizophrenia. Medication is usually the primary method of treatment of catatonic schizophrenia. Other methods utilized include ways to help patients with social skills and take care of other areas of their health.

Medication: Benzodiazepines are often the first-line treatment method with catatonic schizophrenia. They are fast acting so relieve symptoms quickly. Other medications may include antipsychotics and atypical antipsychotics, barbiturates, and antidepressants.

With any medication’s prescribed for schizophrenia, there’s a risk of dependency. A health professional will usually closely monitor patients dosage, effectiveness, and duration. Patients are also monitored for neuroleptic malignant syndrome in reaction to antipsychotic drugs.

Hospitalization: Sometimes people are admitted to hospital as patients for diagnosis and initial treatment, particularly if a patient has neglected their nutrition and hygiene or there are issues around personal safety. Hospitalization can also mean physicians can closely monitor the effectiveness of treatment options.

Psychotherapy: Psychotherapy, combined with medications, can help patients. With this treatment, they learn and implement ways to cope with the schizophrenia disorder and any stress that may trigger episodes or symptoms. This treatment can also help patients to understand the impact of thought processes, responses, and behavior when they are unwell.

Electro-Convulsive Therapy (ECT): ECT, or shock treatment, may help severe or extreme cases of catatonic schizophrenia. However, it is controversial, and not usually considered unless other treatment methods have failed.

To Sum Up

Schizophrenia is a serious and chronic condition, but it is one that can be treated and managed. If you think you are at risk or might know someone who is at risk or experiencing symptoms, seek guidance from a health professional. A person experiencing psychosis or symptoms of schizophrenia is usually unaware of the severity of their symptoms. Similarly, if they have already received a diagnosis of schizophrenia but have not been taking their medication they may not be aware of how unwell they have become. It is often up to family and friends to assist the person get the help needed. Going therapy for schizophrenia is a good way to start in helping a person with catatonic schizophrenia.

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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