Catatonic Schizophrenia – Definition, Symptoms, Causes and Treatments

It is difficult to understand the workings of the human mind, even with advanced psychological methods. Childhood experiences and life experiences, trauma and many other things can lead to mental disorders and catatonic schizophrenia is one of them and it is quite rare, especially in industrialized countries. It is one of the different types of schizophrenia and is characterized by a variety of unusual symptoms, many of which are physical in nature and may be briefly exhibited by the other schizophrenic types.

What is catatonic schizophrenia?

It is a serious neurological or psychological condition in which two types of behaviors are generally displayed: stupor and motor rigidity or excitement. When people experience stiffness or stupor, they cannot speak, respond, or even move and in other cases, they will show intense arousal or mania. Those who experience catatonic arousal will display manic behaviors such as babbling or talking incoherently and those who suffer from catatonic stupor remain in this immobile state for long periods of time.

Symptoms of catatonic schizophrenia

This type of schizophrenia is much rarer than it used to be thanks to improved treatments, catatonic states are more likely to be found in types of mental illness other than schizophrenia, such as neurodevelopment (conditions that affect children during development nervous system), psychotic or depressive bipolar disorders.

People with catatonia can switch between decreased and excessive motor activity. With modern treatments, patients can manage their symptoms more easily, increasing the likelihood of leading a happier and healthier life.

The clinical picture of catatonia is dominated by at least three of the following symptoms:

• Stupor:  No psychomotor activity, no interaction with the environment.
• Catalepsy:  Includes the adoption of unusual postures.
• Waxy flexibility:  If an examiner places the patient’s arm in one position, they will maintain this position until it is moved again.
• Mutism: Limited verbal responses.
• Negativism:  Little or no response to external instructions or stimuli.
• Posture: Actively hold a posture against gravity.
• Mannerism: Carrying out strange and exaggerated actions.
• Stereotypy: Repetitive movements for no apparent reason.
• Agitation: For no known reason.
• Making faces
• Echolalia: Imitating the speech of another person.
• Ecopraxia: Imitating the movements of another person.

Without proper treatment, a catatonic episode can persist for days or even weeks.

What Causes Catatonic Schizophrenia?

In Parkinson’s disease , dopamine deficiency delays voluntary movement, it is not clear what causes catatonic schizophrenia and why only some patients experience it while others do not. Researchers speculate that a combination of genetic and environmental factors contribute to its onset and to schizophrenia in general.

It has been observed that a dopamine imbalance may play a role in the onset of schizophrenia, which can also be caused by genetics. The neurotransmitter serotonin may also play a role here.

The risk factors for catatonic schizophrenia are the same as for schizophrenia:

• Genetics: People with a family history of schizophrenia are at higher risk of developing themselves.
• Viral infection: Some recent studies suggest that viral infections may predispose the child to the development of schizophrenia.
• Fetal malnutrition: If the fetus suffers from malnutrition during pregnancy, there is an increased risk of developing schizophrenia.
• Stress during early life:  Severe stress early in life can contribute to the development of schizophrenia. Stressful experiences often happen just before they appear.
• I abuse childhood trauma.
• Parental age at birth: Older parents are at higher risk of having children who develop schizophrenia.
• Drugs: The use of drugs that affect the mind during adolescence can increase the risk of developing schizophrenia.

Common Features of Catatonic Schizophrenia

Catatonic schizophrenia shows strange positions and movements, or long periods of immobility, she may remain in awkward-looking positions for long periods and resists attempts to reposition them in more comfortable or natural positions.

In addition to lack of mobility, the catatonic schizophrenic may show excessive movement. In cases where people experience excitability as a symptom, they may move in an extreme and erratic manner and may be paced in a repeating pattern and loud exclamations. These actions are useless and are not in response to an environmental stimulus or event.

People with this disorder may also have other signs of schizophrenia, such as hallucinations, delusions, cognitive problems, social withdrawal, outbursts of anger, poor personal hygiene, social problems, and an inability to express emotions .

Diagnosis of catatonic schizophrenia

A series of tests will help doctors diagnose catatonic schizophrenia, a doctor who suspects that a patient may have this type of schizophrenia will recommend a series of medical and psychological tests to help with the diagnosis; these may include:

• Physical exam:  The patient’s height, weight, heart rate, blood pressure, and temperature are checked. The doctor will listen to the heart and lungs and check the abdomen.
• Complete blood count: To detect alcohol and drugs, as well as thyroid function.
• CT scan: The goal is to look for any abnormalities in the structure of the brain.
• Electroencephalogram: To check brain function.
• Psychological evaluation:  A psychiatrist will ask the patient (if possible) about his thoughts, feelings and behavior patterns, they will discuss the symptoms, when they started, how severe they are and how they affect the patient’s life, he will also ask if the patient has thoughts of hurting yourself or others.

It can take a long time to accurately diagnose catatonic schizophrenia. Other conditions, such as mania, seizure disorders, substance abuse, and severe depression , share symptoms with catatonic schizophrenia and should be ruled out first.

Treatment options for catatonic schizophrenia

Schizophrenia is a lifelong condition, although catatonic symptoms may not persist. Patients with schizophrenia require permanent treatment; even when the symptoms seem to have disappeared and the patient thinks they are improvements. Treatment is essentially the same for all forms of schizophrenia.

Methods vary depending on a number of factors, including the severity and types of symptoms, the patient’s health, and their age.

Medication

Medication is the most common form of treatment for schizophrenia.

• The benzodiazepines are perhaps the most common approach to treatment, these drugs act as depressants of the central nervous system, which often are used to treat anxiety . Because these medications are fast-acting, they can relieve catatonic symptoms fairly quickly and can be habit-forming, especially if used as a long-term treatment.
• Barbiturates: These drugs are known as depressants or sedatives, they suppress the central nervous system and their effects range from mild sedation to total anesthesia. Barbiturates quickly relieve catatonia symptoms and if used for a long time, there is a risk of dependence.
• Antidepressants and mood stabilizing drugs : People with catatonic schizophrenia have other mental health problems, such as depression.

Psychotherapy

Sometimes psychotherapy is combined with medication to teach coping skills and how to deal with stressful situations. This treatment is also intended to help people who have mental health problems associated with catatonia learn how to work with their doctor to better manage their condition.

Psychotherapists help patients better understand their feelings, behaviors, and responses, people in therapy learn a variety of coping skills, and acquire new ways of dealing with stressful events in their lives. With proper treatment, an individual suffering from catatonic schizophrenia can find relief from their symptoms and can help patients avoid many of the dangerous complications associated with this disorder, including substance abuse, family problems, and suicide .

Electroconvulsive therapy

Or shock treatment, it has sometimes been used to treat catatonic schizophrenia. This technique involves sending an electrical current through the brain. Since it is so controversial and can lead to serious side effects such as memory loss , it is generally only used in severe cases where patients have not responded to medications, are severely depressed, and are at risk of suicide.

Hospitalization

This may be necessary during severe episodes. Patients are safer in a hospital setting; they are more likely to get proper nutrition, sleep, and hygiene, as well as proper treatment.

Social and vocational skills training

This can help the patient live independently, a vital part of recovery for the patient. The therapist can help you learn good hygiene, prepare nutritious meals, and have better communication, and there may be support in finding work, housing, and joining self-help groups.

Compliance (adherence)

Compliance or adherence in medicine means taking the medicine at the right time and the correct doses. Unfortunately, non-compliance is a major problem for schizophrenia patients, as they may stop taking their medications for long periods of time, significantly interfering with their lives and those of the people around them.

Complications of catatonic schizophrenia

Untreated catatonic schizophrenia can cause health, financial, behavioral, and legal problems; These problems can affect every part of the patient’s life. Complications can include:

• Depression, suicidal thoughts and behaviors: A significant number of patients with schizophrenia have periods of depression.
• Malnutrition.
• Hygiene issues
• Substance abuse, which can include alcohol, prescription drugs, and illegal drugs.
• Inability to find or keep a job, resulting in poverty and homelessness.
• Prison.
• Serious family conflicts
• Inability to study or attend school and other educational institutions.
• Being a victim or a perpetrator of a crime.
• Diseases related to smoking.