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Schizophrenia, Catatonic

Definition :
Schizophrenia is a chronic mental health disorder that results in altered behaviors, thinking and perceptions that don't correspond with real events.

Catatonic schizophrenia is a subtype of schizophrenia. People with catatonic schizophrenia display extreme inactivity or activity that's disconnected from their environment or encounters with other people (catatonic behavior). These episodes can last for only minutes or up to hours.

Men with catatonic schizophrenia usually experience their initial catatonic episode in their teens or 20s, while women usually experience first episodes in their 20s or early 30s.

Although there's no cure for catatonic schizophrenia, medications and well-coordinated mental health care services may help people manage the disease.

Causes:
Most researchers believe that schizophrenia results from problems with early brain development. Studies have focused on the way brain cells communicate with each other through nerve pathways. Too many or too few connections in the important pathways of emotional regulation may lead to psychotic symptoms. More specifically, certain areas of the brain that are rich in the chemical dopamine seem to be affected most often in schizophrenia.

The contributing factors associated with the development of these brain-pathway problems are controversial and are being carefully investigated. Some of the areas of current research include risk-associated genes, exposure to certain viruses or malnutrition in the womb, and stressful childhood environments in genetically susceptible children.

When to seek medical advice :
A person with catatonic schizophrenia isn't likely to seek treatment. The reason for an initial assessment may be emergency or hospital care to address a first-time catatonic episode. If you believe a family member or friend is exhibiting signs of catatonic schizophrenia, help that person seek medical care.

Symptoms:
Early signs and symptoms of schizophrenia — such as social withdrawal, unusual behaviors, anxiety and decline in daily functional abilities — may begin gradually before the primary symptoms of schizophrenia, known collectively as psychosis, are manifested. But disease onset may also be acute with the sudden appearance of psychosis.

The distinguishing psychotic features of catatonic schizophrenia include :

  • Physical immobility. People may be completely immobile and appear to be unaware of their surroundings (catatonic stupor). They may exhibit a partial immobility known as "waxy flexibility." For example, if a person's arm is moved into a certain position, it will stay there for some time.
  • Excessive mobility. These motor activities — such as frenzied pacing, turning around in circles, flailing arms or making loud noises — appear to have no purpose or motivating factors. This kind of behavior is called catatonic excitement.
  • Extreme resistance. Without any apparent motivation, people with catatonic schizophrenia may not respond to instruction, may resist any attempt to be moved or may not speak at all. This kind of behavior is called negativism.
  • Peculiar movements. People may assume inappropriate or unusual postures, grimace for long periods or adopt unusual mannerisms. They may also exhibit habits known as stereotyped behaviors, such as repeating words, obsessively following a routine or always arranging objects exactly the same way.
  • Mimicking speech or movement. A person may repeatedly say a word just spoken by someone else (echolalia) or repeatedly copy a gesture or movement made by someone else (echopraxia).

Although the dominant symptoms of catatonic schizophrenia are the catatonic behaviors, people with this subtype of the disorder also experience some of the other primary signs and symptoms of schizophrenia :

  • Hearing voices or experiencing other sensory events that aren't real (hallucinations)
  • Holding untrue beliefs about reality (delusions)
  • Disorganized thinking
  • Grossly disorganized, irrational behavior
  • Absent or inappropriate emotional expression
  • Inability to initiate plans

The other main subtypes of schizophrenia are disorganized, paranoid and undifferentiated schizophrenia.

Diagnosis:
Catatonic signs and symptoms appear in a number of medical and psychiatric disorders. Therefore, having these manifestations doesn't mean a person necessarily has schizophrenia. And there are no blood or brain-imaging tests that can be used to make a diagnosis of schizophrenia.

A complete diagnostic workup includes both general medical and psychiatric assessments. A diagnosis of catatonic schizophrenia indicates that the catatonic symptoms are dominant, the person has other symptoms of schizophrenia and the symptoms can't be attributed to other disorders.

Diagnosis of any schizophrenia subtype may change. Although the catatonic symptoms may be dominant at the time of initial assessment, they may not be chronic, they may be alleviated with medication, and other symptoms may become prominent during the course of the disease.

Treatment:
Catatonic schizophrenia is a chronic disease. While episodes of symptoms may vary in intensity and duration, people with the disorder don't return to their previous functional abilities without treatment. It can often be managed with coordinated treatments, including :

  • Sedatives
  • Antipsychotic medications that may prevent the recurrence or lessen the intensity of psychotic episodes
  • Psychotherapy that complements drug treatment
  • Electroconvulsive therapy
  • Training in social and vocational skills

People with catatonic schizophrenia may also need services, supervision or specialized care particularly when response to treatment isn't optimal. Potential problems include the following :

  • Difficulty taking medications as directed
  • Risk of injury to self or others during severe catatonic stupor or excitement
  • Generally unhealthy lifestyle
  • Poor management of other medical conditions
  • Risk of dehydration, malnutrition, exhaustion and extremely high fever
  • Neglect of personal hygiene

To address these issues, people with disorganized schizophrenia may need frequent medical assessments, long term care in a supervised setting or hospitalization.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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