Catatonic schizophrenia is a psychotic disorder characterized by hallucinations, catatonic states, and disorganized physical gestures. A catatonic state is when someone exhibits abnormal movements or immobility.
7.6 percent of schizophrenia patients also have catatonia. This means that thousands of Canadians suffer from catatonic schizophrenia.
What is catatonic schizophrenia? What is its history, and what types of catatonia are there? How can a person receive treatment? We explore this question below.
Symptoms of Catatonic Schizophrenia
As the name suggests, the most prominent symptom of catatonic schizophrenia is going into a catatonic state. An individual experiences stupor, withdrawing from their exterior environment. They do not interact with the world around them, including ignoring objects in line of sight.
A person falls into complete silence, a condition called mutism. They do not make any verbal communications, even when cued to do so. This can last for days.
The person's body may become contorted in several ways. Catalepsy involves the body becoming rigid. Limbs stay in the same position and bodily functions like breathing slow down.
Posturing involves holding one position for a long period of time. A person may hold their arms up against gravity.
Someone may be able to move the person's limbs. They can contort them into strange positions, and the person can keep them in place. This is called waxy flexibility.
When an individual emerges from catatonia, they can start talking. But they may mimic someone's words for no apparent reason.
They may repeat what they say over and over again. Repetition can occur with physical actions like washing dishes or cleaning hair.
An individual may struggle to control their emotions. They may become angry over small matters or for no reason at all.
As with other kinds of schizophrenia, a person can experience hallucinations and delusions. They may become convinced that people are out to kill them. They can withdraw from school and work, and they can struggle to take care of themselves.
A person can experience catatonia without having schizophrenia. In order to receive a diagnosis of catatonic schizophrenia, they must show signs of both over several months.
Causes of Catatonic Schizophrenia
There is no one cause of schizophrenia in any of its forms. But scientists have several theories about why a person develops it. Gamma-aminobutyric acid (GABA) is a neurotransmitter. It carries chemical signals from one protein in the brain to another. When GABA attaches to a receptor, it creates a calming effect. High amounts of GABA can alleviate anxiety and stress.
But low amounts can cause a person to feel anxious. They may engage in catatonia as a stress response, withdrawing from the world to keep themselves calm.
The orbitofrontal cortex contains structures related to emotion and memory. If the cortex becomes damaged, symptoms similar to schizophrenia can arise.
The cortex also receives a large amount of GABA. If it doesn't, it can become underdeveloped. This makes it harder to control emotional responses, which can lead to a catatonic response.
Other parts of the brain may affect schizophrenia. The dorsolateral prefrontal cortex controls working memory and attention skills. If the cortex doesn't activate, a person can enter into a catatonic state.
Schizophrenia has genetic components. Scientists have found more than 200 genes that are associated with the condition.
Factors in a person's environment can cause the condition. Survivors of childhood trauma and people who endure social isolation tend to have it more often than others.
A baby who was malnourished in the womb or born early has a higher chance of developing schizophrenia. This could be because their brain may be damaged.
Catatonia — A History of Misdiagnosis
The symptoms of catatonia overlap with a number of conditions. A vegetative state can cause stupor and mutism. Stiff person syndrome is an autoimmune disorder that can cause extreme stiffness and waxy flexibility.
The same goes for schizophrenia. Sleep deprivation can cause a person to hallucinate. Brain damage can induce delusions and emotional instability.
As such, doctors have misdiagnosed catatonia and schizophrenia for centuries. They regarded these conditions as moral failings or instances of demonic possessions.
The Greek physician Hippocrates introduced some of the first treatments for mental illnesses. But he often misdiagnosed them.
He believed that mental health conditions came from an imbalance of bodily humours. He prescribed special diets and bloodlettings instead of medications and therapies. These diagnoses and prescriptions were held for centuries.
The early Renaissance period produced the first conceptions of mental disorders as natural phenomena. This opened the door for better treatments.
In 1852, a French physician named Benedict Morel wrote about a disease he called "premature dementia." He described a group of patients who had disorganized thoughts and a lack of motivation. This was the first clinical description of schizophrenia.
In 1866, a German doctor named Karl Kahlbaum started giving lectures. He described a condition that rendered patients mute and still. He called it "catatonia."
Doctors applied the catatonia definition to a number of conditions. But it took until 1893 for Dr. Emile Kraepalin to produce a description of catatonic schizophrenia. He noted that certain individuals suffered from disorganized thoughts and catatonic states.
But Dr. Kraepalin thought the condition was a type of dementia. The term, "schizophrenia," was not coined until 1907.
Types of Catatonia
Though catatonia has been subject to decades of misdiagnosis, doctors have been able to figure out multiple types of it. The catatonic definition leaves room for five different varieties.
Retarded catatonia is the most common type. It consists of stupor, mutism, and posturing. A person may also perform repetitive actions that do not make sense to others.
You may hear the term, "Kahlbaum syndrome." This is an alternate name for retarded catatonia and is not a separate medical condition.
Delirious mania involves excited movements. A person may talk and move without stopping. They may work themselves into a frenzy, or they may become agitated or confused.
Periodic catatonia creates periods of stupor with periods of excitement. It can occur in patients with schizophrenia, but it is more prominent in bipolar disorder.
Agitated catatonia leads to self-injurious behaviours. An individual may cut, prod, or poke themselves. People on the autism spectrum have this more often than other people.
Malignant catatonia involves a stupor that appears alongside a high fever and abnormal heart rates. This is a life-threatening medical condition that requires hospitalization.
Treatment of Catatonic Schizophrenia
Anyone who has catatonic schizophrenia can receive treatment. The first step is to get a formal diagnosis from a doctor. Turn to a psychiatrist or psychologist with experience in catatonia.
Because catatonia presents differently in every person, treatment plans are personalized. Medications can help with a number of symptoms. Benzodiazepines soothe overactive parts of the brain and mitigate anxiety. Patients can notice a decrease in their symptoms within a week of taking their first pills.
If a person is encountering distress, they can take talk therapy. They can talk to a trained therapist about what they are going through and come up with problem-solving strategies. Online therapy is available for anyone.
Electroconvulsive therapy stimulates the brain through electricity. It can activate the orbitofrontal cortex, allowing an individual to control their emotional impulses.
Transcranial magnetic stimulation uses magnets to stimulate parts of the brain. It works well for people experiencing anxiety and depression.
When a person is in a stupor, they can receive nutrients. A nurse can attach them to an IV or feed them through a tube. They can be wrapped in pillows so they remain warm.
Schizophrenia can be hard for family members and loved ones to deal with. They can receive therapy and training so they know what to do when someone enters a stupor.
Get Help for Your Mental Health
Catatonic schizophrenia combines hallucinations with catatonic states. A person can enter into a stupor for days on end, staying still and silent. Genetics and environmental factors can cause the disorder.
Doctors misdiagnosed patients for centuries. They thought mental illnesses were supernatural phenomena. They did not recognize catatonic schizophrenia until the early 20th century. But, nowadays, doctors have many treatments available for it.
