What is catatonia? Shall we talk about this strange behavior?

Have you ever seen someone suddenly become stone-faced, talk very little, or do the same thing over and over again without any meaning? Perhaps you have also thought, "Oh my God, what is wrong with this person?" When you see things like this, you may have thought. Catatonia is a condition in which our brain functions in some way, and the way we react and behave to the world around us changes. Although this may seem a little complicated, today we will talk about it clearly and in a way that you can understand.

What is catatonia? To be precise...

Simply put, catatonia is a complex condition that disrupts the way our brains function, affecting the way we perceive and respond to the world around us. People with this condition may sometimes be completely unresponsive to things around them, or may behave in very unusual ways. The main symptoms of this condition are decreased speech, unusual movements or lack of movement, and changes in behavior .

Did you know that as far back as 1874, German psychiatrist Karl Kahlbaum first described this condition as catatonia . However, this condition is still poorly understood. One reason is that until recently, many people thought that it only occurred in people with schizophrenia . Also, there are different opinions among psychiatrists about what symptoms are needed to diagnose it, and how many of them are needed. Another thing is that some of the symptoms, such as agitation and speechlessness, are also seen in other diseases, so it is a bit challenging to determine whether this is catatonia.

Who is most likely to be affected by this situation?

Catatonia does not affect anyone in particular based on race or gender. However, it is most commonly seen in conjunction with the following medical conditions:

• Psychiatric conditions: These are illnesses that directly affect your mental health.
• Neurological conditions: These are diseases that affect the function of your brain.
• Other medical conditions: These are conditions that affect the functioning of one or more of your body's systems.

We will talk about this in more detail in the section on causes and symptoms.

How common is catatonia?

Current research suggests that between 0.5% and 2.1% of people receiving psychiatric treatment may experience catatonia. However, this number increases to around 10% among those receiving residential mental health treatment.

What does this do to our bodies, especially the brain?

Catatonia causes parts of our brain to stop working. This is called going into a "catatonic state." The affected areas of the brain control things like:

• Movement.
• Senses: sight, hearing, smell, touch, and taste.
• Memory.
• Thinking and attention skills (Cognitive abilities).
• Motivation.
• Emotions.
• Decision-making and self-control abilities (Executive functions).

As you can see, because catatonia affects so many different areas of the brain, the symptoms can be very diverse. That's why this condition is often seen with many different diseases, and it can be a challenge for specialists to diagnose it.

What are the symptoms of catatonia?

According to the American Psychiatric Association's DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) guidelines, there are 12 officially recognized symptoms of catatonia. Let's see what they are.

• Agitation: This is when someone is simply agitated or agitated. This symptom is not a response to anything else around them, but rather occurs when this agitation occurs.
• Catalepsy: This is when someone puts someone in a certain position and they stay in that position. You can slowly move them to a different position, but they stay in that new position.
• Echolalia: This is the repetition of sounds or words spoken by someone else, like an echo.
• Echopraxia: This involves imitating the movements of another person.
• Grimacing: A single facial expression, usually a tense facial expression, that is held for a long time. Sometimes, it can even appear to be smiling when there is no connection.
• Mannerism: Performing normal movements or actions in a strange, exaggerated, or exaggerated manner.
• Mutism: Being silent most of the time, or not speaking at all. This is a symptom only if there is another condition that prevents speech (e.g., aphasia).
• Negativism: This means not responding to things around you, or opposing things around you without any rational reason.
• Posturing: Holding a specific posture, not because someone else has asked you to, and staying in that position. These postures are very difficult for a normal person to maintain.
• Stereotypy: Repeating the same movements without any clear purpose, such as finger play or rubbing the same part of the body.
• Indifference to the world around you (Stupor):Being awake, but not paying attention to anything around them, and not responding. People with catatonia are almost unresponsive to even the slightest touch (e.g., pinching the body).
• Waxy flexibility: This is when someone tries to change a person's posture, and they initially resist, like a slight push. Then, their muscles slowly relax, and the limb bends like a melted candle.

Imagine, if your friend suddenly started repeating what you say exactly (`(Echolalia)`) or started waving their hands the same way you do (`(Echopraxia)`), you would feel a little strange, wouldn't you? Those are some of the symptoms of this disorder.

What are the different functional levels of catatonia?

Many people think of catatonia as a condition where the body is frozen in place, unable to move. However, this is not always the case. Catatonia can also involve sudden, unexpected changes in behavior. There may be excessive, even continuous, movement. These levels of activity include:

• Excited/Hyperkinetic: This is usually characterized by behavioral changes. They may be fidgety, restless, aggressive, and sometimes violent for no apparent reason. They may also talk and act strangely, imitate what others around them are doing, and may even self-harm .
• Withdrawn/Hypokinetic: This is often what people think of when they hear the word catatonia. These people are awake, but they don't respond to things around them, as if they don't care about the world around them. They are often silent, and their faces show no emotion. They may hold unusual postures, and may resist being shaken. They may not eat or drink, and they may even wet their clothes (incontinence).
• Mixed: This is a combination of both hyperactive and underactive traits. A person can suddenly and without any warning switch between these two levels of functioning.

What is malignant catatonia? Can it be life-threatening?

In some cases, catatonia can lead to life-threatening complications. That's called malignant catatonia . This condition causes a condition called dysautonomia . This means that your autonomic nervous system is not working properly. Your autonomic nervous system controls bodily functions that occur automatically without you even thinking about them (e.g., heart rate, blood pressure).

Symptoms of malignant catatonia are:

• Dangerously high body temperature and fever (Hyperthermia).
• Very fast heartbeat (Tachycardia).
• Excessive sweating (Diaphoresis).
• Unstable blood pressure.
• Cyanosis: This is a condition where the oxygen level in the blood decreases, causing some areas of the skin, especially around the lips and fingernails, to turn blue.

Here's what you need to know: Malignant catatonia is a life-threatening medical emergency. It can even lead to death because it disrupts the body's automatic processes, which are controlled by the brain. Therefore, it is essential to seek medical attention immediately if you experience these symptoms.

What causes this state of catatonia?

Despite nearly 150 years of research, experts still can't say exactly what causes catatonia. However, there are various explanations, ranging from chemical imbalances in the brain to genetic causes that are passed down from generation to generation.

Because there is no specific cause, experts can only speculate about other conditions that may cause catatonia. The most common mental health conditions that are associated with catatonia are:

• Bipolar disorder.
• Schizophrenia.
• Schizoaffective disorder.
• Major depressive disorder.

Neurological and other physical conditions that are commonly seen with catatonia include:

• Autism spectrum disorder.
• Autoimmune diseases (e.g., lupus , multiple sclerosis ).
• Degenerative brain diseases (e.g. dementia , Parkinson's disease ).
• Down syndrome.
• Drug-related conditions (this includes both prescription drugs and illegal drugs).
• Encephalitis , including anti-NMDA receptor encephalitis .
• Electrolyte imbalance conditions.
• Epilepsy.
• Intellectual disability.
• Normal-pressure hydrocephalus.
• Stroke.
• Tourette syndrome.

Is this a contagious disease?

No, not at all.Catatonia is not a contagious disease. You cannot catch it from someone else, nor can you catch it from someone else.

How do doctors diagnose this condition of catatonia?

Your doctor will use a combination of methods to diagnose catatonia. This usually starts with a neurological examination . During this examination, your doctor will examine your reflexes, responses, and how you respond (or don't respond) to the world around you.

Then, the doctor will usually use a standardized assessment tool, such as the Bush Francis Catatonia Rating Scale , to assess the presence and severity of catatonia. Once catatonia is diagnosed, the next step for doctors is to find the cause. This is because catatonia is often associated with another mental or physical illness. Since catatonia can occur with serious, sometimes fatal, illnesses, the first priority is to rule out such serious underlying conditions.

What kind of tests are done?

The following tests are usually performed to diagnose catatonia and find the underlying cause:

• Imaging tests: This may include tests such as CT scans and MRI scans .
• Blood, urine, and cerebrospinal fluid (spinal tap) tests: These tests can detect things like chemical changes in body fluids and infections. (A cerebrospinal fluid test is a test that takes a small amount of fluid from the spinal cord.)
• Brain function testing: An EEG (Electroencephalogram) test analyzes and records the electrical activity of your brain. This can rule out conditions such as epilepsy.

What are the treatments for this? Can it be completely cured?

Treatment for catatonia usually depends on the underlying condition (or conditions) that caused it. If it is caused by a physical or neurological condition, treating that condition, if possible, will often improve the catatonia. When it occurs with a mental illness, other treatments may be the best option.

What medications or treatments are used?

There are two main ways to treat catatonia: medication and electroconvulsive therapy (ECT). Other treatments, such as transcranial magnetic stimulation, may be available, but there is not enough research to determine how effective they are for widespread use.

Medications

Benzodiazepines are the mainstay of treatment for catatonia because they are safe and very effective. Between 60% and 90% of people with catatonia recover from benzodiazepines. Lorazepam is the most commonly used medication, but other medications such as clonazepam , diazepam , and zolpidem are also effective. These medications can be given intravenously (IV) , as an injection, or as a pill.

Other medications (e.g., mood stabilizers , antipsychotic drugs ) may be helpful, but they are not usually given as first-line treatment. They are most useful after the primary catatonia symptoms have resolved, to treat other symptoms. In particular, antipsychotic drugs can cause catatonia to progress to malignant catatonia or neuroleptic malignant syndrome , so caution is needed.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a treatment that sends a very mild electric current to a specific area of ​​your brain, causing a brief seizure. People who receive ECT are given general anesthesia and are in a deep sleep, so they don't feel any pain during the treatment.

ECT is also very effective. It is effective in almost all cases of catatonia. It is the mainstay of treatment for malignant catatonia , and in such cases, it is a life-saving treatment. It is also very useful in cases of catatonia that does not respond to medication.

What complications or side effects can occur during treatment?

The complications and side effects of treatments for catatonia can vary depending on the treatment (or combination of treatments) a person receives. Your doctor can best explain the possible side effects or complications you may experience.

If I have these symptoms, how can I take care of myself or manage the symptoms?

This is very important: Catatonia is a condition that can be difficult to diagnose, even for trained and experienced doctors. It can also be caused by life-threatening conditions that require emergency medical attention. For both of these reasons, you should never try to diagnose or treat it yourself.

How soon will I feel better after treatment? How long will it take to recover?

In conditions like catatonia, everyone's experience is different. Your doctor can give you the best information about your recovery time, as he or she can take into account all the factors that affect your specific condition (such as underlying conditions and your medical history).

Benzodiazepines usually work quickly. When given intravenously (IV), most people start to feel better within 10-15 minutes. When taken orally as a pill, the medication can take as little as 20-30 minutes to start working. However, it can take a while to find the right dose, so some people may not see any improvement in their catatonia until after a few days of treatment.

ECT treatment can also be effective quickly. Some people start to see some improvement within minutes or hours of treatment, while others may need several treatments to respond. Most people receive ECT several times a week for several weeks, but some people may need daily treatment until their symptoms improve.

Is there a way to prevent this from happening or reduce the risk?

Catatonia occurs unexpectedly and for reasons that experts still don't fully understand. Therefore, it is not possible to prevent it from occurring or reduce the risk.

However, if you have been prescribed medication for a mental condition, stopping those medications may increase your risk of developing catatonia.

If I have this condition, what should I expect?

Most people with catatonia are at least somewhat aware of the world around them. Their problem is that they are unable to respond to what is happening around them in a normal way. Also, they may remember some of the events that happened, even though they may not seem to know anything.

Because catatonia affects a person's awareness of the world around them, it is common for people with the condition to be unable to talk about themselves or make decisions about their medical treatment. In such cases, doctors usually ask a family member or close friend to help them make decisions about treatment.

How long can catatonia last?

How long catatonia lasts varies depending on the underlying condition and the treatment you receive. It is important to seek treatment promptly. The longer catatonia lasts, the less likely it is to respond to treatment. Your doctor is the best person to talk to about how long it will last and what to expect.

What is the outlook for this situation?

Catatonia is usually not life-threatening in itself (however, malignant catatonia is).(unless treated promptly, it is fatal). However, this condition can increase the risk of death from diseases that occur due to immobility (e.g., pulmonary embolism , pneumonia ). Also, catatonia can be difficult to treat if it lasts a long time or if a person has it repeatedly. Fortunately, benzodiazepines and ECT have a very high recovery rate. This means that it is a very treatable condition.

People with mood disorders (e.g., bipolar disorder, major depressive disorder ) seem to respond better to treatment than people with schizophrenia . However, this can vary, and not everyone's situation is the same. Your doctor is the best person to give you the most accurate information and outlook for your situation.

How to take care of yourself in a state of severe catatonia?

A person with severe catatonia cannot take care of themselves. They need care from trained medical staff. Because catatonia makes it difficult for a person to move or respond to the world around them, they are at increased risk of complications. This means they cannot eat or drink, which can lead to problems such as dehydration and malnutrition . Pneumonia can develop from lack of movement. They can also develop blood clots, which can lead to stroke or pulmonary embolism . They are also at risk of engaging in behaviors that could harm themselves or others.

When should I see a doctor? Or seek medical advice?

Someone showing signs of catatonia needs medical attention as soon as possible . These symptoms can mimic serious medical conditions that require immediate medical attention. If someone you love is showing signs of catatonia, you may need to take them to the hospital or call an ambulance, as was the case in 1990.

When should I go to an Emergency Treatment Unit (ETU) ?

People with catatonia, especially those with conditions such as schizophrenia , are at increased risk of self-harm and suicide . If you have thoughts of harming yourself, committing suicide, or harming others, you should go to an emergency room (ETU) immediately, or call 1990. If you have these thoughts, you can also call places like the National Mental Health Helpline in Sri Lanka, 1926 , for help.

Finally, it's good to remember these things:

Catatonia is a complex condition that disrupts a person's brain function and affects the way they respond to the world around them. Some people may respond very little or not at all, while others may behave unpredictably and in a way that is dangerous to themselves or others. Catatonia can occur with a variety of conditions, from mental illnesses to physical illnesses. While it is usually not a life-threatening emergency, it can have serious complications and develop into malignant catatonia ( a life-threatening emergency).

Because people with this condition are often unable to care for themselves, they need care from trained medical staff. Fortunately, catatonia is a very treatable condition, and many people respond to medication. Those who do not respond to medication usually respond to electroconvulsive therapy (ECT). With timely, effective treatment, the effects of catatonia can often be reversed, and any underlying medical conditions that may be associated with it can be treated or cured.

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