You may have seen, or heard, some people suddenly stand in the same position as if they were stoned, or continue to make the same movements without any meaning. Sometimes there is no speech, no emotion on the face. When we see things like this, it is really difficult for us to imagine what is happening. Today we are going to talk about such a condition, that is, a condition called catatonia that is sometimes seen with schizophrenia .
What is "Catatonic Schizophrenia"? Is that name still used?
Simply put, "catatonic schizophrenia" is a condition that was once considered a subtype of schizophrenia. At the time, catatonia was the main symptom. However, doctors no longer use this name . This means that it is an outdated classification that is no longer in use.
The American Psychiatric Association removed the term "catatonic schizophrenia" from its 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Similarly, the World Health Organization (WHO) removed the term from its 2019 edition of the International Classification of Diseases (ICD-11).
Doctors now consider schizophrenia to be a separate disease, and catatonia to be a syndrome that can occur with it or with other mental and physical illnesses.
So, what exactly is catatonia?
Catatonia is a collection of symptoms. This is when the signals sent from your brain to your muscles are not managed properly. As a result, your behavior changes in an unusual way. It was previously thought that catatonia only occurred with schizophrenia. However, it has now been discovered that catatonia can occur with other mental illnesses, such as bipolar disorder , and with some physical conditions. In fact, catatonia is more common with bipolar disorder than with schizophrenia.
There are three main forms of catatonia:
1. Excited/hyperkinetic catatonia: This is characterized by excessive body movements. For example, pacing, fidgeting, making unusual or exaggerated movements, repeating or doing the same things, or imitating what someone else is doing or saying.
2. Withdrawn/hypokinetic catatonia: This is a little easier to recognize because these people have very little, if any, response to their surroundings. They may be mute, have no facial expression, remain completely still, stare at the same thing, or hold an unusual position for a long time.
3. Mixed catatonia: This is a combination of the symptoms of both of the above types.
What is the difference between "catatonic schizophrenia" and "paranoid schizophrenia"?
Like "catatonic schizophrenia," "paranoid schizophrenia" is a term that is no longer used. In the past, paranoid schizophrenia referred to people with schizophrenia who had symptoms such as delusions and hallucinations . Catatonic schizophrenia referred to people with symptoms of catatonia. However, keep in mind that neither of these names are used by doctors anymore.
Who is affected the most by this situation?
Schizophrenia usually begins between the ages of 15 and 25 in men . It most often begins between the ages of 25 and 35 in women . The condition is equally common in both sexes. Very rarely, children can also develop schizophrenia. Such cases can be more severe than in adults. Compared with adults, catatonia is more common in children with schizophrenia.
How common is this condition?
Schizophrenia is a common condition, but it is not uncommon. About 85 out of every 10,000 people will develop the condition in their lifetime. Worldwide, doctors diagnose about 2.77 million people with the disease each year.
Researchers have estimated that a small but significant percentage (between 10% and 25%) of people with schizophrenia also experience catatonia.
How does this condition affect my body?
Schizophrenia is a condition that disrupts the way your brain works. It can affect things like your thinking, your ability to concentrate, your memory, and your main senses. Catatonia is especially noticeable when schizophrenia is accompanied by symptoms. This is because it can range from extremes of movement to complete lack of movement . However, many people have symptoms that are in between these two extremes, with less obvious symptoms.
What are the symptoms?
Schizophrenia usually occurs in three stages. There are five main symptoms. The symptoms are most severe during the active stage of schizophrenia. These five main symptoms can occur with or without catatonia.
Those five symptoms are:
1. Delusions: Unfounded, but strongly believed beliefs. For example, thinking that someone is conspiring against you.
2. Seeing or hearing things that are not there (Hallucinations): Seeing, hearing, feeling, or smelling things that are not there.
3. Disorganized or incoherent speaking: The things being said are not connected to each other and do not make sense.
4. Disorganized or unusual movements: Making purposeless, strange movements.
5. Negative symptoms: "Negative" here does not mean bad, but rather "decreased" or "deteriorated." For example, decreased expression of emotions, decreased speech, and decreased interest in daily activities.
For more information about these symptoms and the stages they occur in, see our main article on Schizophrenia.
Symptoms of Catatonia
Historically, there have been about 40 symptoms associated with catatonia. However, the DSM-5 has reduced this list to 12. A doctor will diagnose catatonia with schizophrenia if at least three of these symptoms are present.
1. Agitation: Behaving restlessly and agitatedly for no apparent reason. This is a symptom of catatonia only if it is not in response to something else in the environment.
2. Catalepsy: The ability to remain in a certain position if someone puts you in it. This means you can move them into a different position.
3. Echolalia: Repeating the words or sounds of someone else, as if echoing them.
4. Echopraxia: The act of imitating the movements or behaviors of another person.
5. Grimacing: Maintaining the same facial expression. Usually, the facial muscles appear to be tensed. Sometimes, it may even appear to be smiling at inappropriate times.
6. Mannerism: Performing movements or gestures that we normally make in an unusual, exaggerated way.
7. Mutism: Very little or no speech. This is a symptom only if there is no other reason for the lack of speech (such as a condition such as aphasia).
8. Negativism: Not responding to things around you without any rational reason, or actively opposing those things.
9. Posturing: Maintaining a specific posture. This posture is difficult for someone without catatonia. Unlike catalepsy, this is not a situation where someone else is trying to create the posture.
10. Stereotypy: Repetitive movements that appear to have no purpose. For example, finger-playing, tapping/rubbing parts of the body.
11. Stupor: Unresponsiveness to surroundings, even when awake. People with catatonia often do not respond to painful stimuli (e.g., a bump or a prick).
12. Waxy flexibility: When someone tries to change a person's posture, they first show a slight, barely noticeable resistance, as if they are being pushed. Then the muscles relax, and the limbs bend like a hot wax candle.
Important: Although people with catatonia symptoms are unresponsive to their surroundings, many remain aware of what is happening around them . Research has shown that people with catatonia symptoms, even though they are unresponsive to their surroundings, are able to remember themselves and what happened around them.
Changes in activity level
Although schizophrenia occurs in several stages, the progression of the disease can be different when catatonia is present. Many people with schizophrenia who have catatonia experience rapid progression and worsening of their condition .
Catatonia can also cause a range of activity levels. Some people may be unresponsive to the world around them for a period of time, then suddenly become very active. In some cases, these changes in activity levels can be accompanied by behavior that is reckless or even dangerous to themselves or others .
What are the reasons for this situation?
The exact cause of schizophrenia is not yet known, but scientists believe that there are many factors that contribute to it.
- Chemical imbalances in the brain: These are the chemicals (neurotransmitters) that brain cells (neurons) use to communicate with each other. When these are imbalanced, schizophrenia can occur.
- Congenital brain problems: Problems that occur during brain development while you are in the womb.
- Communication disruptions between different parts of the brain: In order for different parts of the brain to work together, there needs to be good communication between them. Researchers suspect that when these communication networks are disrupted, schizophrenia can occur.
In addition, scientists believe that there are several risk factors that increase the risk of developing schizophrenia. For example, genetic mutations inherited from parents, exposure to certain chemicals, stress or complications during development in the womb, and drug use. However, none of these have been confirmed as definitive causes.
Is this contagious?
Schizophrenia is not a contagious disease. It is not spread from one person to another. Catatonia is not contagious either. However, some infectious diseases (e.g., meningitis) can cause catatonia.
How is the diagnosis made?
Your doctor will use a combination of tests to diagnose schizophrenia. These tests may include a physical exam, neurological exams, lab tests, and imaging scans. There is no single lab test, diagnostic test, or imaging test that can diagnose schizophrenia. However, these tests can help your doctor rule out other serious or life-threatening conditions.
To be diagnosed with schizophrenia, a person must exhibit at least two of the five core symptoms of the disorder. In addition, to be diagnosed with schizophrenia and catatonia, at least three of the 12 catatonia symptoms listed above must be present.
What tests are done to diagnose this condition?
There are several tests that can be done if schizophrenia is suspected:
- Imaging tests: These may include tests such as `(CT scans)` (Computerized Tomography scans) and `(MRI scans)` (Magnetic Resonance Imaging scans).
- Blood, urine, and cerebrospinal fluid (CSF) tests: These tests can detect chemical changes in body fluids, heavy metal poisoning, and infections.
- Brain function test: An ``EEG`` (Electroencephalogram) analyzes and records the electrical activity of your brain. This can rule out conditions such as epilepsy.
How is it treated? Can it be cured?
Schizophrenia can usually be managed, but it cannot be cured . Medication is the main treatment for schizophrenia. However, when the condition is accompanied by catatonia, different treatments are needed.
There are two main ways to treat schizophrenia with catatonia:
1. Medications: The first line of treatment for schizophrenia with catatonia is specific medication. Benzodiazepines (also used to treat anxiety, panic attacks, and epilepsy) are very effective in controlling the symptoms of catatonia. Antipsychotics , which are commonly used to treat schizophrenia, are not usually given in cases of acute catatonia, as they can make the catatonia worse.
2. Electroconvulsive therapy (ECT): This involves sending a mild electric current through your skin and skull to a specific part of your brain. This current causes a brief seizure-like state and changes in brain function. Unlike some movies and TV shows, this treatment is performed under anesthesia, so you don't feel any pain. It is a very safe and effective treatment for catatonia. It is usually used as a second-line treatment. However, in very severe cases (or in malignant catatonia, which is described in the "What is the outlook for this condition?" section below), it is also given as a first-line treatment.
Complications/side effects of treatment
The complications and side effects of schizophrenia treatment depend on several factors, such as the type of medication you take and other health conditions you have. Your doctor is the best person to tell you about the side effects you may experience, as he or she can tailor the information to your specific situation.
How can I manage symptoms if I can't take care of myself?
You should never try to diagnose yourself or a loved one with schizophrenia on your own. This is because it takes training and experience to accurately diagnose it. Also, the symptoms of this disease can also occur with other medical conditions or drug use. Another important thing is that the medication needed to treat schizophrenia can only be taken with a doctor's prescription. For all these reasons, your doctor should be the one to diagnose this condition and recommend treatment.
How soon will I feel better after treatment?
Your doctor is the best source of information about when you will start to feel better and when you will see the effects of your treatment. He or she can take into account your specific situation and all its details and give you the information that is most appropriate for your situation.
How can I reduce my risk or prevent this situation?
Schizophrenia is a condition that develops unexpectedly. This means that it cannot be prevented or the risk of developing it can be reduced.
What should I expect if I have this condition?
Schizophrenia is a condition that is known for disrupting a person's thinking and understanding of the world around them. It causes a state of psychosis, a state of detachment from reality , and people with the disease have difficulty understanding what is real and what is not. They may not even realize they have the disease because their brains are unable to process it.
Schizophrenics with catatonic features may be unaware of everything going on around them, even though they may not respond to what is happening around them. They may also alternate between periods of unresponsiveness and periods of hyperactivity. During these periods of hyperactivity, they may become violent and potentially dangerous to themselves or others.
If schizophrenia is left untreated, the condition can severely disrupt a person's life. It can make it difficult for them to hold down a job, maintain friendships, and maintain relationships. Many people - knowingly or unknowingly - try to ``self-medicate''. This can lead to addictions to alcohol and drugs (``substance use disorders'').
With treatment, schizophrenia can often be managed. Many people who receive treatment, find ways to manage the illness, and follow a treatment plan can live happy, fulfilling lives.
How long does schizophrenia last?
Schizophrenia is a chronic condition . Sometimes symptoms go away and don't come back (`remission`). However, because symptoms can come back unexpectedly, scientists consider it a lifelong condition.
What is the outlook for this situation?
Schizophrenia with catatonia is usually not fatal on its own. However, conditions that occur when you are not moving around a lot (such as pulmonary embolism, pneumonia) can increase your risk of death. There is also a type of catatonia called malignant catatonia . It can be severe and even fatal. Malignant catatonia is dangerous because it can cause a high fever and disrupt your autonomic nervous system (the system that controls your body's systems without you realizing it (such as breathing, blood pressure). Because malignant catatonia can be dangerous, ECT is the first treatment, rather than medication.
In general, schizophrenia with catatonia is a condition that responds well to treatment . Outcomes are usually good, especially if the condition is diagnosed and treated early. However, catatonia with schizophrenia can be more difficult to treat than catatonia with other mental illnesses.
How do I take care of myself?
Even if you have a history of catatonia symptoms, you can manage schizophrenia and take care of yourself. Here are some things you can do:
- Take your medication as prescribed (do not stop taking it without talking to your doctor).
- See your doctor as scheduled (these appointments will help you develop the best treatment plan).
- Don't ignore or ignore your symptoms.
- Avoid alcohol and drug use (these can make your symptoms worse or cause other problems).
- Seek support. Build relationships with people you trust - especially loved ones and your doctor - and don't isolate yourself from them.
When should I see my doctor or seek medical advice?
Your doctor will give you regular appointments. It's very important to keep them. Also, if you notice a change in your symptoms, or if you notice a change in the effectiveness of your medication, you should see your doctor.
When should I go to an Emergency Treatment Unit (ETU) ?
People with current or past symptoms of schizophrenia are at increased risk of self-harm and suicide . If you have thoughts of harming yourself, including suicidal thoughts, or thoughts of harming others , you should go to an emergency room immediately or call a relevant emergency number such as 1990 (Sri Lanka's Suicide Prevention Helpline).
What can I do if my loved one is showing symptoms of schizophrenia or a similar condition?
People with schizophrenia often don't believe they need medical treatment because they can't recognize their symptoms or condition. This can be distressing and frightening for both the person with the symptoms and their caregivers.
If you have schizophrenia with catatonia, you or a loved one may feel anxious or scared. If your loved one is showing symptoms of schizophrenia, especially catatonia, it is important to seek medical attention . People with catatonia and schizophrenia can develop malignant catatonia. In some cases, they may become agitated, act dangerously, and develop other complications.
How to help a loved one with schizophrenia?
If your loved one is showing symptoms of schizophrenia or a related condition, you can help them by doing these things:
- Ask how you can help. By listening and offering your help, you keep the line of communication open, and they feel connected to others.
- Encourage them to see someone who can help. Treatment for schizophrenia, especially medication, can improve a person's symptoms. Often, that's enough to help them realize they have a medical condition that requires medical attention.
- Don't judge or argue. People with schizophrenia have a hard time understanding what is real and what is not. Avoid judging them or trying to convince them that they are seeing hallucinations or having delusions. This can make them lose trust in you or increase their paranoia.
- Stay calm. Anger and frustration can negatively impact your relationship with your loved one with schizophrenia. They can also become easily upset in noisy or chaotic environments. Try to choose a quiet and calm environment. Make them feel as safe and comfortable as possible.
- Get help in an emergency. If someone with schizophrenia talks about harming themselves or others, or if they are showing severe, unreasonable fear, restlessness, or are behaving violently, you should call your local emergency number immediately.
Final Take-Home Message
"Catatonic schizophrenia" is an old subcategory of schizophrenia that is no longer used by doctors. However, the symptom complex catatonia is often seen with schizophrenia. It is also a distinctive feature because it affects a person's movements, behavior, and ability to communicate. In some cases, catatonia can be fatal. Therefore, people with catatonia symptoms should receive medical treatment as soon as possible.
Fortunately, there are treatments for catatonia and schizophrenia. People with schizophrenia can often manage their condition and live fulfilling, happy lives. If you or a loved one is experiencing these symptoms, the best thing to do is not to be afraid or embarrassed, but to seek medical advice.
` Schizophrenia, Catatonia, Mental health, Schizophrenia, Catatonia, Psychosis, Brain diseases
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