Schizophrenia has many symptoms, of which delusions and hallucinations are not the main ones. If the patient falls into a stupor, freezes for a long time in one posture, and is uncomfortable but periodically behaves very agitated, he is diagnosed with catatonic schizophrenia. In such cases, catatonia, or psychomotor disorders, develops in the background of other signs that are characteristic of various forms of schizophrenia. In this article, we will discuss catatonic schizophrenia in more detail.

 

Catatonic Schizophrenia

 

Basic Features

Catatonia is the general name for a group of symptoms that combine various movement disorders. If it develops on the background of signs of schizophrenia, including delirium and hallucinations, the diagnosis is “catatonic schizophrenia. In this pathology, there are alternating periods of stupor – a person freezes for a long time in one pose, usually unnatural, and excitement, during which destructive behaviour is observed.

The catatonic syndrome was first described as a separate mental disorder by the psychologist Carl Ludwig Kalbaum in the second half of the 19th century. During a presentation at a congress of psychiatrists in Innsbruck, he stated that the disorder could affect anyone younger than 50, even young children. For example, in newborns, it can be identified by monotonous torso positions, and in a child 5 or 6 years old by the desire to sniff or lick surrounding objects. But often, the pathology affects people aged 25-30 years, both men and women, but the former have signs earlier than the latter.

Kraepelin and Bleuler later classified the catatonic syndrome as schizophrenia. In the ICD-10, catatonic schizophrenia is included in the pathologies designated by the letter range F20.0-F20.3.

Accurate data on the incidence of the disease cannot be provided by history. Catatonic schizophrenia used to be a more common diagnosis. Today, it is found in only 1-3% of people with schizophrenia.

 

Catatonic Schizophrenia Causes

In schizophrenia, it is always difficult to establish a direct link between one factor and the illness itself. It can be provoked by trauma or stress. However, it’s impossible to prove that they cause catatonic schizophrenia or any other type of schizophrenia.

In general, it is possible to point out the following factors that can trigger the occurrence of a mental disorder of this type of course:

  • Improper fetal development. The process of fetal development can be seriously affected by the pregnant woman’s infectious diseases, the mother’s unhealthy lifestyle, including alcoholism and drug addiction, chronic pathologies of the woman, etc.;
  • Severe birth – prematurity, head trauma during delivery, fetal hypoxia;
  • Genetic predisposition – the probability of developing schizophrenia is higher if people in the family have a mental illness: two possibilities – the transfer of a defective gene from a relative or a gene mutation at conception;
  • Psycho-emotional trauma – any form of violence, death of a loved one, divorce, infidelity, dismissal, expulsion, unrequited love, war, bullying at school, etc.;
  • Neurological illness – postencephalitic syndrome, Tourette’s syndrome;
  • Psychoactive substance use – alcohol, drugs, and other mind-altering drugs;
  • Mental disorders that are associated with schizophrenia – autism, postpartum psychosis;
  • Somatic diseases – viral infections, autoimmune pathologies;
  • Individual features of the personality. For example, “Stachnik” syndrome can lead to schizophrenia. However, it can be a consequence not only of impeccable behaviour but also a tendency to deviate.

The list of factors that can provoke schizophrenia and catatonia is endless. The list should include trauma, poisoning, improper upbringing based on despotism or, on the contrary, permissiveness, etc.

Any such cause can disrupt neurotransmitters, particularly dopamine, which acts as an intermediary between the brain cells.

During the diagnosis, various versions of the origin of the disease are tested since the elimination of the trigger significantly increases the chance of prolonged remission.

 

Clinical Case

A 30-year-old man, a locksmith, had a usual demeanour, but after getting married, he became withdrawn, answering his wife’s questions in a single voice and without interest. Subsequently, he was late home and slept in parks or on a bench in the yard. Periodically, he would assume one pose and stare into the distance for hours.

Eventually, he was hospitalized. At the hospital, he could not answer who he was, where he was and why he had brought him there. For three weeks, observe mutism and negativity. After medication, the man emerged from his stupor. When asked why he was silent, he answered, “I didn’t know what to say.

Remission lasted for two years. The attack occurred suddenly and for no apparent reason. He began to speak incoherently and very quickly. After a short phase of agitation, a stupor occurred. The latter one caught him at the station, where he stood in one position for several hours. He was hospitalized again. This time it took him longer to recover. Doctors gave no precise prognosis.

 

Catatonic Schizophrenia Symptoms

The symptoms of catatonic schizophrenia include alternating stupors and agitation. These are the main symptoms, which can take different forms. There are three types of catatonic agitation:

  • Pathetic. Symptoms appear gradually, and the patient registers moderate speech and motor agitation. As a rule, the person speaks the exact words and strongly desires to communicate, including with strangers. Consciousness is preserved, but actions may be unpredictable.
  • Impulsive. Signs appear in an acute form. The person’s movements are quick and dangerous. He may pose a danger to himself and others. Speech does not make any sense. Often the patient repeats the exact phrases which do not logically fit into the general context. Some patients injure themselves with objects that come to hand.
  • Mute. This type of agitation is characterized by irrational, unpredictable, and aggressive behaviour that is not accompanied by verbal delirium.

Catatonic agitation can go into remission, i.e., disappear, or cause the next phase – stupor. In such a condition, the patient is inhibited – they remain quiet and assumes an unnatural pose. And he may remain in it for several hours to several years. The Russian physiologist Ivan Pavlov claimed to have worked with a patient who had been in a stupor for more than 20 years.

Three types of catatonic stupor:
  1. Classic. The patient stiffens into one posture, which is exaggerated. Waxing flexibility of the patient’s body is observed. It means he might not have been able to assume such a position in a normal state. In such cases, he does not respond to loud speech but may respond to whispers. It is common for a motor activity to return partially and temporarily at night.
  2. Negativistic. The patient tries to resist attempts to change the posture but fails. Flexibility is maintained. The patient is conscious.
  3. Stupor. It is also called the terminal stage of movement disorders. The person can move, but stiffly. Usually, he takes the form of an embryo, in which he stays for weeks.

While in a stupor, the person remains conscious. He understands everything but cannot change his posture. Sometimes he is disturbed by delusions and hallucinations.

The patient may lie, sit, or stand in a stupor, including bending unnaturally. Any motor activity, even related to instincts, is suppressed.

During the stupor, the person can assume almost any posture due to the waxing flexibility of the body. However, the most common are:

  • The hood symptom – fetal pose, the patient, curls up and covers himself with a sheet (robe, blanket, hood).
  • Air cushion syndrome – the patient does not place his head on the cushion. As a result, it seems to hang in the air.
  • Trunk symptom – the person demonstrates primitive reflexes, such as grasping or sucking.

Careful patient care is required. He has impaired blood circulation in the body, and bedsores occur. Should take Measures to prevent infections. Nurses have to feed and drink the patient with the help of a probe.

 

Other symptoms

The catatonic syndrome is the main but not the only symptom of catatonic schizophrenia. Can also observe the following signs:

  • Negativism – the patient, perceives everything negatively, no matter what he is told or offered. The active catatonic does what he is not asked to do, the passive one ignores those around him, and the paradoxical one does everything in defiance.
  • Mutism – lack of desire to contact others, constant silence.
  • Pavlov’s symptom is a sign named after the physiological scientist. The essence is that the patient reacts only to words spoken in a whisper.
  • Stereotypical behaviour – for a long time, a person makes the same movements, for example, beating his head against the wall, scratching until it bleeds, or shaking off invisible dirt.
  • Echolalia and echopraxia are the mannered copying of other people’s words, facial expressions and movements, including those of animals.
  • Automatic Deficiency is the inability to understand and follow the instructions of another person.
  • Confusion is a loss of communication with the outside, memory impairment, and other cognitive abilities.

Delusions and hallucinations can be fantastic. The patient’s mood is often depressed and apathetic. He is poorly oriented in space and time. Leaving him unattended is dangerous for him and those around him.

 

Catatonic Schizophrenia in Men

In men, the catatonic form of schizophrenia usually manifests itself before age 30. Most often, agitation, impulsiveness and stupor alternate with each other. At the same time, the patient may be silent and noisy. In general, his behaviour is inappropriate and is characterized by crinkling, meaningless gesticulation and facial expressions.

Increased salivation, blood pressure, and abnormal heart rhythms are often observed. In the early stage, the patient behaves strangely, groping for objects, opening and closing doors, snatching purses from the hands of others, etc. When the stupor phase sets in, the man becomes lethargic and freezes in an unnatural posture.

 

Catatonic Schizophrenia in Women

In women, catatonic schizophrenia initially resembles hysterical seizures. The patient behaves inadequately, tries to draw more attention to herself, stops performing her usual duties at home or work, loses interest in hobbies, etc.

Progression of the pathology causes typical catatonic symptoms. At first, lethargy appears, and then stupor. Many patients also complain about a loss of sensitivity in the hands and feet, especially when touching hot and cold objects.

During stupor, increased sweating, decreased blood pressure, swelling, and increased muscle tone are observed. During periods of agitation, the woman screams, hits the dishes and laughs loudly for no reason.

 

Catatonic Schizophrenia in Children

Young children who can also develop catatonic schizophrenia, mostly 5-6 years old, sniff and lick objects, repeat words after adults, and mimic the movements of people and animals. Healthy children can also behave this way, but obsessive and somewhat unnatural behaviour is characteristic of the patients.

Catatonic symptoms have a devastating effect not only on the brain but also on other organs. Often the effects are irreversible.

If a child is about 10-12 years old, catatonic schizophrenia is likely to behave like a one-year-old. Parents may pay attention to babbling, finger sucking, drooling, and other strange behavioural patterns for this age. If we talk about adolescents, their symptoms are more pronounced, as in adult men and women.

 

Catatonic Schizophrenia Types

Catatonic schizophrenia is divided into several types depending on the course of the pathology:

  • Lucid catatonia. It is considered to be a less severe variety. The person retains temporal, spatial and personality orientation. During the stupor, the consciousness is clear, and there are no delusions or hallucinations.
  • Oneroid catatonia. Refers to a severe form of schizophrenia in which the patient is very aggressive. He loses control over his thoughts. His actions are destructive. He must be hospitalized immediately.
  • Empty catatonia. Alternating stupors and agitation characterize it. Consciousness remains, but delirium and hallucinations are absent. In general, the patient is adequate and can communicate with people, for example, with the doctor.

The empty and lucid forms are accompanied by a smaller set of symptoms than the oneroid form, which is more dangerous and unpredictable.

 

Catatonic Schizophrenia Diagnosis

Catatonic manifestations are pretty specific; confusing them with other symptoms is difficult. However, it is necessary to make a differential diagnosis, which allows excluding:

  • Temporal lobe epilepsy;
  • Encephalitis;
  • Brain oedema and tumours;
  • Tay-Sachs disease;
  • Affective disorders;
  • Metabolic problems;
  • Hepatocerebral dystrophy;
  • Sodium deficiency;
  • The effects of drug addiction;
  • Depression.

For this purpose, the patient is prescribed MRI, CT, EEG, and various tests. Diagnose catatonic schizophrenia, and the patient must be observed for at least two weeks.

 

Catatonic Schizophrenia Treatment

Treatment of catatonic schizophrenia in the Salvation clinic is prescribed after the diagnosis is confirmed. If contact is maintained during an attack, the doctor talks with the patient, ask questions, and conducts testing. In the absence of a reaction, anamnestic data are obtained from relatives. First, the doctor needs to determine the causes of the pathology. Therefore, after the initial examination, a referral is given for such diagnostic examinations:

Be sure to appoint laboratory tests that will help assess the general condition of the body, and diagnose a latent disease that can cause the development of a catatonic form of schizophrenia.

If the diagnosis is nevertheless confirmed, treatment is prescribed, which is carried out in our psychiatric clinic under the supervision of a team of highly qualified specialists. Here, modern, effective, safe methods are used, with the help of which it will be possible to stop the progression of the pathology and return the patient to a standard, workable life.

See Also: What is Recurrent Schizophrenia?

Psychiatrists at the Salvation clinic use the following methods of therapy for catatonic schizophrenia:

  • Medical treatment – Helps to smooth out the clinical manifestations of the disease. Neuroleptics and tranquillizers are used if a state of excitation accompanies a catatonic attack. With catatonic stupor, sedatives and nootropics, neuroleptics will help to alleviate the condition. The intensity of the use of medications and dosage depends on the degree of progression of the disease and the general condition of the patient’s body.
  • Electroconvulsive therapy is prescribed in extreme cases when medical treatment does not yield positive results. The procedure’s essence is the current’s effect on the brain’s structures. Electroconvulsive therapy is carried out only in a psychiatric clinic and under the supervision of experienced professionals. If the patient is diagnosed with cardiovascular pathologies, diseases of the respiratory and digestive systems, and acute infectious processes, the procedure is contraindicated. After electroconvulsive therapy, patients continue to take medication.

During treatment, the patient is regularly examined using high-precision diagnostic methods. This allows you to determine the effectiveness of treatment, and adjust the therapeutic regimen.

The psychiatric clinic is equipped with modern, high-precision equipment, which can diagnose catatonic schizophrenia in the early stages, significantly improving the prognosis for recovery. This psychopathological disorder is not a sentence today, thanks to an integrated approach. In our centre, each patient is constantly monitored. If necessary, doctors will provide first aid, advise relatives, and advise how to behave with a sick relative. Suppose catatonic schizophrenia is diagnosed promptly and adequately selected therapy and rehabilitation. In that case, it is possible to achieve a stable improvement in the condition, reduce the manifestation of symptoms of the disease, prevent relapses and return a person to an everyday, healthy, active life.

 

Forecast

In most cases, the forecast for catatonic schizophrenia is unfavourable. Over time, the patient’s condition will worsen. Eventually, he will become incapacitated. He needs constant monitoring and care. However, timely initiated treatment can prolong remission and prevent the disintegration of the personality.