By Catatonia is not just about becoming immobile, which is why it is often overlooked. It also involves mutism, slowness, and intense emotionality, among other symptoms that we will discuss in more detail here.
Catatonia has fascinated mental health experts for decades. People who do not move for hours and do not respond to stimuli? It is logical that this syndrome attracts the attention of specialists and even society in general.
However, immobility is not the only symptom of these conditions, but rather a set of symptoms that are not always easy to diagnose in time. We invite you to learn more about this topic.
What is catatonia and what are its symptoms?
Catatonia is a neuropsychiatric syndrome that combines cognitive, motor, behavioral, and autonomic symptoms. The patient usually presents with anosognosia , which makes it rare for the person to seek professional help.
Although this condition is related to motor paralysis, the truth is that there are different manifestations, each one different from the previous one. Let’s look at them in detail.
Akinetic catatonia
In this form of the syndrome we find a state of stupor where there is no reactivity to environmental stimuli; it is the one best known outside the medical context.
The patient is paralyzed and may experience symptoms such as mutism , catalepsy, negativism, and even waxy flexibility (inability to move independently; if placed in a particular position, he will remain in that position).
Excited catatonia
Secondly, there is a lesser-known form of this syndrome: the agitated form. Here, motor patterns such as stereotypies, states of nervous agitation or repetition of other people’s movements and phrases or echolalia are observed .
Malignant catatonia
Finally, there is a potentially fatal catatonic state, classified as malignant, which includes symptoms of fever and dysautonomia .
This imbalance, if not detected, can lead to dehydration, malnutrition, urinary incontinence , urinary tract infections, deep vein thrombosis and pulmonary thromboembolism , as explained by the Spanish Journal of Geriatrics and Gerontology .
Other symptoms
In addition to the symptoms mentioned above, in a catatonic state, signs such as the following may occur:
- Automatic obedience.
- Psychomotor slowing.
- Stereotypies or purposeless movements.
- Paralysis, that is, the classic image of the patient unable to move.
- Intense emotionality that often occurs at the end of the catatonic episode.
- Mannerisms, gestures or exaggerated movements that are carried over into everyday life (such as writing, for example).
Most common causes of catatonic syndrome
The origin of these symptoms is neither unique nor simple, as they are often linked to neuropsychiatric diseases and their diagnosis is not always early. You can read about some of the most common causes below.
Neurological causes
It has been observed that those who suffer from catatonic episodes have an affected right parietal cortex , in their posterior part. This area of the cortex is responsible for voluntary motor movements.
In addition, other areas are also affected, such as the inferior prefrontal and medial orbitofrontal. This explains the emotional dysregulation after the episodes, as well as the anosognosia.
The complexity of brain interconnection means that several regions contribute to the symptoms observed. However, the areas mentioned are linked to the motor and emotional aspects affected during the episodes.
Biological causes
Some organic diseases, as well as substance abuse , can cause the syndrome. Similarly, epilepsy , HIV , or stroke may cause catatonic episodes.
Many other diseases, in their most severe form, are the cause of this syndrome, such as diabetes , hypothyroidism or even severe hypothermia.
Relationship with other disorders
As mentioned above, catatonic behavior is a syndrome associated with different primary causes, it is not a disease . However, it is related to some disorders and conditions, such as the following symptoms:
- Epilepsy.
- Schizophrenia.
- Affective disorders .
- Viral or autoimmune encephalitis.
- Effects from neuroleptic medications (such as clozapine ).
- Physiological problems related to GABA , glutamate, serotonin and dopamine .
Diagnosis and treatment
Since it is possible to make a mistake in its detection, due to the belief that it only includes symptoms of immobility and stupor, there are some useful tools to not overlook a catatonic state. One of the most used is the Bush-Francis Catatonia Scale (BFCRS) .
On the other hand, although it is frequently seen accompanying (or as a consequence of) illnesses or substance abuse , the DSM-V opened the door to considering the syndrome as a disorder. Thus, it establishes a diagnostic criterion in which at least 3 of the symptoms linked to the episodes must be met.
How to treat it?
On the other hand, more recent studies place benzodiazepines as the first-line treatment, as long as it is not a malignant catatonic state. These act as GABA agonists in acute episodes, reversing the symptoms of paralysis and stupor. The most commonly used active ingredient is lorazepam .
In some cases, electroconvulsive therapy (ECT) is also used . As described by Neurology International , it is a useful method if started early; its effectiveness lies in the improvement of blood flow in the orbitofrontal and parietal cortices. This, in turn, increases the activity of the GABA neuroreceptor and its expression.
Repetitive transcranial magnetic stimulation ( rTMS) is a treatment that has been used in recent years, as it does not require anesthesia to stimulate specific areas of the brain, which differentiates it from ECT.
When all else fails, antipsychotics are used . This should be done under medical supervision, with caution and in addition to other drugs, as catatonic symptoms may worsen or withdrawal symptoms may occur when they are withdrawn. Amantadine is also used in some cases.
Finally, it is recommended to perform occupational therapy and provide the patient with professional therapeutic support . In this way, psychoeducation is provided and tools are given to treat the affective symptoms of this syndrome.
Detecting this disease early improves the prognosis
Catatonic states present a range of symptoms and severity that varies from patient to patient. The prognosis improves with early detection and appropriate treatment.
Remember that each case is unique, so detection and treatment vary depending on the individual’s needs. If you suspect that someone you know (or yourself) may suffer from the syndrome, don’t prolong your doubts: it’s best to consult a professional.