Catatonia: meaning, symptoms, causes and treatment

Catatonia is a syndrome that can depend on both organic and psychic pathologies, commonly characterized by mutism, stupor, refusal to eat or drink, posture, and excitement or hypokinesia. Although catatonia has been associated with schizophrenia throughout the 20th century, thus affecting the first editions of the major diagnostic manuals, it is often caused by affective disorders and medical or neurological diseases.

With this Psychology-Online article we will try to describe this complex disease as well as possible, explaining it in a simple and understandable way for everyone, also by non-specialists, without neglecting the important and necessary theoretical and scientific references. Let’s see the meaning, symptoms, causes and treatment of catatonia .

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Index

1. What is catatonia according to psychology
2. Catatonia symptoms
3. Difference between catatonia and catalepsy
4. Causes of catatonia
5. Catatonia treatment

What is catatonia according to psychology

To better understand catatonia, we must go back to 1874, when the psychiatrist Karl Kahlbaum coined the term ( katatonia ), detecting it in patients with serious medical, psychotic and mood disorders: for the German doctor it was, in effect, a disorder with behavioral and motor manifestations such as negativism, mutism, immobility, rigidity, mannerisms or stereotypes, accompanied by affective, cognitive and neurovegetative symptoms (Luchini et al., 2015).

Later, other psychiatrists such as Kraepelin and Bleuler redefined catatonia as a subtype of dementia praecox (Kraepelin, 1919) and schizophrenia (Bleuler, 1911), a definition that influenced the entire clinic of the 20th century until the 1980s and 1990s. , when numerous studies suggested that catatonic syndromes could also be implicated in affective disorders and in various medical conditions such as metabolic, endocrine, neurological, rheumatological and infectious (Luchini et al., 2015).

New discoveries and scientific evidence that have convinced the authors of the latest versions of the most important diagnostic classification systems to change their focus to catatonia (Luchini et al., 2015). In particular, the International Classification of Diseases (ICD-10) has added the possibility of diagnosing an ” organic catatonic disorder ” (F06.1), while with the latest and fifth edition of the DSM (the diagnostic and statistical manual of disorders mental disorders of the American Psychiatric Association ) the syndrome has finally acquired a descriptive autonomy, thus being able to appear within other disorders (psychotic, depressive, medical, etc.).

Catatonia is a syndrome characterized by a well-defined clinical picture, although it manifests with extremely variable signs and symptoms (Luchini et al., 2015). It has a stable course, and not malignant as previously thought, described by several researchers as a generally cyclical disorder, with episodes of excitement, depression and psychosis (Luchini et al., 2015).

Catatonia symptoms

Let’s see then the descriptive criteria of the MDE-5 (APA, 2013), for which catatonia is defined by the presence of three or more of the following symptoms:

• Catalepsy, a momentary loss of mobility, voluntary and involuntary, and of the sensation of the body.
• Waxy flexibility, a decreased response to stimuli, and a tendency to remain immobile.
• Stupor, a lack of critical cognitive function and level of consciousness.
• Agitation, not influenced by external stimuli.
• Mutism, minimal or no verbal response (not applicable with aphasia).
• Negativism, that is, to oppose or not respond to external stimuli or instructions.
• Posture, a spontaneous and active maintenance of posture against gravity.
• Mannerisms, that is, strange caricatures of ordinary actions.
• Stereotypies, such as repetitive, frequent and non-goal-directed movements.
• Grimaces.
• Echolalia, that is, repeating the words spoken by another person.
• Echopraxia, the imitation of movements made by another person.

The authors of the manual have considered all the hypotheses and suggestions proposed in the field of catatonia in the last two decades, making a great effort to improve the usefulness and applicability of the clinical diagnosis of catatonia (Luchini et al, 2015). Indeed, for a possible diagnosis of catatonia according to the MDE-5 (APA, 2013), we have:

• Catatonia due to a general medical condition.
• Specifier “ with catatonia”: schizophrenia , schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, substance-induced psychotic disorder.
• Specifying with other mental disorder (i.e. neurodevelopmental disorder, bipolar disorder, major depressive disorder, other mental disorders).
• Catatonia disorder NOS (not otherwise specified).

Difference between catatonia and catalepsy

The catalepsy , ie passive induction of a position held against gravity (APA, 2013), can be considered as one of the many symptoms of catatonia , which is a syndrome (a complex, more or less characteristic symptom ), and that precisely because of this it can also occur in non-catatonic patients: therefore, a catatonic can have catalepsy, but those who have catalepsy are not necessarily catatonic.

Causes of catatonia

The exact causes of catatonia are not yet fully understood: its epidemiological prevalence is unknown, but catatonia caused by a medical condition is believed to be common, although it is very likely a syndrome underdiagnosed by psychiatrists and other physicians (Daniels, 2009). The renewal of interest in catatonia has led to a deepening of knowledge about the neurobiological bases of the phenomenon, although these are still insufficient for the formulation of a complete pathophysiological interpretation of the disorder (Bartolommei et al., 2012).

• Injury to various regions of the brainhas been associated with the appearance of catatonic manifestations, but patients with focal brain lesions located in these places rarely develop a catatonic syndrome (Bartolommei et al., 2012).
• Catatonic symptoms are common in combination with neurological diseasesthat widely affect the central nervous system, a fact that seems to support the hypothesis that catatonia is the result of dysfunction of neuronal circuits with the participation of multiple structures, rather than focal alterations ( Bartolommei et al., 2012).
• Furthermore, dysfunction of various neurotransmitter systemshas also been implicated in the pathogenesis of catatonic symptoms: since current pharmacological interventions modify the y-aminobutyric acid (GABA) -A , glutamate and dopamine systems , it is considered that Dysregulation of each of these neurotransmitter systems may be involved in catatonia (Daniels, 2009).

Catatonia treatment

Once diagnosed, catatonia responds to specific treatments, although due to its correlation with schizophrenia, it has induced the potentially harmful use of antipsychotics (Luchini et al, 2015). Despite the evolution in recent years of knowledge about the psychopathology and neurobiology of catatonia, however, many problems related to the diagnostic definition and its location in health care remain unresolved, a persistence of uncertainties that have an impact on daily clinical practice (Bartolommei et al., 2012).

The catatonic patient must be assisted by a specialized multidisciplinary and integrated team , and the correct management of the syndrome requires, above all, the identification and treatment of any medical condition (internist, neurological, toxic) responsible for the clinical picture, together with immediate measures and adequate support to reduce morbidity and mortality, associated with immobility and malnutrition, often present (Bartolommei et al., 2012). If not recognized immediately, catatonia can be complicated by serious somatic diseases, such as malnutrition, infections, muscle contractures, pressure ulcers, and thromboembolism (Luchini et al, 2015).

To avoid complications

1. The first measures to prevent possible medical complications are anticoagulant treatment with subcutaneous heparin, urinary catheterization and adequate nursing care (Bartolommei et al., 2012).
2. We must bear in mind that catatonic patients generally refuse to feed and may experience a serious state of malnutrition and dehydration: in this case, adequate hydrationand nutrition are required (Bartolommei et al., 2012).

To treat symptoms

Currently, the elective treatment of catatonic symptoms is:

• the administration of benzodiazepinesintravenously : the most commonly used benzodiazepine is lorazepam , with which rates are reported catatonic remission 70%;
• conducting a cycle of electroconvulsivetherapy (ECT): Electroconvulsive therapy appears effective in 85% of patients (Bartolommei et al., 2012).

Given their synergistic effect, the two treatments can be used together, although the dose of benzodiazepines should be reduced, as they can increase the seizure threshold (Luchini et al, 2015). Recent recent research has published some and few positive data on treatments with GAbA-A agonists (Zolpidem) and NMDA antagonists (memantine, amantadine) (Luchini et al, 2015).

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.