What Is Catatonia?
Catatonia is a psychomotor
disorder. It affects a person’s ability to move in a normal way. Affected
people can experience a variety of symptoms. The most common symptom is stupor,
which means that the patient cannot move, speak, or respond to stimuli.
However, some catatonia sufferers may show excessive movement and violent
Catatonia can last anywhere from just
hours to as many as 10 days. It can reoccur frequently for weeks to years after
the initial episode.
If catatonia is a
symptom of an identifiable cause, it is designated as extrinsic. If no cause
can be determined, it is considered intrinsic.
Types of Catatonia
Mental health professionals
classify catatonia into three categories: retarded, malignant, and excited.
Retarded catatonia is the most
common catatonia form (Coffey,
2013). It causes slow movement. A patient may stare into space and often
does not speak.
Patients with malignant catatonia
are delirious. They often have a fever. They may also have a fast heartbeat and
high blood pressure.
Patients with excited catatonia
appear “sped up.” They are restless and agitated. They are sometimes
What Causes Catatonia?
Common causes of catatonia
include mental disorders, post-traumatic stress disorder, and Parkinson’s
Catatonia is a rarely seen side
effect of some medications used to treat mental illnesses. (If you suspect that
a medication is causing catatonia, seek immediate medical attention. This is
considered a medical emergency.)
Withdrawal from some medications,
such as clozapine, can cause catatonia.
Imaging studies have revealed that
some people with chronic catatonia may have brain abnormalities. This is
especially true of the frontal lobes or thalamus (Rajagopal, 2007).
Another theory is that having excess
or too few neurotransmitters causes catatonia. Neurotransmitters are brain
chemicals that carry messages from one neuron to the next. One theory is that a
sudden reduction in dopamine, a neurotransmitter, causes catatonia. Another
theory is that a reduction in gamma-aminobutryic acid (GABA) leads to the
What Are Risk Factors for Catatonia?
Women have a higher risk of developing catatonia. The risk
increases with age.
An estimated 10 percent of acutely ill psychiatric
inpatients experience catatonia (Taylor and Fink, 2003). Schizophrenia patients
are more likely to have catatonia symptoms than mood disorder patients (Rajagopal, 2007).
Psychiatrists used to classify catatonia as only a symptom
of schizophrenia. Psychiatrists now classify catatonia as its own
Women with post-partum depression may experience catatonia.
Other risk factors are cocaine use, low salt concentration
in the blood, and the use of medications like ciprofloxacin.
What Are the Symptoms of Catatonia?
Catatonia has many symptoms. The most common symptom is
stupor, where a person cannot move or speak. These patients appear to be
staring off into space.
A person with catatonia may also show posturing. This is
when a person stays in the same position for an extended period. Such patients
can remain in that position even when moved around. This is called waxy
Catatonic patients often do not
eat or drink. This can cause malnourishment and dehydration.
Catatonia patients may also have echolalia. This is when a
person responds to conversation by only repeating what he or she has heard.
Symptoms of excited catatonia include excessive, unusual
movements. These include agitation, frenzy, restlessness, and excess or
Malignant catatonia causes the
most severe symptoms. They include delirium, fever, rigidity, and sweating.
Vital signs like blood pressure, breathing, and heart rate can fluctuate. These
symptoms require immediate treatment.
Catatonia symptoms mirror other conditions, including:
- acute psychosis
- neuroleptic malignant syndrome (NMS)
- nonconvulsive status epilepticus
Before they can diagnose
catatonia, doctors must rule out these conditions. Patients must show at least
two chief catatonia symptoms for 24 hours before a doctor can diagnose
How Is Catatonia Diagnosed?
No definitive test for catatonia exists. To diagnose
catatonia, a physical exam and testing must first rule out other conditions.
The Bush-Francis Catatonia Rating Scale (BFCRS) is a test
often used to diagnose catatonia. This scale has 23 items scored from 0 to 3. A
“0” rating means the symptom is absent. A “3” rating means the symptom is
Patients with high rankings on the BFCRS usually respond
well to benzodiazepene treatments (Carroll, et al., 2008).
Blood tests can help to rule out electrolyte imbalances.
These can cause changes in mental function. A pulmonary embolism or blood clot
in the lungs can lead to catatonia symptoms. A fibrin D-dimer blood test can
help diagnose catatonia. If test results are 500 mg/mL, catatonia is likely (Brasic,
Computed tomography (CT) or magnetic resonance imaging (MRI)
scans allow physicians to view the brain. This helps to rule out a brain tumor
How Is Catatonia Treated?
usually the first approach to treating catatonia. They include:
(such as clonazepam, lorazepam, and midazolam)
are usually the first medications prescribed. These medications increase GABA
in the brain. This supports the theory that reduced GABA leads to catatonia.
After five days,
if there is no response to the medication or if symptoms worsen, a physician
may recommend other treatments. These include electroconvulsive treatment
therapy (ECT) is a common treatment for catatonia. This therapy is performed in
a hospital under medical supervision. It is a painless procedure.
Once a patient
is sedated, a special machine delivers an electric shock to the brain. This
induces a seizure in the brain for a period of one to two minutes.
The seizure alters
the flow of neurotransmitters in the brain. This can improve catatonia
What Is the Outlook for Catatonia?
Patients typically respond quickly to catatonia treatments.
If a patient does not respond to prescribed medications, a physician may
prescribe alternative medications until symptoms subside.
Patients who undergo ECT have a high relapse rate for
catatonia. Symptoms usually appear again within a year (Rajagopal, 2007).
Because the exact cause of catatonia is often unknown,
prevention is not possible. However, patients should avoid taking excess
neuroleptic medications, such as Thorazine. Medication abuse may lead to