What is catatonia?
Catatonia is a psychomotor disorder, meaning it involves the connection between mental function and movement. Catatonia affects a person’s ability to move in a normal way.
People with catatonia can experience a variety of symptoms. The most common symptom is stupor, which means that the person can’t move, speak, or respond to stimuli. However, some people with catatonia may exhibit excessive movement and agitated behavior.
Catatonia can last anywhere from a few hours to weeks, months, or years. It can reoccur frequently for weeks to years after the initial episode.
If catatonia is a symptom of an identifiable cause, it’s called extrinsic. If no cause can be determined, it’s considered intrinsic.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) no longer categorizes catatonia into types. However, many mental health professionals may still classify catatonia into three types: akinetic, excited, and malignant.
Akinetic catatonia is the most common catatonia form. It causes slow movement. A person with akinetic catatonia may stare into space and often doesn’t speak. These common symptoms can be seen in people with akinetic catatonia.
People with excited catatonia appear “sped up,” restless, and agitated. They sometimes engage in self-harming behavior. This form is also known as hyperkinetic catatonia.
People with malignant catatonia may experience delirium. They often have a fever. They may also have a fast heartbeat and high blood pressure.
According to the DSM-5, several conditions may cause catatonia. They include:
- neurodevelopmental disorders (disorders affecting the development of the nervous system)
- psychotic disorders
- bipolar disorders
- depressive disorders
- other medical conditions, such as cerebral folate deficiency, rare autoimmune disorders, and rare paraneoplastic disorders (which are related to cancerous tumors)
Catatonia is a rare 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 (Clozaril), can cause catatonia.
Imaging studies have suggested that some people with chronic catatonia may have brain abnormalities.
Some experts believe that having an excess or lack of 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-aminobutyric acid (GABA), another neurotransmitter, leads to the condition.
Women have a higher risk of developing catatonia. The risk increases with age.
Although catatonia has historically been associated with schizophrenia, psychiatrists now classify catatonia as its own disorder, which occurs in the context of other disorders.
An estimated 10 percent of acutely ill psychiatric inpatients experience catatonia. Twenty percent of catatonic inpatients have schizophrenia diagnoses, while 45 percent have mood disorder diagnoses.
Women with postpartum depression (PPD) may experience catatonia.
Other risk factors are cocaine use, low salt concentration in the blood, and the use of medications such as ciprofloxacin (Cipro).
Catatonia has many symptoms, the most common of which include:
- stupor, where a person can’t move, can’t speak, and appears to be staring off into space
- posturing or “waxy flexibility,” where a person stays in the same position for an extended period
- malnourishment and dehydration from lack of eating or drinking
- echolalia, where a person responds to conversation by only repeating what they’ve heard
These common symptoms can be seen in people with retarded catatonia.
Other catatonia symptoms include:
- catalepsy, which is a type of muscular rigidity
- negativism, which is a lack of response or opposition to external stimulation
- echopraxia, which is the mimicking of another person’s movements
Symptoms specific to excited catatonia include excessive, unusual movements. These include:
- purposeless movements
Malignant catatonia causes the most severe symptoms. They include:
Vital signs such as blood pressure, breathing rate, and heart rate can fluctuate. These symptoms require immediate treatment.
Similarity to other conditions
Catatonia symptoms mirror those of other conditions, including:
- acute psychosis
- encephalitis, or inflammation in the brain tissue
- neuroleptic malignant syndrome (NMS), a rare and serious reaction to antipsychotic medications
- nonconvulsive status epilepticus, a type of severe seizure
Doctors must rule out these conditions before they can diagnose catatonia. A person must show at least two chief catatonia symptoms for 24 hours before a doctor can diagnose catatonia.
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 present.
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 also be useful. Recent studies indicate that catatonia is associated with elevated D-dimer levels. However, many conditions (such as pulmonary embolism) may affect D-dimer levels.
CT or MRI scans allow doctors to view the brain. This helps to rule out a brain tumor or swelling.
Medications or electroconvulsive therapy (ECT) may be used to treat catatonia.
Medications are usually the first approach to treating catatonia. Types of drugs that may be prescribed include benzodiazepines, muscle relaxants, and in some cases, tricyclic antidepressants. Benzodiazepines are usually the first medications prescribed.
Benzodiazepines include clonazepam (Klonopin), lorazepam (Ativan), and diazepam (Valium). These medications increase GABA in the brain, which supports the theory that reduced GABA leads to catatonia. People with high rankings on the BFCRS usually respond well to benzodiazepine treatments.
Other specific medications that may be prescribed, based on an individual’s case, include:
- amobarbital, a barbiturate
- bromocriptine (Cycloset, Parlodel)
- carbamazepine (Carbatrol, Epitol, Tegretol)
- lithium carbonate
- thyroid hormone
- zolpidem (Ambien)
After 5 days, if there’s no response to the medication or if symptoms worsen, a doctor may recommend other treatments.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is an effective treatment for catatonia. This therapy is performed in a hospital under medical supervision. It’s a painless procedure.
Once a person is sedated, a special machine delivers an electric shock to the brain. This induces a seizure in the brain for a period of around a minute.
The seizure is believed to cause changes in the amounts of neurotransmitters in the brain. This can improve catatonia symptoms.
According to a 2018 literature review, ECT and benzodiazepines are the only treatments that have been clinically proven to treat catatonia.
People typically respond quickly to catatonia treatments. If a person doesn’t respond to prescribed medications, a doctor may prescribe alternative medications until symptoms subside.
People who undergo ECT have a high relapse rate for catatonia. Symptoms usually appear again within a year.
Because the exact cause of catatonia is often unknown, prevention isn’t possible. However, people with catatonia should avoid taking excess neuroleptic medications, such as chlorpromazine. Medication misuse may aggravate catatonia symptoms.