Catatonia, which is currently categorized as a syndrome of certain mood, medical, neurologic, and psychotic disorders, often manifests as withdrawal combined with unusual movements and behaviors.
In the past, the term catatonic depression has been used to describe a severe case of depression resulting in symptoms of catatonia, but current research has catatonia defined as its own health issue.
In fact, according to the American Psychological Association, while catatonia is often observed in people living with bipolar disorder and major depressive disorder, it can also be present in people living with schizophrenia.
Symptoms of catatonia include the following:
- extreme negativism, which means a lack of response to stimuli or an opposition to stimuli
- automatic obedience
- an inability to move
- difficulty speaking/going mute
- unusual, repetitive movements
- imitating another person’s speech or movements
- a refusal to eat or drink
- periods of agitated excitement
Because catatonia is often a syndrome of other mental health issues, it’s possible that someone living with an issue such as bipolar disorder, schizophrenia, or major depressive disorder may experience worsening of their symptoms before an episode of catatonia.
While the majority of cases are psychiatric, there are other medical conditions that may result in catatonia or a catatonic state. These include:
- Parkinson’s disease
- autoimmune issues
- metabolic abnormalities
- a complication from a prescribed medication
- a complication from substance use
It’s believed that catatonia symptoms may be caused and exacerbated by a dysfunction in the transmission pathways of serotonin, dopamine, glutamate, and GABA (gamma-Aminobutyric acid).
In other words, something is getting in the way of the proper path these neurotransmitters typically take in the brain and body.
One of the best ways to diagnose catatonia is with a physical examination.
Typically, if a doctor encounters ”waxy flexibility” (meaning a patient’s limbs resist moving, then release slowly when the doctor pushes against them) and catalepsy (when a patient is moved into a specific posture and holds it), the diagnosis will be catatonia.
Other examination methods using the Bush Francis Catatonia Rating Scale include:
- a doctor scratching their head in an exaggerated manner to see whether the patient will copy the movement
- a doctor extending their hand out for a handshake while telling the patient something like ”don’t shake my hand” to see what they do
- checking for a patient’s grasp reflex
- checking vital signs and signs of agitation
Typically, an MRI or CT scan won’t be able to illustrate catatonia, but a knowledgeable doctor may be able to use brain imaging to detect abnormalities.
If catatonia is caused by schizophrenia or another major depressive disorder, the first step is to work on treating the underlying mental health issue. Once those symptoms have gotten to a stable place, then doctors can work on treating catatonia.
Typically, treatment falls into two categories: benzodiazepines or electroconvulsive therapy.
Benzodiazepines are a class of psychoactive drugs that enhance the effect of the GABA neurotransmitter. They’re often prescribed for anxiety and panic disorders, and less often, for severe cases of depression.
If lorazepam doesn’t prove effective, electroconvulsive therapy (ECT) is another effective treatment. ECT involves attaching electrodes to the head that send electrical impulses to the brain, triggering a generalized seizure.
Currently, ECT is considered a relatively safe and effective treatment for a range of mood disorders and mental illnesses, including depression.
Catatonia is a syndrome of other underlying mood disorders, but it can also be caused by other factors, including other infections or taking prescribed or illegal drugs.
Someone affected by catatonia may not be able to move, or may seem ”stuck” in an odd, awkward posture. They may also exhibit obedient, automatic behavior or anxiety.
Whether the catatonia is caused by depression, schizophrenia, or another mood disorder, there are ways to treat it, and the prognosis is good.