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 behavior.
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 aggressive.
What Causes Catatonia?
Common causes of catatonia include mental disorders, post-traumatic stress disorder, and Parkinson’s disease.
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 condition.
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 disorder.
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 flexibility.
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 purposeless movements.
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 catatonia.
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 present.
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, 2013).
Computed tomography (CT) or magnetic resonance imaging (MRI) scans allow physicians to view the brain. This helps to rule out a brain tumor or swelling.
How Is Catatonia Treated?
Medications are usually the first approach to treating catatonia. They include:
- benzodiazepines (such as clonazepam, lorazepam, and midazolam)
- lithium carbonate
- muscle relaxants
- thyroid hormone
- tricyclic antidepressants
Benzodiazepines 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 (ECT).
Electroconvulsive 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 symptoms.
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 catatonia