Those with catatonic schizophrenia experience catatonic stupors, in which they are awake, but not fully responsive. They may also be unable to control their movement, speech or expressions.2,3 Between 5-30% of people with a diagnosis of schizophrenia display catatonic symptoms, making it a rare but serious subtype of the disorder.1 Catatonic schizophrenia is usually treatable, but may require different types of medications than are usually prescribed to people with schizophrenia.1,4
What Is Catatonic Schizophrenia?
Catatonic schizophrenia is a subtype of schizophrenia–a mental illness that can cause hallucinations, delusions, and a flattened affect–that includes both symptoms of schizophrenia and catatonia.3 Catatonia is a motor disorder that impairs a person’s movement, speech, and response to outside stimuli.3,5 It is usually a symptom of another neurological or mental health condition, and can be diagnosed as a type of schizophrenia.1,4
During a catatonic stupor, some people are unable to move, talk, or respond to others; they will also be very still or have a rigid posture. Others in this state will repeat words or have random, jerky movements that aren’t controlled.3 Most people with schizophrenia who experience catatonic symptoms can be successfully treated with medication, and come out of their catatonic state in less than a week. A person with schizophrenia may experience catatonia only once, while others have chronic catatonic episodes.4
5 Symptoms of Catatonic Schizophrenia
Someone with catatonic schizophrenia will generally only experience catatonic symptoms occasionally. Normally, they may have schizophrenic symptoms that include occasional hallucinations, delusional thoughts, or an unusual way of speaking or behaving. Despite these, they can still function and interact with people. During a catatonic episode, their affect and behavior will change dramatically, and they typically become unresponsive or enter a stupor.5 In order to be diagnosed with catatonic schizophrenia, a person must have a diagnosis of schizophrenia as well as meet the criteria for catatonia.
Catatonic schizophrenia is diagnosed when someone with schizophrenia displays two or more of the following catatonic symptoms:3,6
- Motor immobility: Being unable to move, speak, eat, or take care of themselves independently; or having a rigid, stiff posture (aka waxy flexibility or catalepsy)
- Excessive motor activity: Psychomotor agitation; jerky movements or tics; or uncontrolled movement that isn’t intentional or in response to something in the environment
- Extreme Negativism: Being unresponsive to external stimuli or verbal prompts; not speaking (aka mutism); or assuming odd or unnatural body posture or positions (posturing)
- Peculiar movements: Assuming strange poses or postures (without external force); grimacing or strange expressions; and repeated voluntary movements or mannerisms
- Echolalia or echopraxia: Mimicking or repeating someone else’s noises, phrases or words, expressions, or posture
How Is Catatonic Schizophrenia Diagnosed?
Catatonic schizophrenia can be diagnosed by a licensed medical or mental health practitioner. Most people diagnosed with catatonic schizophrenia will already have received a schizophrenia diagnosis. A catatonic subtype or specifier is then added if or when they begin to display catatonic symptoms.1
Catatonic schizophrenia is usually diagnosed quickly during a medical or psychiatric evaluation, because catatonic symptoms are usually very easy to detect. Someone who is unresponsive, still, or who has a rigid or odd posture is often suspected to be in a catatonic state.4 Immobility and mutism are the two most commonly observed symptoms in catatonia.5
Someone with schizophrenia who displays catatonic symptoms will usually have their treatment and medication adjusted to treat their catatonia. Because catatonic schizophrenia requires different kinds of medication than normal schizophrenia, it’s crucial for diagnosis to occur early on.4 People who present with catatonic symptoms are also recommended to have an EEG in order to screen for brain injuries or other neurological problems that could be causing their symptoms.5
What Causes Catatonic Schizophrenia?
Most researchers believe that schizophrenia is caused by a combination of psychological, genetic, and environmental factors. It isn’t known what causes catatonic symptoms in someone with schizophrenia, but researchers have presented several theories. Some believe that similar to Parkinson’s disease, people with catatonia have imbalances in certain brain chemicals that help control movement (i.e. GABA, dopamine).5
Clinicians have noted that most people who experience catatonia report feeling very anxious before developing symptoms, and also during the episode.5 Because of this, it’s possible that stressful or traumatic experiences may induce catatonic symptoms in some people with certain mental illnesses. Many who develop catatonic symptoms will have an existing diagnosis of either schizophrenia or bipolar disorder.1,4 It’s also possible that catatonic states may be triggered by prescribed medications or in some cases, by using illicit drugs that may interact with their medications.
Complications of Catatonia
While most who develop catatonic symptoms will respond well to treatment and make a fast recovery, it’s important to be aware of the complications of catatonic states.4
Catatonia combined with a high fever, rapid pulse, or other medical symptoms can be a sign of a rare, but fatal condition called lethal or malignant catatonia. This is by far the most severe complication of catatonia, and requires immediate medical attention to prevent the loss of life.6,7
People experiencing untreated catatonic states may also experience:5,6
- Falls, injuries, or accidents due to their surroundings
- Malnourishment
- Dehydration
- A higher risk for deep vein thrombosis
- A higher risk for pulmonary embolisms
- Ulcers
- Various other medical complications or infections from lack of movement
Treatment for Catatonic Schizophrenia
Catatonia is usually treatable with a combination of medication and inpatient care. Most people who receive medication early will experience relief quickly, some even within a few hours.4 However, other methods of treatment may be necessary if a person does not respond well to initial efforts.
Medications
The recommended frontline treatment for catatonic schizophrenia symptoms are benzodiazepines like lorazepam. While schizophrenic catatonia doesn’t always respond to these medications, they are often the first treatment used for people who present with these symptoms.1,4,5
Electroconvulsive Therapy
Electroconvulsive Therapy (or ECT) is also sometimes recommended for the treatment of catatonic schizophrenia, especially when medications aren’t working.4,5 ECT is a safe treatment overall, but it can have some long-term effects on memory and cognition, which is why many doctors hesitate to use it on catatonic patients. Since most catatonic people are unable to give full consent for ECT, it creates an ethical dilemma for the clinician. ECT is usually reserved for people who do not respond to medication, or those who have symptoms of lethal catatonia.4,5
Hospitalization
Most people in a catatonic schizophrenic stupor will also require round-the-clock medical care and monitoring, as well as inpatient care to help them with recovery.
A person in a catatonic state will usually require assistance with:6
- Nutrition and hydration: People in a catatonic stupor usually are unable to feed and hydrate themselves, and many require IV hydration and nutrition
- Basic hygiene & ADL’s: In a catatonic state, a person is usually unable to shower, dress themselves, or even use the bathroom alone, and may need assistance
- Physical safety & security: Most people with catatonic symptoms are unaware of their surroundings and need constant monitoring to ensure they’re kept safe
- Medical monitoring: Staying in one position for a long time can increase the risk for medical issues like deep vein thrombosis, pulmonary embolisms, and heart problems
How to Get Help for Catatonic Schizophrenia
Catatonic symptoms are serious and require immediate medical and psychiatric attention. The best thing to do if someone displays signs of catatonia is to take them to the nearest hospital, where they can receive a full screening to determine what’s going on.4,5
If you are accompanying a person with catatonia to their treatment, it’s a good idea to stay with them when the medical or psychiatric professionals perform an evaluation. This way, you can provide them with any information you have about their symptoms.
Before going to a hospital, it’s a good idea to gather the following:
- A form of photo identification for the catatonic person
- A copy of the patient’s medical insurance policy information or card
- Contact information for the cationic person’s primary care doctor, psychiatrist, or other doctors
- Any information about current medications, treatments, or diagnoses
- Any medical power of attorney papers (if applicable)
- A list of any known medication/drug allergies
- A few items possibly needed during a patient’s stay (i.e. cane, eye glasses, extra clothing, etc.)
Final Thoughts
Catatonic schizophrenia is a type of schizophrenia that involves one or more catatonic episodes. During a catatonic episode, a person may become unresponsive, still and quiet, or have uncontrolled speech and movements.1,5 Catatonia requires inpatient care and medication in most cases, and early treatment and diagnosis can help to ensure the person’s safety. Most of the time, the symptoms of catatonia will pass and the person will become responsive again after receiving treatment.4
For Further Reading
- Catatonic Schizophrenia–Cleveland Clinic
- Catatonia–UCL Institute
- Mental Health America
- National Alliance on Mental Health
- MentalHealth.gov
Catatonic Schizophrenia Infographics
