Catatonic schizophrenia causes
Symptoms, Causes, Treatment and More
Written by Elizabeth Svoboda
In this Article
- Symptoms
- Diagnosis
- Causes
- Treatment
- Hospitalization
Catatonic schizophrenia is one feature of a serious mental illness called schizophrenia. Schizophrenia prevents you from separating what’s real from what’s not, a state of mind called a psychosis.
Catatonic schizophrenia affects the way you move in extreme ways. You might stay totally still and mute. Or you might get hyperactive for no reason. The new name for this condition is schizophrenia with catatonic features or schizophrenia with catatonia.
Symptoms
Catatonia can show up in many different ways. A core sign is that you don’t move normally, even though you are physically able.
Common symptoms include:
- Not moving
- Not talking
- Sluggish response
- Staring
- Parroting someone’s movements or speech over and over
- Tapping feet or other repeated movements
Diagnosis
Catatonic schizophrenia is no longer a stand-alone diagnosis. Catatonic symptoms can happen not only with schizophrenia, but in mood disorders, autism, and other conditions. But it most often shows up with schizophrenia.
Your doctor may tell you that you have catatonia, or catatonic schizophrenia, if you have at least three of these 12 features. You:
- Stay mute
- Are unmoving or react very little to what’s happening around you (stupor)
- Make odd gestures or movements (mannerisms)
- Passively let others position your limbs or other body parts
- Ignore instructions or requests
- Are agitated or hyperactive for no reason
- Hold your leg up or keep other uncomfortable positions for a long time (posturing)
- Stay locked in an awkward position for a long time and resist attempts to move you (waxy flexibility)
- Mimic someone else’s movements (echopraxia)
- Mimic someone else’s speech (echolalia)
- Repeat senseless gestures like rocking, shrugging, and waving (stereotypy)
- Contort your face into a grimace
Causes
We don’t know what exactly triggers catatonia.
Researchers have found that people with these symptoms have unusual activity in parts of the brain like the forebrain and hypothalamus that govern body movement.
The illness usually starts in your late teens or young adulthood. It is a lifelong condition. But the right treatment will help ease your symptoms.
If you have a family history of schizophrenia, you are more likely to have the condition, too. Also, drugs and alcohol can cause catatonic symptoms in some people with schizophrenia. The same is true for certain antipsychotic drugs or other medications you may take to treat an underlying mental disorder.
Treatment
Medications can be very effective in easing catatonic symptoms. They’re the first option for treating catatonia. Specifically, a class of anti-anxiety drugs called benzodiazepines, or “benzos,” along with ECT, is considered the first-line treatment for catatonic symptoms. Your doctor may prescribe:
- Alprazolam (Xanax), an anti-anxiety drug
- Lorazepam (Ativan, Lorazepan, Intensol), used to treat epilepsy and anxiety
You might take benzodiazepines by mouth or through an IV line.
Your doctor may also prescribe other drugs, such as memantine or lithium, if they are right for you.
Brain stimulation. This treatment uses either electrical currents or magnetic pulses.
- Electroconvulsive therapy (ECT). This can lower your symptoms by half or even get rid of them altogether. Your doctor may recommend it if medications haven’t helped. ECT uses short bursts of electric current that go through a cap on your head to reach your brain. The treatment can leave you with confusion and temporary memory loss.
- Transcranial magnetic stimulation (TMS). You wear a device on your head that sends out a magnetic pulse to activate nerve cells in your brain. TMS can target specific regions of your brain better than ECT can. It also causes fewer thinking and memory problems. But TMS is newer than ECT, and it’s not as clear how well it works.
Hospitalization
If your catatonic symptoms are severe, you may need to be hospitalized for a while.
This decision will be based on your safety. Catatonic symptoms sometimes can disrupt your heart rate, temperature, and blood pressure. You can leave the hospital once your symptoms are under control and you have a long-term treatment plan in place.
Catatonic Schizophrenia: Causes, Symptoms, and Treatment
Catatonia refers to a set of symptoms that might develop in some patients with schizophrenia. It can include periods where the individual moves very little and does not respond to instructions.
At the other end of the extreme, the individual can demonstrate motor activity that is considered “excessive” and “peculiar,” such as echolalia (mimicking sounds) or Echopraxia (mimicking movements). This is called catatonic excitement.
In this article, we will look at the symptoms of catatonic schizophrenia, its causes, diagnosis, and how it is treated.
Fast facts on catatonic schizophrenia
Here are some key points about catatonic schizophrenia. More detail and supporting information is in the main article.
- Catatonia only occurs in some individuals with schizophrenia
- Symptoms can involve flipping between hyperactivity and under activity
- Risk factors for catatonic schizophrenia are the same as those for schizophrenia in general
- There are now a number of effective treatments for the symptoms of catatonic schizophrenia
Catatonic schizophrenia is much rarer than it used to be thanks to improved treatments. Catatonic states are now more likely to be found in types of mental illness other than schizophrenia, such as neurodevelopmental (conditions that affect children during the development of their nervous system), psychotic bipolar, or depressive disorders.
Individuals with catatonia may flip between decreased and excessive motor activity.
With modern treatments, patients with catatonic schizophrenia can manage their symptoms easier, making the likelihood of leading a happier and healthier life much greater.
The clinical picture of catatonia is dominated by at least three of the following symptoms:
- Stupor – no psychomotor activity, no interaction with the environment
- Catalepsy – includes adopting unusual postures
- Waxy flexibility – if an examiner places the patient’s arm in a position, they will maintain this position until it is moved again
- Mutism – limited verbal responses
- Negativism – little or no response to instructions or external stimuli
- Posturing – actively holding a posture against gravity
- Mannerism – carrying out odd, exaggerated actions
- Stereotypy – repetitive movements without an apparent reason
- Agitation – for no known reason
- Grimacing
- Echolalia – mimicking another person’s speech
- Echopraxia – mimicking another person’s movements
Without proper treatment, a catatonic episode can persist for days or even weeks.
Apart from the above, the patient may also have the following symptoms of schizophrenia:
- Delusions – The patient may believe they are being persecuted.
Alternatively, they may think they have extraordinary powers and gifts. - Hallucinations – particularly hearing voices (auditory hallucination), but hallucinations can include visual (seeing things that aren’t there) or hallucinations involving any other sensory system.
- Thought disorder – when speaking, the person can jump from one subject to another for no logical reason. The patient’s speech might be muddled and impossible to understand.
- Lack of motivation (avolition) – the patient loses their drive. They give up on everyday activities, such as washing and cooking.
- Poor expression of emotions – they may not respond to happy or sad events, or may react inappropriately.
- Social withdrawal – when a patient with schizophrenia withdraws socially it is often because they believe somebody is going to harm them.
- Unaware of illness (also referred to as “poor insight”) – because the hallucinations and delusions seem so real to the patient, many do not believe they are ill.
- Cognitive difficulties – the patient’s ability to concentrate, remember things, plan ahead, and to organize is affected and communication becomes more difficult.
Patients with the symptoms of catatonic schizophrenia are not usually able to get medical help on their own. Often, it is a family member or friend who seeks medical help.
The risk factors for catatonic schizophrenia are the same as those for other schizophrenia subtypes, they include:
- Genetics – individuals with a family history of schizophrenia have a higher risk of developing it themselves.
- Viral infection – some recent studies suggest that viral infections may predispose the child to development of schizophrenia.
- Fetal malnutrition – if the fetus suffers from malnutrition during pregnancy, there is a higher risk of developing schizophrenia.
- Stress during early life – severe stress early in life may contribute to the development of schizophrenia. Stressful experiences often occur just before schizophrenia appears.
- Childhood abuse or trauma.
- Age of parents at birth – older parents have a higher risk of having children who develop schizophrenia.
- Drugs – the use of drugs that affect the mind during adolescence may increase the risk of developing schizophrenia.
Nobody is sure what the causes of catatonic schizophrenia are. Research indicates that most forms of schizophrenia are caused by brain dysfunction, we just don’t know why that brain dysfunction occurs. Most likely, it is caused by a combination of genetics and environmental triggers, such as stress.
Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. They believe that this imbalance is most likely caused by genes that make someone susceptible to the illness. Some researchers say the levels of other neurotransmitters, like serotonin, might also be involved.
Share on PinterestA series of tests will help doctors diagnose catatonic schizophrenia.
A physician who suspects a patient may have catatonic schizophrenia will recommend a series of medical and psychological tests to help with the diagnosis; these might include:
- Physical exam – the patient’s height, weight, heart rate, blood pressure, and temperature are checked. The doctor will listen to the heart and lungs and check the abdomen.
- CBC (complete blood count) – to check for alcohol and drugs, as well as thyroid function.
- MRI or CT scan – the aim is to look for any abnormalities in brain structure.
- EEG (electroencephalogram) – to check for brain function.
- Psychological evaluation – a psychiatrist will ask the patient (if possible) about their thoughts, feelings, and behavior patterns. They will discuss symptoms, when they started, how severe they are, and how they affect the patient’s life. They will also ask whether the patient has thoughts about harming themselves or others.
It can take a long time to diagnose catatonic schizophrenia accurately.
Other conditions, like mania, seizure disorder, substance abuse, and severe depression share symptoms with catatonic schizophrenia and must be ruled out first.
Schizophrenia is a condition that lasts throughout life, although the catatonic symptoms may not persist. Patients with schizophrenia require treatment on a permanent basis; even when symptoms seem to have disappeared and the patient believes they are better. Treatment is essentially the same for all forms of schizophrenia.
Methods vary depending on a number of factors, including the severity and types of symptoms, the health of the patient, and their age.
Medication
- Benzodiazepines – this class of drugs act as tranquilizers and are most commonly used for catatonic schizophrenia. The drug is fast acting and may be administered intravenously (injected into a vein). There is a risk of dependency if used for a long time. The patient may have to take this medication for several days or weeks.
- Barbiturates – these drugs are referred to as depressants or sedatives.
They suppress the central nervous system. Their effects range from mild sedation to total anesthesia. Barbiturates rapidly relieve the symptoms of catatonia. If used for a long time, there is a risk of dependency. This drug is used to treat catatonic schizophrenia less often than barbiturates. - Antidepressants and mood-stabilizing drugs – people with catatonic schizophrenia often have other mental health problems, such as depression.
Other treatments
ECT (electroconvulsive therapy) – this is a procedure in which an electric current is sent through the brain to produce controlled seizures (convulsions). ECT is used for catatonic patients who have not responded to medications or other treatments. Side effects can include short-term memory loss.
Hospitalization – this may be necessary during severe episodes. Patients are safer in a hospital setting; they are more likely to get proper nutrition, sleep, and hygiene, as well as the right treatment.
Psychotherapy – for patients with catatonic schizophrenia, medications are the main part of treatment; however, psychotherapy can be useful, but if symptoms are severe, psychotherapy may not be appropriate.
Social and vocational skills training – this may help the patient live independently – a vital part of recovery for the patient. The therapist can help the patient learn good hygiene, prepare nutritional meals, and have better communication. There may also be support in finding work, housing, and joining self-help groups.
Compliance (adherence) – compliance or adherence in medicine means taking the medication at the right times and the right doses. Unfortunately, lack of compliance is a major problem for patients with schizophrenia. Patients can stop taking their medication for long periods, significantly interfering with their lives and the lives of the people around them.
Untreated catatonic schizophrenia can cause problems of a health, financial, behavioral, and legal nature – these problems may affect every part of the patient’s life. Complications can include:
- Depression, suicidal thoughts, suicidal behavior – a significant number of patients with schizophrenia have periods of depression.
- Malnutrition.
- Hygiene problems.
- Substance abuse – which may include alcohol, prescription medications, and illegal drugs.
- Inability to find or maintain employment, resulting in poverty and homelessness.
- Prison.
- Serious family conflicts.
- Inability to study or attend school and other educational institutions.
- Being a victim or perpetrator of crime.
- Smoking-related diseases.
Treatment of catatonic schizophrenia in St. Petersburg
- Main
- Psychiatry
- Treatment of schizophrenia
- Catatonic schizophrenia
The catatonic form (ICD-10 F20.
2) is diagnosed in no more than 3% of the total number of people suffering from schizophrenia. As a rule, the first signs of a mental disorder manifest already in childhood or adolescence, but parents do not attach any importance to them. In addition, catatonic schizophrenia can occur much later, due to severe stress, certain diseases, or TBI. Therefore, an examination is necessary to make an accurate diagnosis. nine0013
Catatonic schizophrenia, left untreated, poses a threat to the life of the patient and the people around him: attacks of catatonic stupor or excitement can cause trauma, as in these states a person loses touch with the surrounding reality.
Catatonic stupor is one of the main symptoms of this form of schizophrenia. An attack can catch a patient at a pedestrian crossing, driving a car or in another situation that could lead to an accident. Therefore, if a person from time to time "plunges into himself" and stops responding to people around him, relatives should not hesitate to make an appointment with a psychiatrist.
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In 2009 the Oxford Academy published an article in the Schizophrenia Bulletin (Fink M, Shorter E, Tailor M, "Catatonia is not schizophrenia: kraepelin's error and the need to recognize catatonia as an independent syndrome in medical nomenclature") in which there is a dominant superiority of manic and depressive disorders over schizophrenia in the event of a catatonic stupor. Thus, it is necessary to understand that stupor can be not only a symptom of catatonic schizophrenia, but also other mental disorders, somatic or neurological diseases. nine0013
Doctor's consultation on the treatment of catatonic schizophrenia:
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Types of catatonic stupor
Usually a person learns about his diagnosis already being hospitalized, when catatonic stupor finds him in a public place.
There are several types of stupor that differ in clinical dynamics and human response to external stimuli. However, stupor does not mean complete incapacity, but such a person certainly needs the help of others. nine0013
Pathetic catatonic excitation
Pathetic catatonic excitation develops over time. At first, moderate motor and speech activity is observed. Speech can be pathos, bright, sometimes with the repetition of other people's phrases (echolalia). This state is often accompanied by euphoria and causeless laughter. With all this, a person does not lose touch with reality.
Impulsive catatonic excitation
Impulsive catatonic excitation develops rapidly. Such a person becomes cruel, prone to destructive behavior and aggression. Speech becomes impoverished and reduced to a chaotic set of phrases, echolalia. Movements can copy others, there is a high probability of self-harm and suicide. nine0013
Silent catatonic excitement
In case of silent catatonic excitement, a person makes senseless chaotic movements, resists attempts to calm him down.
In addition, in an affective state there is a risk of self-harm and suicide, as well as mutilation of others.
Catatonic stupor
Catatonic stupor can last from several hours to several months. A person stops talking, moving and paying attention to external stimuli. Activity appears only at the time of satisfaction of natural needs. Communication with reality is broken - as a rule, at this time a person sees vivid hallucinations. nine0013
Cataleptic stupor
When a cataleptic stupor occurs, a person may be in an uncomfortable position for a long time, but succumb to external influences (for example, attempts to put him to bed). Sometimes such a person may respond to whispers and wake up at night.
Negativistic stupor
Negativistic stupor, in contrast to cataleptic one, is characterized by active resistance when trying to change a person's posture.
Stupor with torpor
In stupor with stupor, motor inhibition is most pronounced.
As a rule, a person takes the fetal position, in which he arrives for a long time.
Syndromokinesis
In some cases, people with catatonic schizophrenia may experience alternating types of stupor, including arousal.
We treat catatonic schizophrenia including drug intolerance and drug resistance. In addition, our clinic employs psychotherapists and psychologists with clinical experience who are also involved in the treatment of mental disorders associated with schizophrenia. nine0013
Symptoms of catatonic schizophrenia
Catatonic stupor is not the only symptom of this type of schizophrenia. Another symptom of the disease and the exact opposite of stupor is catatonic excitement. Excitation can be expressed in motor and speech activity that does not make sense to others. Excitation is no less dangerous and poses a risk both to the life of the patient and to those around him.
In a state of catatonic arousal, a person may lose control of himself, resulting in self-harm and unintentional suicide attempts (eg, going out a window or on the roadway, self-mutilation with sharp objects).
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Some other symptoms of catatonic schizophrenia include:
- grimacing;
- repetition of words or phrases;
- activities that make no sense;
- alternating activity with immobility;
- unquestioning execution of other people's instructions;
- copying the movements of people around;
- aggression, cruelty, negativism;
- assuming unusual postures.
In addition, the course of the disease may be accompanied by general symptoms of schizophrenia - hallucinations, delusions, social self-isolation, depression, emotional dullness, inactivity, unwillingness to take care of oneself, memory disorder. nine0013
In its early stages, catatonic schizophrenia may present with inappropriate behavior (foolishness), frilly or bizarre speech, grimacing, and pathological 'reverie'. When the first signs of the disease occur, we recommend that you seek the advice of a psychiatrist and begin treatment of the catatonic form of schizophrenia in advance.
Treatment of catatonic schizophrenia in our clinic
Physical examination, neuro- and psychological testing is usually sufficient to make a diagnosis. However, in some cases, in order to accurately determine the cause of catatonic schizophrenia and related diseases, an additional examination may be prescribed:
- EEG;
- MRI;
- CT.
Treatment of catatonic schizophrenia in the clinic
Treatment of catatonic schizophrenia in our clinic includes examination, selection of drugs in the minimum effective dosage and psychotherapeutic assistance. As a rule, 1-2 weeks of treatment in a hospital is enough to stop psychosis and normalize the patient's psycho-emotional state.
If there are contraindications to drug treatment (for example, if there is a risk of developing neuroleptic malignant syndrome) or drug resistance, the patient can undergo electroconvulsive therapy (ECT). nine0013
Psychotherapeutic treatment of catatonic schizophrenia
Psychotherapy is an important adjunct to the main (drug) treatment of catatonic schizophrenia.
Often, against the background of the disease, such people develop fears, phobias and behaviors that complicate life. In the process of treatment, all our patients receive psychotherapeutic assistance in the form of group sessions under the guidance of clinical psychologists. If necessary, psychotherapeutic treatment can be continued after discharge. nine0013
Patient management after discharge
Outpatient treatment of catatonic schizophrenia is necessary for the correction of pharmacotherapy, timely prevention of possible side effects and relapse of the disease. As a rule, in the first few months the patient visits the attending physician once every 2-3 weeks, and then once a month.
Treatment of catatonic schizophrenia in St. Petersburg is carried out at: st. Marata, 78. For patients from other cities, after completion of treatment in a hospital, there is the possibility of consultations with the attending physician via Skype. nine0013
Comorbidities of catatonic schizophrenia
Causes of catatonic schizophrenia
Sources
Catatonic schizophrenia - https://pubmed.
ncbi.nlm.nih.gov
— https://www.webmd.com
Schizophrenia with prominent catatonic features: A selective review — https://pubmed.ncbi.nlm.nih.gov
Update date: 11/30/2022
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nine0000 Catatonic schizophrenia: causes, symptoms, diagnosis, treatment Schizophrenia has many symptoms, delusions and hallucinations of which are not the main ones.
If the patient falls into a stupor, freezes for a long time in one position, and uncomfortable, but periodically behaves very excitedly, he is diagnosed with catatonic schizophrenia. In such cases, catatonia, or psychomotor disorders, develops against the background of other signs that are characteristic of various forms of schizophrenia. In the article we will consider this pathology in more detail. nine0622
In this article
- General data
- Causes
- Symptoms
- Other features
- Forms
- Symptoms in men
- Symptoms in women
- Symptoms in children
- Clinical case
- Diagnostics
- Treatment
- Forecast
General data
Catatonia is a general name for a group of symptoms that combine various types of movement disorders. If it develops against the background of signs of schizophrenia, including delusions and hallucinations, the diagnosis is catatonic schizophrenia.
With this pathology, periods of stupor alternate - a person freezing for a long time in one position, as a rule, unnatural, and excitement, during which destructive behavior is observed. nine0013
Catatonic syndrome as a separate mental disorder was first described by psychologist Carl Ludwig Kahlbaum in the second half of the 19th century. At a psychiatric convention in Innsbruck, during a presentation, he said that this disease can appear in anyone up to 50 years old, including young children. So, in newborns, it can be determined by the uniform positions of the body, and in a child of 5-6 years old, if desired, sniff or lick the surrounding objects. But often the pathology affects people aged 25-30 years, both men and women, it’s just that the first signs appear earlier than the second. nine0013
Subsequently, Kraepelin and Bleuler attributed the catatonic syndrome to schizophrenia. In the ICD-10, catatonic schizophrenia is included in the group of pathologies designated by the letter range F20.
0-F20.3.
History cannot provide accurate data on incidence. Previously, catatonic schizophrenia was the more common diagnosis. Today it is detected only in 1-3% of schizophrenics.
Causes
In any form of schizophrenia, it is always difficult to establish a direct link between one or another factor and the disease itself. It can be triggered by trauma or stress, but it is impossible to say unequivocally that they were the real cause of the development of catatonic or other varieties of schizophrenia. nine0013
In general, the following factors can be singled out, which can become an impetus for the occurrence of a mental disorder of this type of course:
- Incorrect development of the fetus. The development of the embryo can be seriously affected by infectious diseases of a pregnant woman, an unhealthy lifestyle of the mother, including alcoholism and drug addiction, chronic pathologies of a woman, etc.
- Difficult labor - prematurity, head trauma during delivery, fetal hypoxia. nine0004
- Genetic predisposition - the likelihood of developing schizophrenia is higher if there were people in the family who suffered from mental illness. Two options are possible - the transfer of a defective gene from a relative or a gene mutation during conception.
- Psycho-emotional trauma - any form of violence, death of a loved one, divorce, betrayal, dismissal, expulsion, unrequited love, war, bullying at school, etc.
- Neurological diseases - postencephalitic syndrome, Tourette's syndrome.
- Taking psychoactive substances - alcohol, drugs, and other drugs that change consciousness.
- Mental disorders associated with schizophrenia - autism, postpartum psychosis.
- Somatic diseases - viral infections, autoimmune pathologies.
- Individual personality traits. So, the “excellent student” syndrome can lead to schizophrenia.
However, it can be the result of not only impeccable behavior, but also a tendency to deviation. nine0004
The list of factors that can provoke schizophrenia and catatonia is endless. The list should include injuries, poisonings, improper upbringing based on despotism or, on the contrary, permissiveness, etc.
Any such cause can cause a disruption in the functioning of neurotransmitters, in particular dopamine, which acts as an intermediary between brain cells.
During the diagnosis, various versions of the origin of the disease are checked, since the elimination of the trigger significantly increases the chance of prolonging remission. nine0013
Symptoms
The symptomatology of catatonic schizophrenia includes alternating stupor and excitation. These are the main symptoms that can take many forms. There are three types of catatonic excitation:
- Pathetic. Symptoms appear gradually, and the patient has moderate speech and motor excitations.
As a rule, a person speaks the same words, has a strong desire to communicate, including with strangers. Consciousness is preserved, but actions can be unpredictable. nine0004
- Impulsive. Signs appear in an acute form, human movements are fast and dangerous. He can be a danger to himself and others. The speech doesn't make any sense. Often the patient repeats the same phrases that do not logically fit into the general context. Some patients injure themselves with objects that are at hand.
- Mute. This type of arousal is characterized by senseless, unpredictable and aggressive behavior that is not accompanied by verbal delusions. nine0004
Catatonic excitation can go into remission, that is, disappear, or cause the next phase - stupor. In this state, the patient is inhibited: he is silent and assumes an unnatural posture. Moreover, it can stay in it from several hours to several years. Russian physiologist Ivan Pavlov claimed to have worked with a patient who had been in a stupor for more than 20 years.
Three types of catatonic stupor:
- Classical. The patient freezes in one position, which is pretentious. Waxy flexibility of the patient's body is observed. This means that in the normal state, he might not have been able to occupy such a position. In such cases, he does not respond to loud speech, but can respond to a whisper. Often motor activity partially and temporarily returns at night.
- Negativistic. The patient tries to resist attempts to change the posture, but nothing works out for him. Flexibility is maintained. The patient is conscious. nine0004
- Stupor with torpor. It is also called the terminal stage of motor disorders. A person can move, but slowed down. As a rule, it simply takes the form of an embryo, in which it remains for weeks.
In a stupor, a person remains conscious. He understands everything, but he cannot change his posture. Sometimes he is disturbed by delusions and hallucinations.
In a stupor, the patient can lie, sit, stand, including unnaturally arched. Any motor activity, even associated with instincts, is suppressed. nine0181
During a stupor, a person can take almost any position, which is explained by the waxy flexibility of the body. However, the most common are:
- Hood symptom - fetal position, the patient is twisted and covered with a sheet (robe, blanket, hood).
- Air cushion syndrome (Dupre) - the patient does not put his head on the pillow, as a result, it seems to hang in the air.
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- Proboscis symptom - a person demonstrates primitive reflexes, such as grasping or sucking.
Patients require careful care. He has impaired blood circulation in the body, there are bedsores. It is necessary to take measures to prevent infections.
Nurses have to feed and water the patient with a probe.
Other features
Catatonic syndrome is the main, but not the only symptom of catatonic schizophrenia. The following symptoms may also be observed:
- Negativism - the patient perceives everything negatively, no matter what he is told or offered. The active catatonic does what he was not asked to do, the passive one ignores others, and the paradoxical one does everything in defiance.
- Mutism - lack of desire to contact others, constant silence.
- Pavlov's symptom is a sign named after a physiologist. The bottom line is that the patient reacts only to words spoken in a whisper. nine0029 Stereotypical behavior - for a long time a person performs the same movements, for example, beats his head against a wall, itches until he bleeds, shakes off invisible dirt from himself.
- Echolalia, echochemistry and echopraxia - mannered copying of other people's words, facial expressions of people and movements, including animals.
- Automatism - mindless execution of someone's instructions, when the patient does not delve into the meaning of his own actions.
- Stupefaction - loss of connection with the outside world, impaired memory and various cognitive abilities. nine0004
Delusions and hallucinations can be fantastic. The mood of the patient is often depressed, apathetic. He is poorly oriented in space and time. Leaving him unattended is dangerous for him and those around him.
Molds
Catatonic schizophrenia is divided into several types depending on the course of the pathology:
- Lucid catatonia. It is considered a less severe variety. A person retains temporal, spatial and personal orientation. During stupor, the consciousness is clear, there are no delusions and hallucinations. nine0004
- Oneiroid catatonia. Refers to severe forms of schizophrenia, in which the patient is very aggressive.
He loses control of his mind. His actions are destructive. Urgent hospitalization required. - Empty catatonia. It is characterized by alternating stupor and excitement. Consciousness is preserved, delirium and hallucinations are absent. In general, the patient is adequate and can communicate with people, for example, to communicate with a doctor. nine0004
The empty and lucid forms are accompanied by fewer symptoms than the oneiroid, which is more dangerous and unpredictable.
Symptoms in men
In men, the catatonic form of schizophrenia usually appears before the age of 30. Most often, excitement, impulsive state and stupor replace each other in turn. In this case, the patient can both be silent and make noise. In general, his behavior is ridiculous and is characterized by antics, meaningless gestures and facial expressions. nine0013
Increased salivation, pressure and irregular heart rhythms are often observed.
At an early stage, the patient behaves strangely - feels objects, opens and closes doors, snatches handbags from the hands of others, etc. When the stupor phase begins, the man first becomes inhibited, after which he freezes in an unnatural position.
Symptoms in women
In women, catatonic schizophrenia at the initial stage is similar to hysterical seizures. The patient behaves inappropriately, seeks to attract more attention to herself, ceases to perform her usual duties at home or at work, loses interest in hobbies, etc. nine0013
The progression of the pathology causes typical catatonic symptoms. First there is lethargy, and then stupor. Also, many patients complain of loss of sensation in the arms and legs, especially when in contact with hot and cold objects.
During stupor, there is increased sweating, decreased pressure, swelling and increased muscle tone. During periods of excitement, a woman screams, breaks dishes and laughs out loud for no reason.
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Symptoms in children
Small children, who can also develop catatonic schizophrenia, and mostly 5-6 years old, sniff and lick objects, repeat words after adults, as well as the movements of people and animals. Healthy babies can behave this way, but patients are characterized by obsession and some unnatural actions.
Catatonic symptoms have a devastating effect not only on the brain, but also on other organs. Often the consequences are irreversible. nine0181
If the child is about 10-12 years old, then with catatonic schizophrenia, he will most likely behave like a one-year-old. Parents may notice babbling, thumb sucking, drooling, and other behaviors that are strange for this age. If we talk about adolescents, then their symptoms are more pronounced, as in adult men and women.
Clinical case
A 30-year-old man, a mechanic, was distinguished by normal behavior, but after his marriage he became withdrawn, answered his wife's questions in monosyllables and without interest.
Subsequently, he began to be late home, spent the night in parks or in the yard on a bench. Periodically took one position and looked into the distance for hours. nine0013
As a result, he was hospitalized. In the hospital, he could not answer who he was, where he was and why he was brought there. Mutism and negativism were observed for three weeks. After medical treatment, the man came out of his stupor. When asked why he was silent, he answered: "I did not know what to say."
The remission lasted two years. The attack happened suddenly for no apparent reason. He began to speak incoherently and very quickly. After a short phase of the excited state, a stupor set in, and the latter caught him at the station, where he stood for several hours in one position. Was hospitalized again. This time it took longer to recover. Doctors did not give exact predictions. nine0013
Diagnosis
Catatonic manifestations are rather specific signs, and therefore it is difficult to confuse them with other symptoms.
However, it is necessary to conduct a differential diagnosis, which allows to exclude:
- temporal lobe epilepsy;
- encephalitis;
- cerebral edema and tumors;
- Tay-Sachs disease;
- mood disorders;
- metabolic problems; nine0029 hepatocerebral dystrophy;
- sodium deficiency;
- consequences of drug addiction;
- depression.
For this, the patient is prescribed MRI, CT, EEG and various tests. To make a diagnosis of catatonic schizophrenia, you will have to observe the patient for at least two weeks.
Treatment
Treatment of catatonic schizophrenia is carried out permanently. During the period of remission, the patient may be allowed to go home, but therapy continues. nine0013
During an exacerbation, the following methods are used:
- Drug treatment that allows you to stop the physical manifestations of the disease.
When excited, they give tranquilizers and antipsychotics. In the period of stupor - antipsychotics and nootropics. If the patient is unable to take pills, medications are administered through injections and droppers. The dose and duration of the course are selected individually. - Electroconvulsive therapy. It is used only in extreme cases, when there are contraindications to drugs or they do not give any effect. During the procedures, the patient is exposed to electric current. This allows you to bring him out of his stupor. This therapy is not used for cardiovascular, infectious and viral pathologies, as well as for diseases of the respiratory and digestive systems. nine0004
Treatment does not always help to bring a person out of the acute phase, however, it is possible to stop some of the symptoms in almost all cases.
Forecast
In most cases, the outcome of catatonic schizophrenia is unfavorable. Over time, the patient's condition will worsen.
