Catatonic Symptoms in Schizophrenia and Other Conditions

Catatonia is marked by a significant decrease in someone's reactivity to their environment. This can involve stupor, mutism, negativism, or motor rigidity, and even purposeless excitement.

Although you may have heard the term "catatonic schizophrenia," this diagnosis no longer officially exists in the current "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR). It was previously one of the subtypes of schizophrenia.

Currently, it is used to describe someone who is diagnosed with schizophrenia and who also meets the diagnostic criteria for catatonia. Catatonia can also occur in other conditions.

While these symptoms can be scary and extremely debilitating, knowing more about them (and what treatments are available) can help you better manage them or help a loved one.

Characteristics of Catatonic Behavior

According to the DSM-5-TR, catatonia is characterized by:

• Agitation: Feeling upset and irritable
• Catalepsy: Holding the body in the same position
• Echolalia: Echoing what others say
• Echopraxia: Mimicking other people's movements
• Grimacing: Holding the same tense facial expression
• Mannerisms: Making exaggerated movements
• Mutism: Being unable to speak or unusually quiet
• Negativism: Not responding to environmental events
• Stereotypy: Repetitive movements that occur without a purpose
• Stupor: Being awake but non-responsive
• Waxy flexibility: Resistance to changing body positions followed by slow responses
  

Catatonia can also cause a person to perform strange movements. They may also experience catatonic posturing where they stay in uncomfortable-looking positions without attempting to shift into more comfortable or natural ones.

In addition to a lack of mobility, erratic and extreme movement is possible in catatonic behavior. For example, a person might pace in a repeated pattern and make loud exclamations for no reason (i.e., not in response to an environmental stimulus or event).​ Parrot-like repetition or echoing of words, known as echolalia, is also a common catatonic behavior.

While a person who is catatonic may not be able to speak or move, they are still conscious and aware. A person in a catatonic state may also experience intense emotions and feelings of anxiety but not be able to express what they are experiencing.

How Is Catatonic Behavior Diagnosed?

There are no labs or tests to diagnose catatonic symptoms. Catatonic behavior can also occur in conditions such as autism and mood disorders, so a doctor will evaluate symptoms to determine what is causing them. 

A doctor will perform a series of medical exams and psychological evaluations to assess the individual's physical and mental health, as well as rule out other conditions.

Depending on the results, a doctor may order a magnetic resonance imaging (MRI) scan or an electroencephalogram (EEG) to check for any lesions or unusual brain wave patterns. A test may also be given to check for drugs and alcohol.

During the psychiatric evaluation, the individual will be asked questions about their thoughts and behaviors. A psychiatrist will attempt to discover how long they have been experiencing the symptoms in question.

What Causes Catatonic Behavior?

The exact causes of catatonic behavior are not clear. There is also no single cause of schizophrenia or other conditions that are sometimes accompanied by catatonic symptoms.

Causes of Catatonic Behavior

• Brain abnormalities: These include unusual activity in the brain, including irregularities in neurotransmitter systems involving dopamine, glutamate, and gamma-aminobutyric acid (GABA). Brain imaging suggests that catatonic symptoms are associated with brain abnormalities in most cases.
• Psychiatric conditions: Catatonia or catatonic behavior is a serious psychiatric condition that has historically been associated with schizophrenia, but it can be present in various psychiatric conditions, including schizoaffective disorder, bipolar disorder, and major depressive disorder. Depression that includes catatonia as a symptom is sometimes referred to as catatonic depression.
• Substances and other medications: Catatonic behavior may also result from drugs, alcohol, and certain medications.
• Medical conditions: Some other medical conditions can cause catatonic behavior or behaviors that can be mistaken for catatonia. Dystonia, encephalopathy, HIV, and renal failure are conditions that can potentially cause catatonia.

Catatonic symptoms like facial contortions, strange limb movements, or unusual body positions can lead to a misdiagnosis of tardive dyskinesia or other movement disorders. Similarly, Tourette's syndrome may be confused for catatonia due to some of the vocalizations that can be part of the syndrome.

Causes of Schizophrenia

While the exact causes of schizophrenia are not fully understood, it is believed that a combination of genetic and environmental influences may play a role. Genetics appear to make people more vulnerable to the condition, but other factors, including viral infections, exposure to toxins, neurochemical irregularities, stress, and trauma, can also play a role. 

Treatment of Catatonic Symptoms

Treatments for catatonic behavior can vary depending on the individual's needs and diagnosis. Schizophrenia is a lifelong, chronic condition, which means people must take steps to stay ahead of and manage their catatonic behaviors and schizophrenia.

Medication

Benzodiazepines like Ativan (lorazepam) are perhaps the most common approach to treatment. These drugs act as depressants on the central nervous system, which is why they are often used to treat anxiety.

There is some debate around the use of antipsychotics in catatonia. In some cases, antipsychotics can worsen catatonia and are often discontinued in its acute management. However, they are generally reintroduced to treat and prevent the symptoms of schizophrenia.

Electroconvulsive Therapy (ECT)

ECT, formerly known as electroshock therapy, is increasingly used to effectively treat catatonia in schizophrenia and other psychiatric conditions. Research has shown that ECT has an 80% to 100% efficacy rate in treating catatonia.

Coping With Catatonic Behavior

Witnessing someone experience catatonic behavior with schizophrenia is certainly scary. Steps people can take to help cope:

Stay Informed

Perhaps the best thing friends and family members can do is to stay educated about diagnosis, symptoms, and effective treatment. By staying informed, loved ones can get help immediately if they notice any signs of catatonia like rigidity or stupor, or erratic extreme movements.

Be Prepared to Describe Symptoms

Depending on the severity and type of symptoms, people may need to step in to describe the catatonic behaviors to their loved one's doctor.

Offer Encouragement and Support

People can also help by doing their best to encourage someone experiencing catatonic behavior to work with their mental health professionals. Sticking to the treatment plan will help ensure that schizophrenia is well-managed and controlled.

Care for Yourself

Self-care is also essential for sustaining the mental energy required to support someone with a mental illness. Caregivers should try to get ample sleep, eat right, exercise, and make time for relaxation and fun.

Takeaways

Getting a proper diagnosis and complying with treatment is key to coping with catatonic behavior. While schizophrenia is a lifelong disease, catatonia can be controlled. With appropriate treatment, people suffering from catatonic symptoms as part of schizophrenia and other psychiatric conditions can find significant relief from their symptoms.