Catatonic Behavior In Bipolar Disorder And Other Conditions: How Harmful Is It?

How can you tell if someone is catatonic?

The way catatonia is presented is varied, making it difficult to diagnose catatonia accurately. The most commonly known form of catatonia is characterized by a lack of movement, catalepsy, and waxy flexibility. Waxy flexibility means that, when examined, a catatonic person exhibits slight, even resistance to being repositioned. Catalepsy refers to the tendency for a catatonic person to maintain their position against gravity. Those with other psychiatric concerns, like schizophrenia, depression, or psychotic patients may have different symptom profiles. 

Other forms of catatonia may present with different symptoms. While many people assume that those with catatonia are mute, the condition might involve symptoms like echolalia, which is repeating the words of others. They may also exhibit repetitive and stereotyped movements. The complex presentation of catatonia makes it challenging to discern exactly what is causing the symptoms. In medical settings, physicians usually use benzodiazepines, antiepileptics, or antidepressants to treat catatonia, with a diagnosis usually being reached based on the patient’s response. 

Can people with catatonia move?

Many people consider those with catatonia to be like statues, stuck in an immovable pose and unable to engage in voluntary movement. However, the actual presentation of catatonia can vary considerably. The medical definition of catatonia generally refers to behaviors that are increased, decreased, or abnormal compared to baseline. The most common type of catatonia does present with limited movement, but a second type of catatonia can present with quite a bit of motion. The person might move randomly, repeat the motions of those around them, or exaggerate typical movements. 

How do you get someone out of a catatonic state?

To help someone experiencing a catatonic state, immediate medical help is required. Treatment usually starts with benzodiazepines, like lorazepam, which can quickly reverse catatonic symptoms. If these aren't effective, medical providers might use mood stabilizers or antipsychotics. Identifying and treating any underlying health issues causing the catatonia is also important. Conditions like complex partial seizures can sometimes cause symptoms similar to catatonia and may require different treatment approaches. 

Electroconvulsive therapy: A brain stimulation therapy

In more severe cases where medications don't work, electroconvulsive therapy (ECT) is often used, especially when the catatonia is related to mood disorders. ECT is likely an effective treatment if other approaches have failed, but it does come with a higher risk to the patient. Once the catatonia symptoms resolve, it is important to offer supportive care, additional diagnosis, and ongoing monitoring to ensure that the symptoms do not return. 

What happens when someone becomes catatonic?

When someone goes catatonic, they experience a marked disturbance in their movement and psychomotor behavior. While many assume that catatonia turns a person into a “statue” unable to move, that may not be the case for everyone. There are two primary types of catatonia: the more commonly known form - akinetic catatonia -  involves extreme lack of movement, responsiveness, and speech, while the other type - excited catatonia -  involves excessive and peculiar motor activity.

In the first type, the person may remain motionless, mute, and unresponsive for hours or even days. This state can include "waxy flexibility," where their limbs remain in positions placed by another person. In the second type of catatonia, the person may exhibit purposeless or bizarre movements, echolalia (repeating others' words), or echopraxia (mimicking others' movements). The second type of catatonia is more serious than the motionless type. It is sometimes referred to as “malignant” catatonia and can rapidly be fatal if not treated immediately. 

Are catatonic people conscious?

People in a catatonic state can move between several states of consciousness. Those that appear unresponsive or immobile are not necessarily unconscious. In many cases, individuals in a catatonic state are aware of their surroundings but are unable to respond or move. This lack of response can be misinterpreted as unconsciousness, even if they know what is happening around them. It is difficult to determine exactly what level of consciousness a person with catatonia is experiencing, especially if other medical conditions or psychiatric disorders are involved. 

Do catatonic people have thoughts?

It is likely that catatonic people have thoughts and move between various levels of consciousness. Because they cannot control speech or movement properly, a catatonic person may not be able to indicate their thoughts or how aware they are of their surroundings. Predicting a catatonic person’s thoughts can be further complicated by the presence of other medical problems or mental health conditions, which can both cause and exacerbate the symptoms of catatonia. 

How are catatonic patients treated, and is electroconvulsive therapy effective?

Catatonic patients are most commonly treated through the use of clinical psychopharmacology. Benzodiazepines, such as lorazepam, are often the first line of treatment. These drugs can quickly reduce catatonic symptoms. When diagnosing and treating catatonia, medical practitioners often stop all medications that might be contributing to the condition and administer a “lorazepam challenge,” observing the treatment response. Lorazepam is administered slowly via IV, and catatonia symptoms are observed. If the symptoms decrease, a dosing schedule for lorazepam is determined to prevent symptoms from reappearing. 

If lorazepam or another benzodiazepine is ineffective, medical providers may try other types of medications, such as mood stabilizers or antiepileptic medication. If pharmacological therapy fails, the American Psychiatric Association recommends the use of electroconvulsive therapy (ECT). ECT treatments apply controlled electrical stimulation to the patient’s brain under the supervision of medical professionals. 

Treatment also typically involves ongoing diagnosis to identify underlying conditions. Supportive care is also important to ensure that symptoms do not return. Regular monitoring and follow-up are essential to adjust the treatment plan and manage the condition effectively.

How long can a person live in a catatonic state?

The duration of a catatonic state can vary widely depending on the underlying cause and the effectiveness of treatment. Some individuals may experience catatonic episodes that last for hours or days, while others might remain in a catatonic state for weeks or even longer without appropriate treatment. Clinical manifestations can vary widely, as can the severity of the catatonic symptoms. 

The length of a catatonic episode varies based on the underlying cause. For example, catatonia due to a treatable psychiatric condition like major depression may resolve relatively quickly with appropriate medication and therapy. However, if catatonia is a symptom of a more chronic or severe neurological condition, it might persist for longer. 

If someone is in a catatonic state, it is important to get them medical attention immediately. In some cases, catatonia rapidly progresses to become fatal, and it is important to remember that catatonia is not a typical symptom of any illness. The presence of catatonia indicates that a significantly more severe underlying problem may be present. 

Can you go catatonic from stress?

Catatonia is strongly associated with mood disorders, such as depression and bipolar disorder. Stress is known to worsen the symptoms of mood disorders, making it likely that stressful live events can increase the possibility of catatonic symptoms. In some cases, catatonia is attributed to only the psychiatric condition, while in other cases, it may have different underlying causes. For example, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM), lists major depressive disorder with catatonic features as a specifier for major depression, which means that the depression is so severe that a person is unable to move or speak for long periods. 

What happens if catatonia is not treated?

Untreated catatonia is a potentially lethal condition. The most common type, characterized by disordered motion and speech, is considered to be less dangerous than the type associated with bizarre or excessive movement. Catatonia can rapidly progress to a lethal state if left untreated, although the decline is likely quicker in those exhibiting the second type of catatonia. Regardless of the exact symptoms a person presents, catatonia should always be considered a medical emergency and treated by medical professionals. 

Is catatonia associated with bipolar disorder?

Catatonia is commonly associated with mood disorders. Many people diagnosed with bipolar disorder are also reported to have catatonia. About 28% of bipolar disorder patients manifest symptoms of catatonia. 

Can catatonic schizophrenia be cured? 

Many experts categorized schizophrenia as long-lasting since symptoms can return. Schizophrenia is not curable. However, medications can be used to treat the disorder. Schizophrenia with catatonic features will require a different type of treatment.