Understanding Catatonic Schizophrenia
In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), catatonic schizophrenia was a diagnostic category subtype. This subtype generally applied to individuals who experienced catatonic symptoms alongside traditional signs of schizophrenia, like hallucinations and delusions. Although catatonic schizophrenia is no longer a diagnostic term, individuals with schizophrenia may continue to experience catatonia. Understanding this symptom can be the first step to finding support, which often involves working with a licensed therapist.
What is catatonic schizophrenia?
Catatonic schizophrenia was a subtype of schizophrenia spectrum disorder in the DSM-IV alongside other schizophrenia subtypes like paranoid schizophrenia. This condition was typically diagnosed when an individual experienced symptoms of schizophrenia alongside catatonia. Symptoms of the catatonic subtype included the following:
- Moving very little and seeming to be in a “trance”
- Excessive motor activity without a purpose or that doesn’t seem to be influenced by external stimuli
- Negativism, a motiveless resistance to instructions
- A rigid posture that does not change when attempts to be moved occur
- Experiencing selective mutism or becoming non-verbal
- Inappropriate or unusual voluntary movements, posturing, mannerisms, grimacing, or gestures
- Echolalia (the repetition of words spoken by another person, usually without meaning)
- Echopraxia (the involuntary imitation of another’s actions)
Catatonic schizophrenia is an outdated subtype of schizophrenia
Although this subtype is no longer diagnosed in individuals with schizophrenia, catatonia can still be a common symptom in some people living with schizophrenia spectrum disorder, and it may cause significant distress and difficulty in daily life. Catatonia generally occurs in 1% to 50% of people with chronic schizophrenia symptoms.
Changes to the diagnostic criteria in the DSM-5
The current diagnostic criteria for all schizophrenia spectrum disorders include the following:
- Negative symptoms, like a lack of emotional expression
- A lack of function in several significant areas, such as a person’s personal life, professional life, and social life
- Delusions
- Hallucinations
- Abnormal psychomotor behavior
- Disorganized speech or catatonic behavior
- Other psychotic symptoms
In general, the above symptoms cannot stem from schizoaffective disorder or bipolar disorder. In addition, if an individual was diagnosed with autism spectrum disorder (ASD) in childhood, a schizophrenia diagnosis may only be made if prominent delusions and hallucinations are present for at least one month in adulthood. Symptoms also cannot be due to the misuse of substances or substance use disorder.
Catatonia symptoms and catatonia prevalence
Catatonia can occur alongside any mental illness and can be common in mood disorders like severe major depressive disorder, bipolar disorder, personality disorders, and psychotic disorders. However, catatonia itself tends to be quite rare. According to studies, catatonia typically occurs in 5% to 20% of patients in inpatient psychiatric settings.
Still, there are no studies on the prevalence of catatonia in the general population. It’s thought that one in 10 people with severe mental illness may experience catatonia at some point in their lives.
Waxy flexibility and other symptoms of catatonia
Catatonia usually causes an individual to stop reacting to external stimuli and partake in unusual, irrational, or strange behavior, often non-verbally. They may not respond to attempts to get them to communicate. Catatonia can look like a rigid body posture, refusal to move, mutism, a lack of reflexes, strange movements, or a limp body.Individuals with catatonia can experience waxy flexibility. This is when the patient’s body shows slight resistance to movement. Some people with catatonia may remain sitting, standing, or lying down for hours or days at a time.
Echolalia may also occur with catatonia. This usually involves repeating sounds or phrases that may have no connection to verbal speech or an understandable pattern of talking. Echopraxia may also be present, which generally involves the involuntary repetition of another person’s actions. For example, the person may wave when another person waves or move their arms in ways similar to someone they’re observing.
It may be difficult or impossible to get someone out of a state of catatonia. For this reason, people experiencing this condition may be sent to inpatient care in a hospital or clinical setting where they can be monitored and supported.
Types of catatonia
There are normally three types of catatonia, including the following:
- Akinetic catatonia: The most common type of catatonia, akinetic catatonia, usually involves a lack of verbal and emotional responses to others. Those experiencing this type of catatonia may display a rigid body posture and sit or lie without responding to others, despite being awake or conscious.
- Malignant catatonia: This type of catatonia may occur when an individual is unable to move for significant amounts of time. It can result in health challenges like low blood pressure, slow heart rate, dehydration, malnutrition, kidney failure, and more. This type of catatonia often requires hospitalization.
- Excited catatonia: Excited catatonia can occur when an individual moves around in unpredictable and strange ways. They may be agitated, defensive, or aggressive. They may also mimic the movements of others.
How to manage catatonia
An individual with acute catatonia usually cannot control their symptoms and may require support from family members, a caregiver, or professionals. Below are some ways individuals may receive support.
Electroconvulsive therapy and other medication options
Medication is often one of the first interventions doctors use when an individual arrives at a hospital to treat catatonia. Benzodiazepines may be used to ease anxiety for the patient. If the catatonia is severe, electroconvulsive therapy (ECT) might be used alongside medication. This option is often used when sedatives do not work on their own to bring the individual out of catatonia.
Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
Social support for individuals with catatonia
Having a support system can be a helpful way for individuals with schizophrenic catatonia to manage symptoms. Close friends or family members may notice when catatonia is occurring and provide a comfortable and safe environment for the individual until symptoms pass. They can also notify the proper emergency support services if crisis intervention is required.
Crisis intervention for medical and mental health support
Crisis intervention can also be a helpful option for people with catatonia. This intervention might look like acute hospitalization or long-term inpatient care. If an individual is experiencing malignant catatonia and is at risk for long-term health complications, they may receive care in a hospital setting to monitor vitals. Some people may require IV support and manual feeding if they are unable to eat or drink on their own.
Catatonia can last from a few hours to several years. People living with catatonia for years may stay in an assisted living facility to receive continuous medical and mental health support and treatment.
Therapy can help with mental health and mental illness
Friends, family members, and support groups can be helpful resources when attempting to manage short-term catatonia. However, this symptom can be challenging to witness, and it may be difficult for someone living with schizophrenia to manage without professional assistance. In these cases, caregivers or individuals coming out of an episode may benefit from therapy.
If you don’t feel comfortable speaking to a professional in your area, you might try online therapy through a platform like BetterHelp. With an online platform, you can meet with a therapist from the convenience of your home via phone, video, or live chat sessions.
Effectiveness of online therapy for mental illness
Studies show that online therapy can be effective for people living with schizophrenia, although those experiencing acute psychosis or catatonia may require in-person care. In a 2021 study, schizophrenia researchers found that young people living with first-episode psychosis usually found online treatment effective in decreasing distress and reducing visits to emergency rooms for psychiatric admission. Online therapy can also be effective for depression, social anxiety, PTSD, and OCD, which commonly co-occur with schizophrenia.
Takeaway
Frequently asked questions
Can electroconvulsive therapy help with catatonic schizophrenia?
When medications and psychotherapy do not work for people with catatonia, ECT is commonly used. Electroconvulsive therapy or ECT is effective in improving severe symptoms of catatonia cases. It is also used for treating schizophrenia and affective disorders.
In what psychiatric disorder is waxy flexibility observed?
Waxy flexibility is one of the symptoms observed in patients with catatonia. Catatonia is often associated with schizophrenia. Waxy flexibility can also occur in people with bipolar disorder.
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