What is Catatonia?
Catatonia consists of a cluster of symptoms that often include inactivity and a lack of communication and can also include agitation, confusion, and restlessness.
There was a time when it was thought to be a mental illness, such as schizophrenia. It is also known that some mental illnesses and conditions that alter your metabolism can leave you catatonic. Approximately 1 out of 10 people with a severe mental illness will experience this at some point.
Different symptoms of catatonia can be experienced by people with the disorder. Stumor is the most common symptom, in which the person is immobile, without speech, and incapable of responding to stimuli. However, some people with the disorder may act agitated and excessively move.
This disorder may last for several hours, weeks, months, or years. Several weeks to years after the initial episode, it may recur frequently.
Symptoms of external causes are called extrinsic. It is intrinsic if there is no determinable cause. When left untreated, catatonia can cause grave problems.
What are the types of catatonia?
Catatonia is no longer classified into types in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Mental health professionals still divide it into three categories, which they call retarded, excited, and malignant.
Most people have this problem. When you speak to someone with akinetic catatonia, they often stare blankly and won’t respond. Even if they respond, it may only be to repeat your statement. Some people sit or lie in strange positions and refuse to move.
The person might move around in this type of situation, but their movements are impulsive and pointless. There can be signs of agitation, combat, delirium, or they can mimic someone trying to help them.
The symptoms that occur in this type cause other health problems, such as dangerous changes in blood pressure, body temperature, breathing, and heart rate. Dehydration, blood clots, or kidney failure can occur in someone who has suffered a catatonic state for a long period of time.
Catatonia can be caused by several conditions, according to the DSM-5. These include:
- Neurodevelopmental disorders (disorders that affect the brain’s development)
- Psychotic disorders
- Bipolar disorders
- Depressive disorders
Other medical conditions involved in cancer include cerebral folate deficiency, rare autoimmune disorders, and rare paraneoplastic disorders (which frequently occur in relation to cancerous tumors).
Some medications used to treat mental illness can cause catatonia, a rare side effect. Seek immediate medical attention if you suspect a medication is causing the disorder. Medical emergencies are considered in this case.
There is a possibility that can occur as a result of drug withdrawal, such as with clozapine (Clozaril).
The brains of some individuals with chronic conditions may be abnormal according to imaging studies.
According to some experts, this is caused by an excess or lack of neurotransmitters. Brain chemicals called neurotransmitters transfer information between neurons.
According to one theory, this can be caused by a sudden decrease in the neurotransmitter dopamine. An alternative theory states that the disorder is caused by reductions in another neurotransmitter, gamma-aminobutyric acid (GABA).
What are the risk factors for catatonia?
Catatonia is more common in women. As we age, the risk increases.
Psychiatrists now classify catatonia as its own disorder, which occurs in conjunction with another disorder, rather than being associated with schizophrenia.
It is estimated that 10 percent of acutely ill psychiatric inpatients experience this disorder. The symptoms of schizophrenia are diagnosed in 20% of catatonic inpatients, and mood disorders in 45% of them.
Catatonia is a symptom of postpartum depression (PPD).
The use of cocaine, low levels of salt in the blood, and the use of medicines such as ciprofloxacin (Cipro) pose additional risks.
What are the symptoms of catatonia?
The most common symptoms of catatonia are:
- Stupor is a state of being incapable of moving, speaking, and appearing to stare off into space
- Posing or waxy flexibility is staying in a position for a long period of time
- Dehydration and malnutrition caused by an insufficient diet and drinking
- Echolalia: repeating what you hear from a conversation
Catatonia retarded may display these symptoms. This disorder may also include the following symptoms:
- Calatrepsy is a muscular rigidity characterized by rigidity
- Negativism is the absence of reaction or opposition to external stimuli
- Echopraxia refers to mimicking another person’s movements
This is caused by excessive, unusual movements is called excited catatonia. Some of these are:
- Purposeless movements
Symptoms of malignant catatonia are most severe. The following are among them:
Several vital signs can fluctuate, including blood pressure, breathing rate, and heart rate. The symptoms must be treated immediately.
Similarities with other conditions
Many conditions have symptoms similar to catatonia, including:
- Acute psychosis
- Brain inflammation, or encephalitis
- Antipsychotic medications can cause a potentially dangerous reaction known as a neuroleptic malignant syndrome (NMS).
- Epileptic status epilepticus without convulsions
Catatonia cannot be diagnosed until these conditions have been ruled out. Before a doctor can diagnose an illness, a person must exhibit at least two of its most prominent symptoms during 24 hours.
What is the diagnosis?
This cannot be diagnosed through a standard test. A physical examination and tests are necessary to diagnose.
This disorder is often diagnosed using the Bush-Francis Catatonia Rating Scale (BFCRS). The scale has 23 items ranging from 0 to 3. A “0” rating indicates that the symptom is absent. A “3” rating indicates the symptom is present.
It is possible to rule out electrolyte imbalances through blood tests. A mental function can be affected by these factors. When a blood clot forms in the lungs, it can cause catatonia symptoms.
Tests for fibrin D-dimer are also useful. A recent study suggests that elevated D-dimers are associated with the disorder. D-dimer levels may be affected by a variety of conditions (such as pulmonary embolism).
Doctors can view the brain using CT or MRI scans. The procedure eliminates the possibility of a brain tumor.
What is the treatment for catatonia?
The treatment of catatonia may include medication or electroconvulsive therapy (ECT).
Treatment of catatonia usually begins with medication. A doctor may prescribe benzodiazepines, muscle relaxers, and sometimes tricyclic antidepressants. The first medication prescribed is usually a benzodiazepine.
There are three types of benzodiazepines: clonazepam (Klonopin), lorazepam (Ativan), and diazepam (Valium). GABA is increased in the brain by these medications, which provides support for the theory that low GABA leads to catatonia. The BFCRS is usually a good predictor of benzodiazepine responses for people with high scores.
Depending on an individual’s circumstances, medications such as:
- Amobarbital, a barbiturate
- Bromocriptine (Cycloset, Parlodel)
- Carbamazepine (Carbatrol, Epitol, Tegretol)
- Lithium carbonate
- Thyroid hormone
- Zolpidem (Ambien)
If the medication does not work or if the symptoms worsen after 5 days, a doctor may suggest other treatments.
Electroconvulsive therapy (ECT)
Catatonia can be effectively treated with electroconvulsive therapy (ECT). In this therapy, you will receive medical supervision. The procedure is painless.
The brain is shocked once a person is sedated with a special machine. During this time, the brain experiences a seizure for approximately one minute.
There is evidence to suggest that seizures alter brain neurotransmitter levels. The symptoms of catatonia are improved by this treatment.
The only three treatments proven to be clinically effective for treating catatonia are ECT and benzodiazepines, according to a 2018 literature review.
What is the outlook?
Catatonia treatments typically produce quick results. Patients who aren’t responding to prescribed medications may be prescribed alternate medications until their symptoms subside.
The relapse rate for this disorder is high among those who undergo ECT. It usually takes a year for symptoms to return.
Is it possible to prevent catatonia?
Catatonia can’t be prevented because it’s difficult to identify exactly what causes it. In any case, patients with the disorder should not take excess neuroleptics, including chlorpromazine. The symptoms of catatonia may be aggravated by medication misuse.