Catatonia is a syndrome that can depend on both organic and psychological pathologies, commonly characterized by mutism, stupor, refusal to eat or drink, posture and excitement or hypokinesia. Although catatonia has been associated with schizophrenia throughout the 20th century, affecting early editions of major diagnostic manuals, it is often caused by affective disorders and medical or neurological diseases.
With this Psychology-Online article we will try to describe this complex disease as best as possible, explaining it in a simple and understandable way for everyone, also for non-specialists, without leaving aside the important and necessary theoretical and scientific references. We’ll see The meaning, symptoms, causes and treatment of catatonia.
What is catatonia according to psychology
To better understand catatonia, we must go back to 1874, when the psychiatrist Karl Kahlbaum coined the term (katatonia) detecting it in patients with serious medical pathologies, psychotics and mood disorders: for the German doctor it was, in effect, a disorder. with behavioral and motor manifestations such as negativism, mutism, immobility, rigidity, mannerisms or stereotypies, accompanied by affective, cognitive and neurovegetative symptoms (Luchini et al., 2015).
Later, other psychiatrists such as Kraepelin and Bleuler redefined catatonia as a subtype of dementia praecox (Kraepelin, 1919) and schizophrenia (Bleuler, 1911), a definition that influenced the entire clinic of the 20th century until the 1980s and 1990s. , when numerous studies suggested that catatonic syndromes could also be involved in affective disorders and in various medical conditions such as metabolic, endocrine, neurological, rheumatological and infectious conditions (Luchini et al., 2015).
New discoveries and scientific evidence that have convinced the authors of the latest versions of the most important diagnostic classification systems to change their approach to catatonia (Luchini et al., 2015). In particular, the International Classification of Diseases (ICD-10) has added the possibility of diagnosing an “organic catatonic disorder” (F06.1), while with the latest and fifth edition of the DSM (the diagnostic and statistical manual of mental disorders of the American Psychiatric Association) syndrome has finally acquired a descriptive autonomy, and can thus appear within other disorders (psychotics, depressives, doctors, etc.).
Catatonia is a syndrome characterized by a well-defined clinical picture, although it manifests with extremely variable signs and symptoms (Luchini et al., 2015). Have a stable course, and not malignant as thought in the past, described by several researchers as a generally cyclical disorder, with episodes of excitement, depression and psychosis (Luchini et al., 2015).
Symptoms of catatonia
Let’s see then the descriptive criteria of the MDE-5 (APA, 2013), for which catatonia is defined by the presence of three or more of the following symptoms:
- Catalepsya momentary loss of mobility, voluntary and involuntary, and sensitivity of the body.
- Waxy flexibilitya decreased response to stimuli and a tendency to remain in a still posture.
- Stupora lack of critical cognitive function and level of consciousness.
- Agitationnot influenced by external stimuli.
- Mutisma minimal or no verbal response (not applicable with aphasia).
- Negativismthat is, opposing or not responding to external stimuli or instructions.
- Positiona spontaneous and active maintenance of posture against gravity.
- Mannerismsthat is, strange caricatures of common stocks.
- Stereotypessuch as repetitive, frequent and non-goal-directed movements.
- Silly faces.
- Echolaliathat is, repeating the words spoken by another person.
- Echopraxiathe imitation of movements made by another person.
The authors of the manual have considered all the hypotheses and suggestions proposed in the field of catatonia in the last two decades, making great efforts to improve the usefulness and applicability of the clinical diagnosis of catatonia (Luchini et al, 2015). Indeed, for a possible diagnosis of catatonia according to the MDE-5 (APA, 2013), we have:
- Catatonia due to a medical illness.
- Specifier “with catatonia”: schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, substance-induced psychotic disorder.
- Specifier with another mental disorder (i.e., neurodevelopmental disorder, bipolar disorder, major depressive disorder, other mental disorders).
- Catatonia disorder NOS (not otherwise specified).
Difference between catatonia and catalepsy
The catalepsythat is, the passive induction of a maintained posture against gravity (APA, 2013), it can be considered as one of the many symptoms of catatoniawhich is a syndrome (a complex, more or less characteristic, of symptoms), and that precisely for this reason can also occur in non-catatonic patients: therefore, a catatonic person can have catalepsy, but those who have catalepsy are not necessarily catatonic .
Causes of catatonia
The exact causes of catatonia are not yet fully understood: its epidemiological prevalence is unknown, but catatonia caused by a medical condition is believed to be common, although it is most likely a syndrome underdiagnosed by psychiatrists and other doctors. (Daniels, 2009). The renewal of interest in catatonia has led to a deepening of knowledge about the neurobiological bases of the phenomenon, although these are still insufficient for the formulation of a complete pathophysiological interpretation of the disorder (Bartolommei et al., 2012).
- has been associated injury to various regions of the brain with the appearance of catatonic manifestations, but subjects with focal brain lesions located in these places rarely develop a catatonic syndrome (Bartolommei et al., 2012).
- Catatonic symptoms are common in combination with neurological diseases that widely affect the central nervous system, a fact that seems to support the hypothesis that catatonia is the result of the dysfunction of neuronal circuits with the participation of multiple structures, rather than focal alterations (Bartolommei et al., 2012).
- Besides, the dysfunction of several neurotransmitter systems has also been implicated in the pathogenesis of catatonic symptoms: given that current pharmacological interventions modify the , glutamate and , systems, it is considered that the deregulation of each of these neurotransmitter systems may be involved in catatonia (Daniels, 2009).
Catatonia treatment
Once diagnosed, catatonia responds to specific treatments, although due to its correlation with schizophrenia, it has induced the potentially harmful use of antipsychotics (Luchini et al, 2015). Despite the evolution in recent years of knowledge about the psychopathology and neurobiology of catatonia, however, many problems related to the diagnostic definition and its location in healthcare remain unresolved, a persistence of uncertainties that impact everyday clinical practice (Bartolommei et al., 2012).
The catatonic patient must be assisted by a specialized multidisciplinary and integrated team, and the correct management of the syndrome requires, above all, the identification and treatment of any medical condition (internist, neurological, toxic) responsible for the clinical picture, together with immediate and appropriate support measures to reduce the morbidity and mortality, associated to immobility and malnutrition, often present (Bartolommei et al., 2012). If not recognized immediately, catatonia can be complicated by serious somatic diseases, such as malnutrition, infections, muscle contractures, pressure ulcers and thromboembolism (Luchini et al, 2015).
To avoid complications
- The first measures to prevent possible medical complications are anticoagulant treatment with subcutaneous heparinin urinary catheterization and in adequate nursing care (Bartolommei et al., 2012).
- We must bear in mind that catatonic patients generally refuse to eat and may experience a serious state of malnutrition and dehydration: in this case, a hydration and one feeding appropriate (Bartolommei et al., 2012).
To treat symptoms
Currently, the elective treatment of catatonic symptoms is:
- the administration of benzodiazepines intravenously: The most commonly used benzodiazepine is lorazepam, with catatonic remission rates of 70% reported;
- carrying out a cycle of Electroconvulsive therapy (ECT): electroconvulsive therapy appears effective in 85% of patients (Bartolommei et al., 2012).
Given their synergistic effect, the two treatments can be used together, although the dose of benzodiazepines should be reduced, as they can increase the seizure threshold (Luchini et al, 2015). Recent research has published some and few positive data on treatments with GAbA-A agonists (Zolpidem) and NMDA antagonists (memantine, amantadine) (Luchini et al, 2015).
This article is merely informative, at Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
If you want to read more articles similar to Catatonia: meaning, symptoms, causes and treatmentwe recommend that you enter our category.
Bibliography
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington DC: American Psychiatric Publishing.
- Bartolommei, N., Lattanzi, L., Callari, A., Cosentino, L., Luchini, F. & Mauri, M. (2012). Catatonia: a critical review and therapeutic recommendations. Journal of Psychopathology 2012;18:234-246.
- Daniels, J.M.D. (2009). Catatonia: Clinical Aspects and Neurobiological Correlates. The Journal of Neuropsychiatry and Clinical Neuroscience Fall 2009, 21:4:371-380.
- Luchini, F., Bartolommei, N., Benvenuti, A., Mauri, M. & Lattanzi, L. (2015). Catatonia from the first descriptions to DSM 5. Journal of Psychopathology 2015;21:145-151.