Catatonic Schizophrenia

• Physical immobility. You may be completely unable to move or speak, or you may stare, hold your body in a rigid position and seem to be unaware of your surroundings (catatonic stupor). You also may have a form of immobility known as waxy flexibility. For example, if your arm is moved into a certain position, it will stay in that position for hours.
• Excessive mobility. Rather than being unable to move, you may move in an excited manner that appears to have no purpose. You may pace in a frenzy, turn in circles, flail your arms or make loud noises.
• Extreme resistance. You may not respond to instructions, may resist any attempt to be moved or may not speak at all.
• Peculiar movements. You may have inappropriate or unusual postures, grimace for long periods or adopt unusual mannerisms. You may also have habits known as stereotyped behaviors, which can include repeating words, obsessively following a routine, or always arranging objects exactly the same way.
• Mimicking speech or movement. You may repeatedly say a word just spoken by someone else (echolalia) or repeatedly copy a gesture or movement made by someone else (echopraxia).

Other signs and symptoms of catatonic schizophrenia

Although the main symptoms of catatonic schizophrenia are catatonic behaviors, you may also have some of the other common signs and symptoms of schizophrenia, such as:

• Having beliefs not based on reality (delusions)
• Seeing or hearing things that don't exist (hallucinations), especially voices
• Incoherent speech
• Neglect of personal hygiene
• Lack of emotions
• Emotions inappropriate to the situation
• Angry outbursts
• Trouble functioning at school or work
• Social isolation
• Clumsy, uncoordinated movements

It's unlikely that you'll come out of a catatonic episode on your own. Catatonic episodes can last just minutes or even for days or weeks without effective treatment.

Causes

• It's not known what causes catatonic schizophrenia. However, a growing body of evidence suggests that catatonic schizophrenia and other forms of schizophrenia are caused by brain dysfunction. Why and how that brain dysfunction occurs is still under investigation, though.
• It's thought that an interaction of genetics and environment may lead to this brain dysfunction. Problems with certain naturally occurring brain chemicals called neurotransmitters also may contribute to catatonic schizophrenia. Imaging studies show differences in the brain structure of people with schizophrenia, but researchers aren't yet sure about the significance of these changes.

Risk factors

Although the precise cause of catatonic schizophrenia isn't known, researchers have identified certain factors that seem to increase the risk of developing or triggering catatonic schizophrenia, including:

• Having a family history of schizophrenia
• Exposure to viruses while in the womb
• Malnutrition while in the womb
• Stressful life circumstances
• Trauma or abuse during childhood
• Older paternal age
• Taking psychoactive drugs during adolescence

Complications

Left untreated, catatonic schizophrenia can result in severe emotional, behavioral, health, and even legal and financial problems that affect every area of your life. Complications that catatonic schizophrenia may cause or be associated with include:

• Suicidal thoughts and behavior
• Self-destructive behavior
• Malnutrition
• Poor hygiene
• Depression
• Abuse of alcohol, drugs or prescription medications
• Poverty
• Homelessness
• Incarceration
• Family conflicts
• Inability to work or attend school
• Being a victim or perpetrator of violent crime
• Heart and lung disease related to smoking

Diagnosis

If your doctor or mental health provider believes you may have catatonic schizophrenia or another mental illness, he or she typically runs a series of medical and psychological tests and exams. These can help pinpoint a diagnosis, rule out other problems that could be causing your symptoms and check for any related complications.

These exams and tests generally include:

• Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
• Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
• Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns, if this is possible. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide, self-harm or harming others. Your doctor may also want to talk to family or friends, if possible. If you're unresponsive or your behavior seems inappropriate, your doctor will check for catatonic symptoms.

Diagnostic criteria for catatonic schizophrenia

To be diagnosed with catatonic schizophrenia, you must meet certain symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for catatonic schizophrenia include:

• Being unable to move
• Being unable to speak
• Remaining in the same position for long periods
• Excessive or overly excited behavior with no clear purpose
• Resisting instructions or attempts to move you
• Peculiar movements, such as grimacing or unusual postures
• Mimicking words and movements of others

It can sometimes be difficult to diagnose catatonic schizophrenia because catatonic behavior is often a symptom of other conditions, including severe depression, mania, drug intoxication, autism and seizure disorders. Be sure to stick with it until you get an accurate diagnosis, though, so that you can get appropriate treatment.

Treatments and drugs

Catatonic schizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have subsided. Treatment can be challenging because you may feel as if you don't need treatment, and you may refuse to follow treatment recommendations. But effective treatment can help you take control of your condition and enjoy a happier and healthier life.

Treatment options are generally similar for all types of schizophrenia. But the specific treatment approach that's best for you depends on your particular situation and the severity of your symptoms.

Treatment teams

Catatonic schizophrenia treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well because the condition can affect so many areas of your life. Your treatment team can help make sure that you're getting all of the treatment you need and that your care is coordinated among all of your health care providers.

The team involved in treatment of catatonic schizophrenia may include your:

• Family or primary care doctor
• Psychiatrist
• Psychotherapist
• Pharmacist
• Family members
• Case worker
• Psychiatric nurse
• Social worker

Main treatment options

The main treatments for catatonic schizophrenia are:

• Medications
• Electroconvulsive therapy (ECT)
• Hospitalization
• Psychotherapy
• Vocational skills training

Medications for catatonic schizophrenia

Medications are one of the cornerstones of catatonic schizophrenia treatment. Those most commonly prescribed for catatonic schizophrenia include:

• Benzodiazepines. These medications, also called anti-anxiety medications, are sedatives. They are generally the medication of choice to treat catatonic schizophrenia. Benzodiazepines, which may be injected in a vein — especially if you're in a state of catatonia — are typically fast acting, helping relieve catatonic symptoms quickly. They may cause dependency with long-term use. These medications may also help if you have anxiety along with catatonic schizophrenia. You may need to take benzodiazepines for a period of days or weeks to relieve your catatonic symptoms.
• Barbiturates. These medications also are sedatives and have a similar effect as benzodiazepines, quickly relieving catatonic symptoms. They, too, may be habit-forming with long-term use. They're generally not routinely used to treat catatonic schizophrenia.
• Other medications. It's common to have other mental health issues along with catatonic schizophrenia. Antidepressants can be helpful if you have symptoms of depression. And mood-stabilizing medications may help with aggression or hostility.
• Antipsychotic medications. These are generally the medication of choice for schizophrenia. However, they aren't used as often for the catatonic type of schizophrenia because they can actually worsen catatonic symptoms.

Choosing a medication

In general, the goal of treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Which medication is best for you depends on your individual situation. Benzodiazepines and barbiturates may help quickly relieve your catatonic state and may be used on an emergency basis in the hospital. But it can take several weeks after first starting other medications to notice an improvement in your other symptoms, such as depression or anxiety.

If one medication doesn't work well for you or has intolerable side effects, your doctor may recommend combining medications, switching to a different medication or adjusting your dosage. Don't stop taking your medication without talking to your doctor, even if you're feeling better. You may have a relapse of psychotic symptoms if you stop taking your medication. In addition, some medications need to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.

Electroconvulsive therapy (ECT) for catatonic schizophrenia

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through your brain to trigger a brief seizure. This seems to cause changes in brain chemistry that can reduce symptoms of certain mental illnesses, such as catatonic schizophrenia. ECT may be an option for you if your symptoms are severe or if medications haven't helped relieve a catatonic episode. Deciding whether electroconvulsive therapy is a good option for you can be extremely difficult. If possible, make sure you or your guardian understand all the pros and cons.

Hospitalization for catatonic schizophrenia

During crisis periods or times of severe catatonic symptoms, hospitalization may be necessary. This can help ensure your own safety and that of others, and make sure that you're getting proper treatment, nutrition, sleep and hygiene. Partial hospitalization and residential care also may be options.

Psychotherapy for catatonic schizophrenia

Although medications are the cornerstone of catatonic schizophrenia treatment, psychotherapy also is important. Psychotherapy may not be appropriate for everyone, though, especially if symptoms are too severe to engage in a therapeutic process that requires two-way communication. Psychotherapy may include:

• Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the distress and daily life challenges brought on by having a chronic mental illness like catatonic schizophrenia. Therapy can help improve communication skills, relationships, your ability to work and your motivation to stick to your treatment plan. Learning about catatonic schizophrenia can help you understand it better, cope with lingering symptoms, and understand the importance of taking your medications. Therapy also can help you cope with stigma surrounding catatonic schizophrenia.
• Family therapy. Both you and your family may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse, and can help you stick to your treatment plan. Family therapy can also help you and your family communicate better with each other and understand family conflicts. Family therapy also can help family members cope and reduce their distress about your condition.

Social and vocational skills training for catatonic schizophrenia

Training in social and vocational skills to live independently is an important part of recovery from catatonic schizophrenia. With the help of a therapist, you can learn such skills as good hygiene, cooking and better communication. Many communities have programs that can help you with jobs, housing, self-help groups and crisis situations. If you don't have a case manager to help you with these services, ask your doctors about getting one.

Treatment challenges in catatonic schizophrenia

When you have appropriate treatment and stick to your treatment plan, you have a good chance of leading a productive life and functioning well in daily activities. But be prepared for challenges that can interfere with treatment.

For one thing, you, like many others with schizophrenia, may find it hard to follow your treatment plan. You may believe that you don't need medications or other treatment. Also, if you're not thinking clearly, you may forget to take your medications or to go to therapy appointments. Talk to your doctors about tips to stick to your treatment plan. Even with good treatment, you may have a relapse. Have a plan in place to deal with a relapse.

Smoking, and often heavy smoking, is common when you have schizophrenia. Some evidence suggests that smoking improves thinking and concentration in schizophrenia. But smoking can interfere with certain medications. Be honest with your doctors about your smoking habits. And be sure you understand the serious health risks of smoking.

Similarly, using alcohol and drugs can make catatonic schizophrenia symptoms worse. If you have a problem with alcohol or substance abuse, you may benefit from treatment programs that include care for both schizophrenia and substance abuse.

Lifestyle remedies

Catatonic schizophrenia isn't an illness that you can treat on your own. But you can do some things for yourself that will build on your treatment plan:

• Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, schizophrenia symptoms are likely to come back.
• Pay attention to warning signs. You and your caregivers may have identified things that may trigger your catatonic schizophrenia symptoms, cause a relapse or prevent you from carrying out your daily activities. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Involve family members or friends in watching for warning signs. Addressing schizophrenia symptoms early on can prevent the situation from worsening.
• Avoid drugs and alcohol. Alcohol and illicit drugs can worsen schizophrenia symptoms. Get appropriate treatment for a substance abuse problem.
• Check first before taking other medications. Contact the doctor who's treating you for catatonic schizophrenia before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals or supplements. These can interact with your schizophrenia medications.

Coping and support

Coping with an illness as serious as catatonic schizophrenia can be challenging. Medications can have unwanted side effects, and you may feel angry or resentful about having a condition that requires lifelong treatment. During periods when you feel better, you may be tempted to stop treatment, which can trigger a relapse. Here are some ways to cope with catatonic schizophrenia:

• Learn about catatonic schizophrenia. Education about your condition can empower you and motivate you to stick to your treatment plan.
• Join a support group. Support groups for people with schizophrenia can help you reach out to others facing similar challenges.
• Stay focused on your goals. Recovery from catatonic schizophrenia is an ongoing process. Stay motivated by keeping your recovery goals in mind. Remind yourself that you're responsible for managing your illness and working toward your goals.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
• Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.
• Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily tasks.

Prevention

There's no sure way to prevent catatonic schizophrenia. Evidence shows that some signs of schizophrenia may be present from early childhood or even infancy. Early identification and treatment for people at risk of schizophrenia, perhaps starting in childhood, may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Also, sticking with your treatment plan can help prevent relapses or worsening of catatonic schizophrenia symptoms.

References:

http://www.minddisorders.com/Br-Del/Catatonic-disorders.html

http://www.psyweb.com/mdisord/SchizoDis/cattype.jsp

http://psychcentral.com/lib/catatonic-schizophrenia/

https://en.wikipedia.org/wiki/Catatonia

http://www.schizophrenic.com/content/schizophrenia/diagnosis/catatonic-schizophrenia