Catatonia is a condition that affects both the mind and the ability to move. It disrupts the normal link in the middle of mental processes and physical movement, making it difficult for a person to move as they usually would.
Individuals with catatonia can show a range of signs. The most common is a stupor, where the person is unable to talk, move, or react to anything around them. On the other hand, some individuals with catatonia might become overly active and display restless or agitated behavior.
The duration of catatonia can vary greatly. It can last just a few hours or stretch on for weeks, a few months, or even years. The condition can also come back repeatedly, sometimes lasting for weeks or years after the first episode.
Catatonia is categorized based on whether a clear cause is identified. If a specific cause is found, it’s called extrinsic catatonia. If no cause can be identified, it’s referred to as intrinsic catatonia.
Types
Catatonia is not divided into specific types in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. However, some mental health providers still use older classifications to describe catatonia in three kinds: akinetic, excited, and cancerous.
Akinetic Catatonia
This is the most common form of catatonia. It is characterized by very gradual movement or a lack of movement. Individuals with akinetic catatonia may appear to be staring into space and often do not speak. They might seem unresponsive and may not react to their surroundings.
Excited Catatonia
Also known as hyperkinetic catatonia, this type involves increased physical activity. Individuals with excited catatonia can appear agitated, restless, and overly active. They may talk rapidly and move around a lot.
Cancerous Catatonia
This is a severe form of catatonia that can be life-threatening. It often involves symptoms such as confusion or delirium, high fever, rapid heartbeat, and hypertension. These symptoms indicate a medical emergency and immediate treatment is needed.
Causes
Catatonia can arise from various conditions and factors, as outlined in the DSM-5. Neurodevelopmental disorders, which affect the nervous system development, are one possible cause. Bipolar, psychotic, and depressive disorders are also associated with catatonia. Additionally, certain medical conditions, like rare autoimmune disorders, cerebral folate deficiency, and rare paraneoplastic disorders (which are linked to malignant tumors), can trigger catatonia.
Medications can also cause catatonia as a rare side effect, especially those utilized to treat mental diseases. If catatonia is suspected to be a result of medication, it is crucial to need emergency medical attention, as this situation is reported as a medical emergency. Furthermore, withdrawal from certain medicines, like clozapine, can also lead to catatonia disease.
Organic causes have been recommended by imaging studies, which show that some individuals with long-term catatonia may have abnormalities in their brains. Specialists believe that imbalances in neurotransmitters—chemicals in the brain that transmit signals between neurons—may play a role. A theory posits that a sudden drop in dopamine levels, a key neurotransmitter, might lead to catatonia. Another theory suggests that a reduction in gamma-aminobutyric acid, also another neurotransmitter, could cause this condition.
Risk Factors
Certain factors can increase the likelihood of getting catatonia. Women are more prone to this condition, and the risk tends to rise with age. While catatonia was once primarily linked to schizophrenia, it is now recognized as a distinct disorder that can occur alongside various other mental health conditions.
Catatonia affects approximately 10% of psychiatric patients who are acutely ill. Among these individuals, around 20% have a diagnosis of schizophrenia, while 45% have affective disorders (mood disorders). Women experiencing postpartum depression might also have a chance of getting catatonia.
Additional risk factors include the use of substances like cocaine, low levels of salt in the blood, and certain medications, like the antibiotic ciprofloxacin.
Symptoms
Catatonia presents with a variety of symptoms, the most common being stupor. In this state, a person is unable to move or speak and seems to be gazing off into space. Another symptom is posturing, where an individual stays in a similar position for an expanded period. Individuals with catatonia may also experience dehydration and malnourishment due to a lack of drinking or eating. Echolalia, where an individual only repeats what they hear, is another common symptom. These symptoms are typically seen in individuals with retarded catatonia
Other signs of catatonia include:
- Catalepsy: This is when the muscles become very stiff and rigid.
- Negativism: This is when a person doesn’t respond or react against what’s happening around them.
- Echopraxia: This involves copying or mimicking someone else’s movements.
- Mutism: This is when a person doesn’t speak at all.
- Grimacing: This involves making unusual facial expressions.
Similarity to Other Conditions
The symptoms of catatonia can resemble those of other conditions, like acute psychosis, encephalitis, neuroleptic cancerous syndrome, and nonconvulsive status epilepticus (a kind of serious seizure). Because of these similarities, healthcare providers must eliminate these other conditions before diagnosing catatonia. For a diagnosis, a healthcare provider must display at least two primary symptoms of catatonia for at least 24 hours.
Diagnosis
There is no specific test that can definitively diagnose catatonia. Instead, diagnosing catatonia involves a process of elimination to rule out other possible conditions.
Initially, healthcare providers will perform a physical examination and various examinations to exclude other disorders. One commonly used tool is the Bush-Francis Catatonia Rating Scale.
Blood tests are also important in the diagnostic process. They help to identify issues such as electrolyte imbalances, which can affect mental function. Additionally, a pulmonary embolism can cause symptoms similar to catatonia.
A fibrin D-dimer blood test can provide useful information. Elevated levels of D-dimer have been linked with catatonia, but since high D-dimer levels can also result from other conditions, like pulmonary embolism, this test alone is not conclusive.
Finally, imaging studies like CT scans or MRIs are used to examine the brain. These scans help to eliminate physical causes of symptoms, like brain tumors or inflammation, which could be mistaken for catatonia.
Treatment
Catatonia can be treated using medications or electroconvulsive therapy.
Medications
Medications are typically the first line of treatment for catatonia. The most common medications used are benzodiazepines, which are known to increase the levels of GABA, a neurotransmitter in the brain that may be reduced in catatonia. Benzodiazepines involve clonazepam, lorazepam, and diazepam. These drugs often lead to significant improvement in symptoms, especially for individuals with high scores on the Bush-Francis Catatonia Rating Scale (BFCRS).
In addition to benzodiazepines, other medications that might be suggested depending on the individual’s condition include amobarbital, bromocriptine, carbamazepine, lithium carbonate, zolpidem, and thyroid hormone. If there is no improvement within five days of starting medication, or if signs worsen, a healthcare provider may consider other interventions.
Electroconvulsive Therapy
Electroconvulsive therapy is another effective intervention for catatonia. This procedure is carried out in a hospital under medical supervision and is painless. During ECT, an individual is first sedated, and then a machine takes a controlled electric shock over the brain. This shock induces a short seizure that lasts about a minute. The spasm is thought to alter neurotransmitter levels in the brain, which can help reduce catatonia symptoms.
A study in 2018 reviewed, benzodiazepines and ECT are the only interventions that have been clinically demonstrated to be effective for treating catatonia.
Outlook
The outlook for catatonia is generally positive, as most individuals react rapidly to treatment. If an individual does not show improvement with the initial medications prescribed, healthcare providers may try other medications until they find one that alleviates the symptoms.
However, those who receive electroconvulsive therapy for catatonia often experience a high rate of relapse. In many cases, symptoms may return within a year after treatment.
Summary
Catatonia is a condition affecting movement and mental function, with symptoms including stupor, posturing, and echolalia. It can be caused by various disorders, medications, or organic factors like neurotransmitter imbalances. Diagnosis involves ruling out other conditions using tools like the Bush-Francis Catatonia Rating Scale and imaging studies. Treatment typically starts with medications such as benzodiazepines and may include electroconvulsive therapy (ECT) if needed. While most people respond well to these treatments, relapse is common, especially after ECT, with symptoms often reappearing within a year.
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