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Catatonic schizophrenia

Definition


Disease: Catatonic schizophrenia Catatonic schizophrenia
Category: Psychiatric diseases

Disease Definition:

One of several types of schizophrenia, a chronic mental illness in which reality is interpreted abnormally (psychosis), is catatonic schizophrenia. Extremes of behavior are included in catatonic schizophrenia. A person has overexcited or hyperactive motion and he/she may involuntarily imitate sounds or movements of others at one extreme of catatonic schizophrenia. And at the other, the person is unable to move, respond or speak.

 

Because of improved schizophrenia treatment, catatonic schizophrenia is rare today. As a matter of fact, with certain other mental illnesses, being in a state of catatonia is more likely to occur. A person can manage the symptoms of catatonic schizophrenia and work toward leading a happier, healthier life with effective treatment. 
 

Work Group:


Symptoms, Causes

Symptoms:

The signs and symptoms of catatonic schizophrenia fall into several categories of catatonic behaviors, and these include the following:

Mimicking speech or movement:

The person may repeatedly copy a gesture or movement made by someone else (echopraxia) or repeatedly say a word just spoken by someone else (echolalia).

Excessive mobility:

The person may move in an excited manner that appears to have no purpose, rather than being unable to move. He/she may turn in circles, make loud noises, pace in a frenzy or flail his/her arms.

Physical immobility:

The person may stare, hold his/her body in a rigid position and seem to be unaware of the surroundings (catatonic stupor), or he/she may be completely unable to move or speak. The patient may have a form of immobility known as waxy flexibility as well; for instance, in this condition, if his/her arm is moved into a certain position, it stays in that position for hours.

Extreme resistance:

The patient may not speak at all, resist any attempt to be moved, or may not respond to instructions.

Peculiar movements:

The patient may grimace for a long time, adopt unusual manners or have inappropriate or unusual postures. He/she may have habits known as stereotyped behaviors as well; these include always arranging objects exactly the same way, repeating words, or obsessively following a routine.

 

OTHER SIGNS AND SYMPTOMS OF CATATONIC SCHIZOPHRENIA:

A person may have some of the other common signs and symptoms of schizophrenia as well, although the main symptoms of catatonic schizophrenia are catatonic behaviors. Here are the other signs and symptoms:

 

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

 

Coming out of a catatonic episode on one's own is unlikely to happen. Without effective treatment, catatonic episodes can last just minutes or even for days or weeks.

 

A person may not be able to seek medical help on his/her own in the case of having any symptoms of catatonic schizophrenia. And he/she may not believe he/she needs treatment during periods when the symptoms subside. The ones who initially suggest that the person should seek help or should be taken to the hospital by emergency personnel are usually people at work or school, or friends and family.

 

A person should try to work up the courage to confide in someone, whether it's a loved one or friend, a faith leader, a health care professional or someone else he/she trusts. This trusted person can help the patient take the right path towards a successful treatment.

 

HOW TO HELP SOMEONE WHO MAY HAVE CATATONIC SCHIZOPHRENIA:

A person should have an open and honest discussion about his/her concerns, if possible, when having a loved one he/she thinks may have symptoms of catatonic schizophrenia. The person can offer encouragement and support and help his/her loved one find a qualified doctor or mental health provider, though forcing someone to seek professional help may be not done. This concerned person can contact the local emergency services or take the patient to a hospital if the patient is unresponsive or in an apparent catatonic state. Emergency hospitalization, in some cases, may be needed.
 

Causes:

The cause of catatonic schizophrenia is not understood. However, brain dysfunction is the cause of catatonic schizophrenia and other forms of schizophrenia, which is suggested by a growing body of evidence, though how and why that brain dysfunction occurs is still being investigated.

 

It is believed that this brain dysfunction may be caused by an interaction of environment and genetics. Catatonic schizophrenia may be caused by problems with certain naturally occurring brain chemicals called neurotransmitters as well. There are differences in the brain structure of people with schizophrenia and this is shown in imaging studies, however, the significance of these changes is not clear yet.

 

Certain factors that seem to increase the risk of developing or triggering catatonic schizophrenia have been identified, although the exact cause of catatonic schizophrenia isn't known, these factors include the following:

 

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

 

Between the teenage years and the mid-30s is when schizophrenia typically becomes apparent.
 

Complications

Complications:

In the case of leaving the condition untreated, severe health, emotional, behavioral, and even financial and legal problems that affect every area of the life of the patient may be the result of catatonic schizophrenia. The following may be included in the complications that catatonic schizophrenia may cause or be associated with:

 

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

Treatments:

This chronic condition requires lifelong treatment, even during periods when the patient feels better and the symptoms have subsided. Because a person may feel as if he/she doesn’t need treatment and he/she refuses to follow treatment recommendations, treatment can be challenging. However effective treatment can help the patient enjoy a happier and healthier life as it can help him/her take control of the condition.

 

For all types of schizophrenia, treatment options are similar in general. However, a person’s particular situation and the severity of the symptoms are the things that determine the specific treatment approach that's best for each patient.

 

TREATMENT TEAMS:

A psychiatrist skilled in treating the catatonic schizophrenia is the one who usually guides the treatment of this condition. However, as the condition can affect so many areas of the patient's life, he/she may have others on the treatment team as well. The treatment team can help make sure that the patient is getting all of the treatment he/she needs and that his/her care is coordinated among all of his/her health care providers.

 

The following may be included in the team involved in treatment of catatonic schizophrenia:

 

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

 

MAIN TREATMENT OPTIONS: 

The following are the main treatments for catatonic schizophrenia:

 

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

 

MEDICATIONS:

One of the bases of catatonic schizophrenia treatment is medications. The medications that are usually prescribed for catatonic schizophrenia include the following:

Benzodiazepines:

The medication of choice to treat catatonic schizophrenia is usually these medications, which are called anti-anxiety medications as well, and they are sedatives. In helping relieve catatonic symptoms quickly, benzodiazepines are usually fast acting and they may be injected in a vein, if the patient is in a state of catatonia in particular. However, with long-term use, they may cause dependency. When having anxiety along with catatonic schizophrenia, these medications may help as well. To relieve the catatonic symptoms, the patient may need to take benzodiazepines for a period of days or weeks.

Barbiturates:

Quickly relieving catatonic symptoms, these medications are sedatives as well and they have a similar effect as benzodiazepines. With long-term use, they may be habit-forming as well. In general, they are not routinely used to treat catatonic schizophrenia.

Other medications:

Together with catatonic schizophrenia, it's common to have other mental health issues. When having symptoms of depression, antidepressants can be helpful. And with aggression or hostility, mood-stabilizing medications may help.

Antipsychotic medications:

For schizophrenia, these are the medication of choice in general. But because they can actually worsen catatonic symptoms, they aren't used as often for the catatonic type of schizophrenia.

 

HOW TO CHOOSE A MEDICATION: 

Controlling signs and symptoms at the lowest possible dosage in an effective way is the goal of treatment with medications in general. The individual situation of the patient is the thing that determines which medication is best for him/her. Barbiturates and benzodiazepines may be used on an emergency basis in the hospital and may quickly relieve the catatonic state of the patient. However, to notice an improvement in the other symptoms, such as anxiety or depression, it can take several weeks after first starting other medications.

 

Combining medications, switching to a different medication or adjusting the dosage of the patient may be recommended if one medication doesn’t work well for the patient or has intolerable side effects. Even if the patient is feeling better, he/she shouldn't stop taking the medications without talking to the doctor. When stopping taking the medication, the patient may have a relapse of psychotic symptoms. Besides, to avoid withdrawal symptoms, some medications need to be tapered off, rather than stopped abruptly.

 

ECT FOR CATATONIC SCHIZOPHRENIA:

The procedure in which electric currents are passed through the brain to trigger a brief seizure is called electroconvulsive therapy (ECT). This is likely to cause changes in brain chemistry that can reduce symptoms of certain mental illnesses, such as catatonic schizophrenia. If medications haven't helped relieve a catatonic episode or if the symptoms are severe, ECT may be an option for the patient. It may be extremely difficult to decide whether electroconvulsive therapy is a good option for the patient. The patient or his/her guardian should understand all the pros and cons if it's possible.

 

HOSPITALIZATION:

Hospitalization may be necessary during crisis periods or times of severe catatonic symptoms. This can make sure the patient is getting proper treatment, hygiene, sleep and nutrition and can help ensure the safety of the patient and that of others. Another option may be partial hospitalization and residential care as well.

 

PSYCHOTHERAPY:

Psychotherapy is important as well, despite the fact that medications are the bases of catatonic schizophrenia treatment. However, if symptoms are too severe to engage in a therapeutic process that requires two-way communication in particular, psychotherapy may not be appropriate for everyone. The following may be included in psychotherapy:

Individual therapy:

The patient may learn ways to cope with the distress and daily life challenges brought on by having a chronic mental illness like catatonic schizophrenia, by psychotherapy with a skilled mental health provider. This therapy can help improve relationships, communication skills, patient's motivation to stick to his/her treatment plan and his/her ability to work. The patient may understand catatonic schizophrenia better, cope with lingering symptoms, and understand the importance of taking the medications by learning about this condition. He/she can cope with stigma surrounding catatonic schizophrenia as well by therapy.

Family therapy:

Therapy that provides support and education to families may be helpful for both the patient and the family. If the family members understand the patient's illness, can recognize stressful situations that might trigger a relapse, and can help that patient stick to the treatment plan, the symptoms will have a better chance of improving. This therapy can help family members cope and reduce their distress about the condition and it can help the patient and the family communicate better with each other and understand family conflicts.

 

SOCIAL AND VOCATIONAL SKILLS TRAINING:

An important part of recovery from catatonic schizophrenia is training in social and vocational skills to live independently. The patient can learn such skills as good hygiene, cooking and better communication with the help of a therapist. Many communities have programs that can help the patient with housing, self-help groups, jobs and crisis situations. The patient can ask the doctors about getting a case manager to help him/her with these services.

 

TREATMENT CHALLENGES IN CATATONIC SCHIZOPHRENIA:

The patient has a good chance of leading a productive life and functioning well in daily activities when having appropriate treatment and sticking to the treatment plan. However, he/she should be prepared for challenges that can interfere with treatment.

 

The patient may find it hard to follow the treatment plan, just like many others with schizophrenia. He/she may believe that medications or other treatments are not needed. And the patient may forget to take the medications or go to therapy appointments when not thinking clearly. The doctor may give the patient some tips to stick to the treatment plan. Having a plan in place to deal with a relapse is important because the patient may have a relapse even with a good treatment.

 

When having schizophrenia, smoking, and often heavy smoking is common. Some evidence has suggested that smoking improves thinking and concentration in schizophrenia. However, smoking can interfere with some medications in particular. The patient should understand the serious health risks of smoking and should be honest with the doctor about his/her smoking habits.

 

Using alcohol and drugs can make catatonic schizophrenia symptoms worse in a similar way. The patient may benefit from treatment programs that include care for both schizophrenia and substance abuse in case he/she has a problem with alcohol or substance abuse.
 

Prognosis:

Not available

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