What is Catatonic Schizophrenia?
Catatonic schizophrenia is a subtype of schizophrenia that includes extreme changes in behavior, the patient may not move throughout the day having a drastic reduction in activity and go from unexpected to the opposite process, developing states of enormous hyperexcitation or even uncontrolled hyperactivity. Patients may also present other movement disorders in the form of seemingly purposeless actions that are performed repeatedly, this type of behavior is called stereotyped behavior, and it is related to the voluntary exclusion of participation in any creative or productive activity.
Sometimes, a person with catatonic schizophrenia may develop the tendency to use strange positions that his body adopts unconsciously for the patient, also manifesting unusual movements or facial contortions, which explains that in many cases a wrong diagnosis can be made and Be confused with tardive dyskinesia. A patient with catatonic schizophrenia may remain immobile for long periods of time, may even be for hours or days in an awkward position and the mere fact of moving is inconceivable. Experts say that people who have a mental state of catatonia are very likely to be affected by other types of mental illness, so it is very important that it is detected on time. With the treatments currently available, patients with catatonic schizophrenia are able to manage their symptoms, so the probability of leading to a healthy and happy life is much greater. In conclusion, this type of schizophrenia is characterized by marked alteration of behavior, which may include stupor, negativism, excitement and sometimes rapid alternation between the extremes from emotion to depressive process for no apparent reason. Associated features include stereotyped behaviors, mannerisms and waxy flexibility.
Catatonic Schizophrenia Causes:
No one knows for sure what causes catatonic schizophrenia. Most forms of schizophrenia are caused by brain dysfunction, but there is currently no conclusive scientific study explaining that brain dysfunction. Most likely, it is caused by a combination of genetic and environmental factors. Experts believe that an imbalance of dopamine, a neurotransmitter, is implicated in the onset of schizophrenia.
“It is also believed that this imbalance is probably caused by the genes themselves, which make us more susceptible to the disease”.
Some researchers claim that the levels of other neurotransmitters such as serotonin may also be involved. We also have some risk factors that increase the likelihood of developing this condition or disease. For example, obesity greatly increases the risk of developing type 2 diabetes. Therefore, obesity is a risk factor for type 2 diabetes. The risk factors for catatonic schizophrenia are fundamentally the same as those of most subtypes of schizophrenia, including:
- Genetic: Children with a family history of schizophrenia have a higher risk of developing this disease. If there is no history of this disease in your family the chances of developing it are less than 1%. However, this risk rises to 10% if one of your parents is or was a victim of it. A gene commonly called “the schizophrenia gene” plays a very surprising role in the brain as it controls the birth of new neurons, in addition to its integration into existing brain circuits, and according to an article published by a Swedish scientist, schizophrenia and bipolar disorder have the same genetic causes located in brain neurotransmitters.
- Viral infection: if the fetus is exposed to a viral infection, it will have a higher risk of suffering from schizophrenia.
- Fetal malnutrition: if the fetus suffers from malnutrition during the mother’s pregnancy, there is an increased risk of developing schizophrenia.
- Stress during early life: experts claim that severe stress in early life can be a contributing factor to the development of schizophrenia. Stressful experiences often precede the onset of schizophrenia. Before acute symptoms are evident, people with schizophrenia usually become grumpy, anxious and irritable people, leading to social problems with the environment of the affected. Therefore, it is extremely difficult to know if schizophrenia was the cause of these situations or occurred as a result of them.
- Physical and / or sexual abuse or other trauma in childhood.
- Age of the parents when the baby was conceived: older parents have a higher risk of having children who will later develop schizophrenia, compared to younger parents.
- Drugs: Abuse of substances that affect cognitive or mental processes during adolescence may increase the risk of developing schizophrenia.
Catatonic Schizophrenia Symptoms:
A symptom is something that the patient’s senses describe, while a sign is something that others, like the doctor, perceive. For example, drowsiness can be a symptom, while dilated pupils can be a sign or signal, we will explain the most important symptoms of catatonic schizophrenia:
- Inefficiency when moving. The patient cannot speak or move. You can look and keep your body in a fixed position. He seems not to be aware of his surroundings (catatonic stupor).
- No movement. This is part of physical immobility. If the patient’s arm, for example, is moved by another person in a certain position, it can remain in that position for hours.
- Excessive mobility the patient moves excitedly with what does not seem to have a specific or useful purpose. This can include going around with lots of energy or walking in circles making strong and unusual statements.
- It does not cooperate. The patient can resist any attempt to move. They can remain totally silent for a long time and not respond to indications or external agents.
- Strange movements Patient posture may be unusual or inappropriate. There may be strange gestures and faces.
- Unusual behavior the patient can repeat words constantly, usually following a ritual or an obsession, being able to develop strong emotional dependencies of specific actions or circumstances.
- The echolalia (imitation of expressions) and echopraxia (imitation of movements) are common in interacting with others. It is usually based on the repetition of a movement or gesture made by the other party.
Apart from the above, which are examples of the symptoms of catatonic schizophrenia in particular, patients can also present the following signs and symptoms of schizophrenia as a whole and common to all subtypes:
- Delusions: the patient has false beliefs of persecution or delusions of greatness. They may feel that things are controlled from the outside or think they have supernatural powers. Some patients with schizophrenia hide for weeks or months in order to protect themselves from imaginary persecution.
- Auditory hallucinations: the schizophrenic has a tendency to listen to voices, but he can also feel, taste or smell things that are not there, having these experiences so profound that everything he is hearing or feeling is very real for the patient.
- Thought disorder: the sick person can jump from one subject to another without any logical reason. The patient’s conversation can be confusing and incoherent. In some cases, the patient may believe that someone is playing with his mind.
- Lack of motivation: the schizophrenic loses himself, causing other people to see him as a lazy person, but keep in mind that this condition is not laziness or laziness, but a consequence of his illness.
- They do not show emotions: they tend to develop resistance to certain emotional responses such as sadness or happiness.
- Social isolation: when a patient with schizophrenia withdraws socially it is often because he believes that someone is going to harm them. Another reason could be the fear of interacting with other human beings due to lack of social skills.
- They do not realize their illness: as hallucinations and delusions seem to be so real to patients, many of them cannot believe they are sick. They go to the extreme of refusing to take medications that could greatly help them out of fear of side effects.
- The cognitive difficulties: the patient’s ability to concentrate, remember things, planning and organizing is difficult, and communication becomes more difficult. They can also develop the habit of having meaningless talks or incoherent speeches, as well as lack of personal hygiene.
- Attacks of anger and movements without coordination or with clumsiness are other side effects of catatonic schizophrenia.
Treatment of Catatonic Schizophrenia:
Catatonic schizophrenia is a disease that lasts a lifetime, it is a chronic condition. Patients with catatonic schizophrenia require permanent treatment, even when the symptoms appear to have disappeared, because this disease usually has periods in which patients think they are well and no longer require treatment. The treatment is basically the same for all forms of schizophrenia, there are variations depending on the severity and type of symptoms, the patient’s health and age, as well as other factors. A whole team of health professionals will be involved in the treatment of a person with catatonic schizophrenia. Schizophrenia can affect many areas of the patient’s life; therefore the team must have a wide range of experts, which should include:
- General practitioner, primary care physician and a family doctor.
- A pediatrician
- A social worker.
- A pharmacist
- A psychiatric nurse
- A psychiatrist.
- A psychotherapist
- The patient’s own relatives, not as experts, but as a support pillar of the treatment.
Treatment options for catatonic schizophrenia generally include drugs, electroconvulsive therapy, psychotherapy, hospitalization and professional training skills, as discussed in the other articles in this section.
Techniques to Treat Catatonic Schizophrenia:
- Electroconvulsive therapy. It is a procedure in which an electric current is sent through the brain to produce controlled seizures. Sometimes this method is given to patients with depression who have not responded or cannot take antidepressants. Sometimes it is also used for patients with very severe depression, or those at high risk of suicide. Experts believe that electroconvulsion triggers a massive release of neurochemicals in the brain, aiding in disease control. It is important that the treating physician explain the pros and cons of this treatment.
- This may be necessary during severe episodes. Patients are safer in a hospital environment, since in these places they are given adequate nutrition, proper management of their hygiene, as well as adequate sleep treatment. Sometimes partial hospitalization helps.
- Psychotherapy. For patients with catatonic schizophrenia, medications are a main part of the treatment, however, psychotherapy is a very important part. If the symptoms are very severe, psychotherapy may not be appropriate since psychotherapy consists of a series of techniques for the treatment of mental, emotional health and some psychiatric disorders. Psychotherapy helps the patient understand what helps them feel good, as well as the acceptance of their strengths and weaknesses. So people can evolve and identify their thoughts and feelings, this to deal with difficult situations.
- Training in social skills and professional training. This can help the patient to live independently, a vital part of recovery for the patient. The therapist can help the patient learn good hygiene, prepare nutritious meals, and have better communication. It can also help to have a job, decent housing and join self-help groups.
- Compliance or adherence in medicine means following the treatment regimen or treatment plan. Unfortunately, lack of compliance is a major problem for patients with schizophrenia. Patients may be taking their medications throughout their lives and this brings them great personal costs. Experts say that a significant percentage of patients take their medication within the first months of treatment and that after that time they forget about it, even before that time they stop taking it. To deal with this problem and have a successful treatment, it needs to have a long life regime of both drugs and psychosocial therapies.
If catatonic schizophrenia is not treated, it can become a serious and serious problem resulting in effects on the financial, behavioral and legal situation. These problems can affect every part of the patient’s life. Complications may include:
- Depression and suicidal thoughts. A significant number of patients with schizophrenia have long periods of depression. Symptoms of depression should not be ignored, as there is a risk that can get worse and cause suicidal thoughts and behaviors if you stop treating. The National Health Service of the United Kingdom states that in an investigation carried out it showed that 3 out of 10 people with schizophrenia will attempt suicide at least once, and 1 in 10 people with schizophrenia end up committing suicide. We clarify that these results refer to schizophrenia in general, not specifically to catatonic schizophrenia.
- Hygiene problem
- Abuse of illegal substances, which may include alcohol, non-prescription drugs and illegal drugs.
- The inability to find or keep a job. What results in poverty and destitution. The patient may feel oblivious when entering the labor market due to fears of not being able to face their responsibilities. Experts say that people who manage to continue working tend to have a better quality of life compared to those who do not, therefore, it is recommended that the patient try to have a productive activity (work).
- Prison sentences related to the previous points or episodes of public disorder.
- Serious family conflicts.
- Inability to study or attend school and other educational institutions.
- It can be a perpetrator of a crime (murder, assaults), in situations that are beyond the control of the patient.
- Diseases related to smoking as they are people with very large smoking tendencies.
Medications for Catatonic Schizophrenia:
This is a class of drugs that act as tranquilizers. These are used regularly to treat anxiety, so they are also called anti-anxiety medications. Benzodiazepines are generally the medication of choice for catatonic schizophrenia. The drug is fast acting and can be administered intravenously, it is injected into a vein, this may be the only way for the patient to leave the catatonic state. Benzodiazepine helps relieve catatonic symptoms quickly. There is a risk of dependence if they are used for a long time.
These drugs act as depressants, their effects can vary from mild sedation to total anesthesia. Simply put, they are sedative and have an effect similar to benzodiazepines. Barbiturates can quickly relieve the symptoms of catatonia. If used for a long time there is a risk of dependence. This medicine is not routinely used for the treatment of catatonic schizophrenia.
Antidepressants and Mood Stabilizers:
People with catatonic schizophrenia often have other mental health problems, such as depression and aggressiveness.
These are generally used for schizophrenia. Since antipsychotics can make catatonic symptoms worse, they are not generally used for patients with catatonic schizophrenia.