Catatonia

Definition

Catatonia is a condition marked by changes in muscle tone or activity associated with a large number of serious mental and physical illnesses. There are two distinct sets of symptoms that are characteristic of this condition. In catatonic stupor the individual experiences a deficit of motor (movement) activity that can render him/her motionless. Catatonic excitement, or excessive movement, is associated with violent behavior directed toward oneself or others.

Features of catatonia may also be seen in Neuroleptic Malignant Syndrome (NMS) which is an uncommon (but potentially lethal) reaction to some medications used to treat major mental illnesses. NMS is considered a medical emergency since 25% of untreated cases result in death. Catatonia can also be present in individuals suffering from a number of other physical and emotional conditions such as drug intoxication, depression, and schizophrenia. It is most commonly associated with mood disorders.

Description

In catatonic stupor, motor activity may be reduced to zero. Individuals avoid bathing and grooming, make little or no eye contact with others, may be mute and rigid, and initiate no social behaviors. In catatonic excitement the individual is extremely hyperactive although the activity seems to have no purpose. Violence toward him/herself or others may also be seen.

NMS is observed as a dangerous side effect associated with certain neuroleptic (antipsychotic) drugs such as haloperidol (Haldol). It comes on suddenly and is characterized by stiffening of the muscles, fever, confusion and heavy sweating.

Catatonia can also be categorized as intrinsic or extrinsic. If the condition has an identifiable cause, it is designated as extrinsic. If no cause can be determined following physical examination, laboratory testing, and history taking, the illness is considered to be intrinsic.

Causes and symptoms

The causes of catatonia are largely unknown although research indicates that brain structure and function are altered in this condition. While this and other information point to a physical cause, none has yet been proven. A variety of medical conditions also may lead to catatonia including head trauma, cerebrovascular disease, encephalitis, and certain metabolic disorders. NMS is an adverse side effect of certain antipsychotic drugs.

A variety of symptoms are associated with catatonia. Among the more common are echopraxia (imitation of the gestures of others) and echolalia (parrot-like repetition of words spoken by others). Other signs and symptoms include violence directed toward him/herself, the assumption of inappropriate posture, selective mutism, negativism, facial grimaces, and animal-like noises.

Catatonic stupor is marked by immobility and a behavior known as cerea flexibilitas (waxy flexibility) in which the individual can be made to assume bizarre (and sometimes painful) postures that they will maintain for extended periods of time. The individual may become dehydrated and malnourished because food and liquids are refused. In extreme situations such individuals must be fed through a tube. Catatonic excitement is characterized by hyperactivity and violence; the individual may harm him/herself or others. On rare occasions, isolation or restraint may be needed to ensure the individual's safety and the safety of others.

Diagnosis

Recognition of catatonia is made on the basis of specific movement symptoms. These include odd ways of walking such as walking on tiptoes or ritualistic pacing, and rarely, hopping and skipping. Repetitive odd movements of the fingers or hands, as well as imitating the speech or movements of others also may indicate that catatonia is present. There are no laboratory or other tests that can be used to positively diagnose this condition, but medical and neurological tests are necessary to rule out underlying lesions or disorders that may be causing the symptoms observed.

Treatment

Treatment of catatonia includes medications such as benzodiazipines (which are the preferred treatment) and rarely barbiturates. Antipsychotic drugs may be appropriate in some cases, but often cause catatonia to worsen. Electroconvulsive therapy may prove beneficial for clients who do not respond to medication. If these approaches are unsuccessful, treatment will be redirected to attempts to control the signs and symptoms of the illness.

Prognosis

Catatonia usually responds quickly to medication interventions.

Prevention

There is currently no known way to prevent catatonia because the cause has not yet been identified. Research efforts continue to explore possible origins. Avoiding excessive use of neuroleptic drugs can help minimize the risk of developing catatonic-like symptoms.

Resources

BOOKS

Frisch, Noreen Cavan, and Lawrence E. Frisch. Psychiatric Mental Health Nursing. Albany, NY: Delmar Publishers, 1998.

KEY TERMS

Barbiturates— A group of medicines that slow breathing and lower the body temperature and blood pressure. They can be habit forming and are now used chiefly for anesthesia.

Benzodiazipines— This group of medicines is used to help reduce anxiety (especially before surgery) and to help people sleep.

Electroconvulsive therapy— This type of therapy is used to treat major depression and severe mental illness that does not respond to medications. A measured dose of electricity is introduced into the brain in order to produce a convulsion. Electroconvulsive therapy is safe and effective.

Mutism— The inability or refusal to speak.

Negativism— Behavior characterized by resistance, opposition, and refusal to cooperate with requests, even the most reasonable ones.

Neuroleptic drugs— Antipsychotic drugs, including major tranquilizers, used in the treatment of psychoses like schizophrenia.

Catatonia

Definition

Catatonia is a disturbance of motor behavior that can have either a psychological or neurological cause. Its most well-known form involves a rigid, immobile position that is held by a person for a considerable length of time— often days, weeks, or longer. It can also refer to agitated, purposeless motor activity that is not stimulated by something in the environment. A less extreme form of catatonia involves very slowed motor activity. Often, the physical posture of a catatonic individual is unusual and/or inappropriate, and the individual may hold a posture if placed in it by someone else. According to the handbook used by mental health professionals to diagnose mental disorders, the Diagnostic and Statistical Manual of the American Psychiatric Association, 4th Edition, Text Revision, also known as the DSM-IV-TR, some 5–9% of all psychiatric inpatients show some catatonic symptoms. Of these, 25–50% are associated with mood disorders, 10–15% are associated with schizophrenia , and the remainder are associated with other mental disorders.

Description

Types of catatonia

CATATONIC SCHIZOPHRENIA. As with all types of schizophrenia, the catatonic type, fortunately rare today, involves a marked disturbance in all spheres of life. As a schizophrenic disorder, the individual shows disturbances in thinking, feeling, and behavior. Most schizophrenics are unable to form meaningful intimate relationships or train for and sustain meaningful employment.

The catatonic type of schizophrenia is characterized by severe psychomotor disturbance. Individuals with this disorder show extreme immobility. They may stay in the same position for hours, days, weeks, or longer. The position they assume may be unusual and appear uncomfortable to the observer. If another person moves part of the catatonic individual's body, such as a limb, he or she may maintain the position into which they are placed, a condition known as "waxy flexibility." Sometimes catatonia presents itself as excessive motor activity, but the activity seems purposeless, and does not appear to fit with what is happening in the environment. In its most severe forms, whether stupor or agitation, the individual may need close supervision to keep from injuring him- or herself, or others.

DEPRESSION WITH CATATONIC FEATURES. Individuals who are severely depressed may show disturbances of motor behavior that is similar to that of catatonic schizophrenics, as previously described. They may be essentially immobile, or exhibit excessive but random-seeming motor activity. Extreme negativism, elective mutism (choosing not to speak), peculiar movements, mimicking words or phrases (known as "echolalia") or mimicking movements (known as "echopraxia") may also be part of the picture. Again, in its most extreme forms, catatonic stupor (not moving for hours, days, weeks, or longer), and catatonic activity (random-seeming activity) may necessitate supervision so that the individual does not hurt him- or herself, or others. Catatonic behaviors may also be seen in persons with other mood disorders, such as manic or mixed-mood states; these are also known as Bipolar I and Bipolar II disorders.

CATATONIC DISORDER DUE TO GENERAL MEDICAL CONDITION. Individuals with catatonia due to a medical condition may show symptoms similar to persons with catatonic schizophrenia and catatonic depression. However, the cause is believed to be physiological. Certain neurologic diseases, such as encephalitis, may cause catatonic symptoms that can be either temporary, or lasting.

See also Affect; Bipolar disorders; Catatonic disorder; Major depressive disorder; Manic episode; Schizophrenia

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Kaplan, Harold I., MD, and Benjamin J. Sadock, MD. Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 8th edition. Baltimore, MD: Lippincott Williams and Wilkins, 1998.

Barbara Sternberg, Ph.D.

catatonia , mental state generally characterized by statuesque posturing, muscular immobility, mutism, and apparent stupor. The muscles are held in a pliant state called waxy flexibility, and the catatonic person obediently permits himself to be rearranged into awkward positions that he may subsequently hold for hours. Another form of catatonia involves continuous incoherent shouting, psychomotor agitation, and a violent destructiveness which can lead to collapse and death if untreated. Loss of memory or intellect is not necessarily implied: catatonic patients often display excellent memory of their surroundings during the catatonic state. In recent years, drug therapy has been helpful in the avoidance of catatonic disturbances, and the appearance of catatonia is now quite rare. Described by Karl Kahlbaum (1874) as catatonia, the term was subsumed under Eugen Bleuler 's concept of schizophrenia in 1911. It has recently been classified as catatonic schizophrenia by the American Psychiatric Association.

cat·a·to·ni·a / ˌkatəˈtōnēə/ • n. Psychiatry abnormality of movement and behavior arising from a disturbed mental state (typically schizophrenia). It may involve repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism. ∎ inf. a state of immobility and stupor.

catatonia (kat-ă-toh-niă) n. a state in which a person becomes mute or stuporous or adopts bizarre postures (see also flexibilitas cerea). Catatonia was once a noted feature of schizophrenia but is now hardly ever seen in developed countries. It remains common in developing countries.
—catatonic adj.