Catatonia is the medical term for a psychomotor complex of behavioral, emotional, and motor symptoms. Catatonia symptoms can occur in schizophrenia, depression, and neurologic disorders. Electroconvulsive therapy is used when drug treatment fails.
What is catatonia?
Catatonia is a psychomotor syndrome that can occur in the setting of major depression, catatonic schizophrenia, or metabolic and neurologic disorders. The syndrome was first described in the 19th century by Kahlbaum, who related it to depression as a symptom complex. Later, Kraepelin and Bleuler described catatonia as a subtype of schizophrenia. A special form of catatonia is pernicious or malignant catatonia, which can assume life-threatening proportions if left untreated. In addition to depressive and schizophrenic states, agitation can also be catatonic. This catatonic agitation is also known as catatonic raptus and is expressed opposite to catatonic depression. In all cases of catatonia, patients show symptoms at the emotional level, as well as behavioral abnormalities and physiological limitations, primarily affecting motor function. The complex was described by its first describer, Kahlbaum, as a mental and muscular state of tension that can be triggered by depression. Today, medical science knows that catatonia is not directly related to a specific diagnosis.
Causes
The causes of catatonia are many and varied. For example, the syndrome may present as part of primary illnesses such as AIDS. Especially in the neurologic form of the disease, patients often show catatonic features. Other neurological diseases are also possible causes. In this case, a physiological change in brain tissue causes the symptoms. Alcohol consumption or drug influence can also trigger catatonia. An equally conceivable cause is a metabolic disorder. If schizophrenia triggers catatonia, environmental factors, genetic factors, and psychodynamic components probably interact. If depression can be uncovered as the cause of catatonia, losses, stresses, and overwhelming demands play a primary role as causes. Traumatic childhood experiences and biochemical changes in the brain are also discussed as causes. The same applies to medications, which in turn can themselves trigger catatonia. Catatonic syndrome may also occur as part of a dissociative neurotic disorder.
Symptoms, complaints, and signs
In catatonia, the entire body tenses into a state of tension with increased muscle tone. Patients remain in a rigid position that is maintained for several hours. They usually undergo passive movements, maintaining the body position for hours after the movement sequence. During passive movement, waxy muscle resistance is evident. In addition, mutism is usually present. This means that the affected persons no longer speak or only repeat what they hear. In this context, there is also talk of echolalia. Some patients especially repeat words and sentences that have a special sound and rhyme, for example. What is demanded of them, catatonic people perform either mechanically or they practice negativism. In doing so, they perform the exact opposite of what they were asked to do. In the case of catatonic schizophrenia, symptoms can range from tremendous agitation to extreme passivity. For example, in catatonic agitation, patients throw themselves on the floor, grimace, and exhibit aimless aggressive behavior. Volitional movements are angular and discordant.
Diagnosis and course of the disease
The physician diagnoses catatonia primarily by observation and passive movements. To rule out neurologic disease as a cause, an MRI may be necessary. During the medical history, the physician finds out whether mental abnormalities have occurred in the past. With the help of this knowledge, he or she assesses the catatonia in the context of a primary disease.
Complications
Catatonia results in a variety of complaints. In the process, the affected person suffers from severe psychological distress and motor limitations that significantly reduce the person’s quality of life.Likewise, those affected may be dependent on the help of other people in their daily lives. The patient’s body is very tense and strained, so that relaxation often does not occur. Likewise, the muscles can no longer be moved easily and the patients can no longer speak properly. It is not uncommon for other people’s speech to be repeated. Furthermore, catatonia can lead to aggressive behavior. Therefore, in some cases, the treatment of this disease must also take place in a closed clinic. Likewise, self-injurious behavior may also occur. Due to the neurological limitations, breathing difficulties or fever often occur. However, the treatment of catatonia proves to be relatively difficult, since especially the psychological complaints cannot be completely limited in every case. Often, complete recovery of the patient is not possible. If epileptic seizures occur, these must also be limited. If necessary, the life expectancy of the affected person may be shortened.
When should you see a doctor?
Catatonia represents an emergency medical special case. If an affected person shows symptoms of catatonia, an emergency physician must be alerted and first aid measures must be initiated. If people show stiffness all over the body, they need urgent medical attention. If an unnatural posture of the body is observed, which appears frightening to outsiders, no part of the body can be moved voluntarily anymore, then a doctor should be called. If the affected person is suddenly unable to speak or respond meaningfully to direct address, he or she needs medical care as soon as possible. If there is a slowed response to instructions or if basically the opposite of what is desired is performed, these are indications of existing health irregularities. Some patients in a state of catatonia speak in rhymes or with a special sound rhythm. Since only medically trained personnel can react in a sufficient form to the state of catatonia as well as to the existing underlying disease, the presence of a physician is required immediately. Sufferers often remain in a stiff position for several hours and are unable to take in food or sufficient fluids to nourish the organism. A physician should be contacted within minutes of the onset of catatonia. If movements are initiated externally, there is often a waxy sensation in the patient’s muscles.
Treatment and therapy
Catatonia can assume life-threatening proportions in some circumstances. Patients do not consume food or fluids. Therefore, catatonic phenomena must be responded to as quickly as possible. If not intervened, catatonia may progress to malignant catatonia. In this case, high fever occurs without signs of inflammation or infectious signs. Muscle tension destroys muscles bit by bit as part of this phenomenon. In addition, vegetative dysregulation can occur, resulting in respiratory insufficiency, for example. So that the patient is spared this life-threatening form of catatonia, the attending physician carries out a psychopharmacological therapy. This therapy corresponds primarily to the administration of GABA-ergic substances. In addition, if a mental disorder is suspected as the cause, the primary disorder is specifically treated. In the case of schizophrenia, neuroleptics are given for this purpose. In the case of depressive disorders, on the other hand, patients are treated with antidepressants. If these measures fail and the catatonia does not subside despite all efforts, electroconvulsive therapy is performed. Under anesthesia, the patient is given electrical impulses that last for several seconds. The impulses trigger a minimal epileptic seizure. Electroconvulsive therapy is usually performed eight to 12 times over a two- to three-day period.
Outlook and prognosis
Catatonia represents a life-threatening condition for the patient. In severe cases, premature death of the affected person occurs because important vital functions cannot take place adequately in this physical state. Without the fastest possible and intensive medical care, the affected person has little chance of alleviating his or her existing symptoms.Complications and secondary diseases are to be expected, leading to a severe impairment of the quality of life. Even with the fastest possible medical care, long-term impairments and health disorders are to be expected. Catatonia is a symptom of an existing underlying disease. This is usually severe and treatable only with long-term therapies. In many cases, a permanent or long-term clinical stay of the affected person takes place because of the presence of a mental disorder. The patient is not able to take responsibility for his or her own lifestyle. The existing complaints do not allow this even after overcoming a catatonia. Due to the present cause of catatonia, the overall condition of the affected person must always be taken into account when making a prognosis. Even though the muscle tension has been successfully managed and a stabilization of the health condition has been achieved, the patient cannot be discharged from treatment as recovered. Further follow-up treatment and daily medical care are necessary for people who have suffered catatonia.
Prevention
There are many causes of catatonia. Although intoxication-related catatonia may be preventable, neurologic catatonia specifically cannot be prevented.
Follow-up
In most cases of catatonia, affected individuals have very few and also very limited measures and options for direct aftercare. First and foremost, therefore, a rapid and, above all, an early diagnosis must be made in order to prevent the occurrence of other complications and complaints. There is also no possibility of self-healing. Most of those affected are dependent on taking various medications to alleviate the symptoms permanently and properly. Regular intake and correct dosage should always be ensured in order to permanently limit the symptoms. If there is any uncertainty or if there are any questions or side effects, a doctor should always be contacted first. Likewise, many of those affected by catatonia are dependent on the help of their own family in everyday life to alleviate the symptoms. Loving conversations have a positive effect on the course of the disease and can also prevent depression and other psychological upsets. The disease may also reduce the life expectancy of the person affected, as it cannot always be completely cured. Contact with other patients may also be useful in this process.
What you can do yourself
In case of catatonia, the affected person has no possibilities to help himself or to optimize his daily life because of the present symptoms. The body cannot be moved and, consequently, no changes can be made in this condition to help improve overall well-being. The patient is dependent on the medical care of doctors, relatives or nursing staff. Within the scope of their possibilities, these can implement small things for the sick person in the organization of everyday life. Since the relatives of a patient are often emotionally overwhelmed with the situation, they often need help and support in everyday life. They can join a self-help group for relatives. There, they have the opportunity to discuss their own feelings and experiences with other patients. This contributes to an emotional relief. In a self-help group, relatives can count on mutual support and receive tips on how to deal with the circumstances. The use of relaxation techniques is also advisable. Using proven methods such as yoga, meditation, autogenic training or breathing techniques, relatives can reduce stress and at the same time gain new strength to cope with everyday life. If possible, they should not manage the care of a person suffering from catatonia alone.
