Catatonic schizophrenia is one of the different types of schizophrenia. It involves psychomotor disturbances.
What is catatonic schizophrenia?
Catatonic schizophrenia refers to a rare type of schizophrenia. In this variant, affected individuals suffer from psychomotor disorders. Typical manifestations are disturbances of the posture as well as the movement sequences. But other symptoms of schizophrenia also show up. The first description of catatonic schizophrenia took place in 1874 by the German psychiatrist Karl Ludwig Kahlbaum (1828-1899). In later years, the neurologist Karl Leonhard (1904-1988) made more detailed studies of the disease. In modern times, catatonic schizophrenia is diagnosed only in rare cases.
Causes
As with schizophrenia in general, the causes of the catatonic form are still unclear. Medical experts suspect that genetic, psychodynamic, and environmental influences play a role in its onset and interact with each other. The mental illness emerges from a paranoid course. From the psychopathological school of Wernicke-Kleist-Leonhard, catatonic schizophrenia is considered as a heterogeneous group of disorders just like all other forms of schizophrenia. Karl Leonhard held the view of genetic triggers for the subtype of periodic catatonia, which progresses in episodes. As a rule, schizophrenic disorders do not manifest themselves until after puberty. However, in about two percent of all sufferers, they appear in childhood.
Symptoms, complaints, and signs
A typical feature of catatonic schizophrenia is motor disturbances. These are noticeable by movements of the arms, hands, and legs that appear strange. Similarly, stereotyped movement patterns or strange postures are possible and may persist for hours. Patients enter a completely rigid state accompanied by hallucinations or delusions. Most patients can no longer be spoken to in this state. Sometimes the state of rigidity abruptly changes into a violent state of agitation. In the worst case, the patients may even physically attack other people. It is not uncommon for other typical symptoms of schizophrenia to appear. These may include thought disorders, hearing voices and anxiety. There are a variety of other possible accompanying symptoms of catatonic schizophrenia such as command automatism, perseveration, negativism, muteness (mutism), catalepsy, echolalia, proskinesis, ambition, and mannerisms. In particular, negativism and command automatism are considered typical of catatonic schizophrenia. Whereas in command automatism the patient carries out without resistance any instruction that is demanded of him, in negativism the exact opposite is the case. If rigidity (stupor) occurs together with fever, it is malignant, pernicious or febrile catatonia. In earlier times, this form of the disease was often fatal. Thanks to modern treatment methods and medications, however, very few deaths from it occur nowadays. Since the patient’s body temperature increases in most cases during catatonic schizophrenia, a clinical measurement is absolutely necessary. The same is true for the CK level. Thus, there is a concern for an increase in both parameters, which must be treated.
Diagnosis and disease progression
Catatonic schizophrenia is diagnosed on the basis of the typical symptoms. In this case, the patient must suffer from catatonia (flaccidity), catalepsy (persistence in a rigid posture), and flexibilitis cerea (waxy pliability). In general, a specialist or clinic should be consulted if schizophrenia is suspected. Some therapy centers specialize in the early diagnosis and treatment of catatonic schizophrenia. The doctor makes the diagnosis after extensive discussions with the patient, following strictly defined criteria. In Germany, special questionnaires are also used. To confirm the diagnosis, bizarre postures, hallucinations or delusions must occur for at least one month. Differential diagnosis also plays an important role. In this process, the doctor rules out other causes that could be responsible for the occurrence of the complaints.These include, among others, neurological diseases, brain tumors, and the abuse of medications or drugs. For this reason, various neurological and physical examinations are performed in principle when catatonic schizophrenia is suspected. The course of catatonic schizophrenia can vary greatly from individual to individual. For this reason, it is not possible to make a general prognosis. However, in most affected individuals, the symptoms diminish over time. In principle, all forms of schizophrenia require lifelong therapy.
Complications
In this type of schizophrenia, the main complications are motor and mental disorders of the patient. These have a very negative effect on the life and daily routine of the affected person and can significantly reduce the quality of life. Those affected suffer above all from severe thinking disorders and perceptual disturbances. Likewise, it is not uncommon for hallucinations to occur. Likewise, the patients possess a strong negative attitude towards various things and people. A strong fever occurs, which is accompanied by a state of rigidity. In the worst case, the patient may die. Likewise, mild aggression or irritability of the patient may occur. In many cases, therefore, treatment in a closed clinic is necessary if the patient poses a danger to himself or to other people. Likewise, the affected person may be dependent on the help of other people in everyday life. In many cases, taking medication causes side effects, such as fatigue or exhaustion; not every treatment leads to a positive course of the disease.
When should you go to the doctor?
Catatonic schizophrenia is a serious health condition that requires treatment by medically trained professionals and around-the-clock care. If people suffer from delusions and hallucinations, they need a doctor. If catalepsy or catatonia occurs, a doctor must be alerted as soon as possible. Muscle rigidity over the entire body is a warning sign that should be acted upon immediately. Disturbances and abnormalities of behavior as well as personality, must be evaluated by a specialist. In catatonic schizophrenia, the affected person is unable to go about his or her daily life independently. Sudden attacks on other persons, fisticuffs and an uncontrolled demeanor must be presented to a physician. If instructions are generally met with the opposite reaction, there is a pathological distrust that must be investigated. If there is paranoia or a strong attitude of refusal toward all people, a physician should be contacted. If echolalia or mannerisms occur, a doctor’s visit must be made. The patient must be placed in psychiatric care so that he can be adequately cared for and so that he is not a danger to himself or others. Since there is often a lack of insight into the illness, a medical officer is required in severe cases to assess the person’s state of health and take further measures.
Treatment and therapy
To effectively treat catatonic schizophrenia, the patient is usually given medications such as benzodiazepines. With these agents, such as lorazepram, a breakthrough in catalepsy can often be achieved. The typical anxiety states can also be attenuated by the drugs. Just as in the other types of schizophrenia, neuroleptics are also used in cataleptic schizophrenia. The administration of mood stabilizers is also considered useful. These include primarily lithium, olanzapine, carbamazepine, valproic acid, and lamotrigine. If treatment with benzodiazepines does not lead to the desired success, therapy with amantadine, which belongs to the NMDA receptors, and dopamine agonists is possible as an alternative. In some cases, special electroconvulsive therapy (ECT) is used to treat catatonia. It has the advantage of being effective and fast acting. It is performed when benzodiazepine therapy is unsuccessful. If the state of rigidity persists for a very long time, physiotherapy may be useful in some circumstances.
Outlook and prognosis
Catatonic schizophrenia has an unfavorable prognosis. It is a psychosomatic disorder associated with numerous severe symptoms. Without optimal and adequate medical care, there is a risk to self as well as the possibility of endangering the lives of others.Sufferers experience violent states of agitation. In these, there are often assaults and attacks on other people. Treatment is therefore imperative and, thanks to modern possibilities, increasingly leads to an improved outcome. The cure of catatonic schizophrenia is nevertheless to this day less the goal of therapy. The focus of psychotherapeutic as well as drug treatment is on alleviating existing symptoms and reducing aggressive behavioral tendencies. At the same time, fears and delusions are to be reduced. These often lead to situations of excessive demands on the environment as well as on the person affected. The overall quality of life is to be improved through the interaction of various therapeutic approaches, so that interaction with other people becomes possible. A stable social environment is essential in improving the prognosis. Despite all the problems, relatives should be aware of this. A clinical stay is nevertheless necessary with the patient. Coping with everyday life cannot take place without daily care. In addition, there is an increased risk of suffering sequelae with this disease. These can be physical or psychological in nature.
Prevention
Because the causes of catatonic schizophrenia are largely unknown and genetic triggers are suspected, no effective preventive measures can be taken against the mental illness.
Follow-up
Catatonic schizophrenia is treated as a psychosomatic illness with the help of a team of physicians. This therapy often drags on for a long time and thus includes aftercare and prevention. The medical and psychotherapeutic care can reduce the subsequent symptoms. Nevertheless, the ill persons can suffer from strong states of agitation. As a result, they endanger themselves and also their environment. For this reason, comprehensive treatment is necessary, which leads to good results through the use of modern measures. Although a cure is hardly possible, the aggressive behavior can be combated. At the same time, illness-related fears and associated delusions are alleviated. The family of the affected person receives noticeable relief through a suitable therapy approach. In a stable environment, patients feel relatively safe, which clearly supports the positive prognosis. Nevertheless, daily care in the context of a clinical stay is recommended. This reduces the risk of sequelae, which can be of a psychological nature or manifest themselves in physical symptoms. During follow-up care, relatives should therefore work closely with therapists and physicians, because the affected persons themselves often do not have the opportunity to become active themselves due to their illness.
What you can do yourself
In the case of catatonic schizophrenia, the affected person has no possibilities on their own to make their everyday life more pleasant or to take advantage of self-help tips. Physically, the disease does not allow for any self-initiated changes due to the disturbances in movement patterns. Furthermore, it is part of the clinical picture of schizophrenia that the mental disorder does not allow any insight for measures of positive change. Only small things to be individually examined can be undertaken to improve the general well-being. For the reasons described, the affected person is almost completely dependent on the support of relatives as well as comprehensive medical care. Due to the severity of the disease, people from the social environment are strongly advised to inform themselves in detail about the disease, its course and symptoms. This makes it easier to deal with the patient and promotes the necessary understanding of the behavior shown in everyday life. The cognitive abilities of a person suffering from schizophrenia are not comparable to those of a healthy person. The relatives should prepare and adjust to this. It is recommended that the relatives work closely with a team of doctors and therapists. This ensures the best possible medical care and relieves family members immensely. In addition, therapeutic measures can be taken to prevent further complaints and improve well-being.