You might have heard the term catatonia before, but you may not understand exactly what it entails. If you’re wondering what exactly catatonic behavior looks like, you’re not alone. We’re going to cover what this behavior is, what causes it, its associated conditions, and whether or not it is harmful.
What Is Catatonic Behavior?
The terms "catatonia" and "catatonic behavior" are sometimes used interchangeably. They refer to when a person significantly decreases reactivity to their environment. Usually, when a person is exhibiting catatonic behavior, they will display motor rigidity, negativism (lack of response to stimuli), mutism, or stupor. However, sometimes individuals experiencing catatonia will also show a kind of purposeless excitement with seemingly meaningless motions.
Regardless of the exact symptoms, it can be debilitating for the person who is exhibiting them and frightening for onlookers.
Symptoms Of Catatonia
While catatonia is often associated with other mental illnesses, it is its own diagnosis. However, it is not its own disorder, but rather a part of other mental illnesses. The physical symptoms experienced during a catatonic state can vary between individuals.
- Stupor: a stack that resembles unconsciousness while the individual is still conscious
- Catalepsy: rigid body posture
- Mutism: very little to no verbal communication
- Waxy flexibility: body stays in a position another person places it into
- Negativism: a lack of response to stimuli or instruction
- Posturing: holding a posture against the force of gravity
- Mannerisms: odd and/or exaggerated movements
- Stereotypy: meaningless, repetitive movements
- Agitation without cause
- Grimacing without cause
- Echolalia: repetition of another’s words without reason
- Echopraxia: repetition of another person’s movements without reason
What Causes Catatonia?
The exact causes of catatonia are not understood, but it can be linked to both psychiatric and physical illnesses. Some researchers believe that issues with neurotransmitters, specifically gamma-aminobutyric acid and glutamate signaling, may be to blame. Even though professionals are not sure of the exact causes of catatonia, it can still be successfully treated.
Illnesses And Conditions Linked To Catatonia
As mentioned above, numerous illnesses and conditions are linked to catatonia. That means individuals who have been diagnosed with these illnesses may be more likely to develop catatonia. In fact, catatonia is observed in approximately 10% of individuals who are receiving inpatient psychiatric care for acute illnesses.
Catatonia has long been linked to schizophrenia, and about 10 to 15% of catatonia cases with psychiatric causes are linked to schizophrenia.
In the past, mental health professionals used the term catatonic schizophrenia to refer to individuals who were living with schizophrenia and also experiencing catatonia. However, with the publication of DSM-5, this term is no longer used.
However, catatonic behavior is still considered one possible characteristic symptom of schizophrenia. Additionally, professionals now specify if catatonia is occurring comorbidly with schizophrenia.
Mood disorders are associated with catatonia more often than schizophrenia is—about 30% of catatonia cases with psychiatric causes are associated with mood disorders.
Although catatonia does not frequently occur with major depressive disorder, comorbidity is possible. Some research suggests that catatonia may be more likely to occur in individuals who are experiencing depression after birth or the loss of a loved one.
While it is sometimes obvious that someone is experiencing catatonia, a diagnosis isn’t always easy. Sometimes catatonia is misdiagnosed as symptoms of other mental illnesses. This can be detrimental, as catatonia benefits from a specific treatment.
If you are concerned that someone you know is experiencing catatonia, it is best to contact a mental health professional. This professional will use symptom-based diagnostic criteria to determine whether or not this individual is experiencing catatonia. They may also be able to diagnose any mental disorders the individual is living with.
Dangers Of Misdiagnosis
There is certainly a danger of misdiagnosis with catatonia. Symptoms of catatonia can occur due to physical and mental illnesses, so it can take time to make an accurate diagnosis. The problem is how it wreaks havoc with the motor functions of the human body. This can make catatonia appear like something else, such as Tourette's Syndrome or tardive dyskinesia. A doctor may need to take days or weeks before accurately classifying someone as catatonic.
How Harmful Is Catatonia?
As for how harmful catatonia is, that's not an easy question to answer, since the condition can take several different forms or manifest with multiple symptoms. In and of itself, catatonia does not necessarily cause an individual harm.
However, it is possible for he catatonic person to injure themselves or become injured by outside forces. For example, if someone experiencing catatonia is engaging in a series of repetitive movements, they might run into something and harm themselves. Additionally, someone who is in a catatonic state might walk into traffic or be taken advantage of by others.
Therefore, it’s best to get professional help for someone who is experiencing catatonia.
The Effects Of Catatonia On A Family
It can be frightening when someone you love enters a catatonic state. You may not know how to help, and while this is okay, it can also lead to feelings like anxiety, guilt, and helplessness. One of the best things you can do for your loved one during this time is to take care of yourself. By caring for your own physical and mental health, you will be better able to help the individual who is experiencing catatonic behavior.
If the catatonic behavior is new, it is natural to experience confusion as well as grief for the loss of who this person was. While catatonia is treatable and the person may return to their normal behavior, it is still okay to be upset or confused.
Get Support with Online Therapy
One way to support yourself during this time is by speaking with a licensed therapist. They may be able to help you work through your emotions in a healthy way. However, if you are trying to take care of someone experiencing catatonia, it may be hard to find time to attend an in-person appointment. If that’s the case, online therapy may be a more convenient option.
Research suggests that online cognitive behavioral therapy (CBT) may be just as effective as traditional in-person CBT. CBT is a type of therapy that can help you recognize and alter negative thought patterns. Therefore, it may help you deal with feelings of dread or guilt related to knowing someone experiencing catatonia.
How can you tell if someone is catatonic?
The way catatonia presents is varied, making it difficult to diagnose catatonia accurately. The most commonly known form of catatonia is characterized by a lack of movement, catalepsy, and waxy flexibility. Waxy flexibility means that, when examined, a catatonic person exhibits slight, even resistance to being repositioned. Catalepsy refers to the tendency for a catatonic person to maintain their position against gravity. Those with other psychiatric concerns, like schizophrenia, depression, or psychotic patients may have different symptom profiles.
Other forms of catatonia may present with different symptoms. While many people assume that those with catatonia are mute, the condition might involve symptoms like echolalia, which is repeating the words of others. They may also exhibit repetitive and stereotyped movements. The complex presentation of catatonia makes it challenging to discern exactly what is causing the symptoms. In medical settings, physicians usually use benzodiazepines, antiepileptics, or antidepressants to treat catatonia, with a diagnosis usually being reached based on the patient’s response.
Can people with catatonia move?
Many people consider those with catatonia to be like statues, stuck in an immovable pose and unable to engage in voluntary movement. However, the actual presentation of catatonia can vary considerably. The medical definition of catatonia generally refers to behaviors that are increased, decreased, or abnormal compared to baseline. The most common type of catatonia does present with limited movement, but a second type of catatonia can present with quite a bit of motion. The person might move randomly, repeat the motions of those around them, or exaggerate typical movements.
How do you get someone out of a catatonic state?
To help someone experiencing a catatonic state, immediate medical help is required. Treatment usually starts with benzodiazepines, like lorazepam, which can quickly reverse catatonic symptoms. If these aren't effective, medical providers might use mood stabilizers or antipsychotics. Identifying and treating any underlying health issues causing the catatonia is also important. Conditions like complex partial seizures can sometimes cause symptoms similar to catatonia and may require different treatment approaches.
In more severe cases where medications don't work, electroconvulsive therapy (ECT) is often used, especially when the catatonia is related to mood disorders. ECT is likely an effective treatment if other approaches have failed, but it does come with a higher risk to the patient. Once the catatonia symptoms resolve, it is important to offer supportive care, additional diagnosis, and ongoing monitoring to ensure that the symptoms do not return.
What happens when someone goes catatonic?
When someone goes catatonic, they experience a marked disturbance in their movement and psychomotor behavior. While many assume that catatonia turns a person into a “statue” unable to move, that may not be the case for everyone. There are two primary types of catatonia: the more commonly known form - akinetic catatonia - involves extreme lack of movement, responsiveness, and speech, while the other type - excited catatonia - involves excessive and peculiar motor activity.
In the first type, the person may remain motionless, mute, and unresponsive for hours or even days. This state can include "waxy flexibility," where their limbs remain in positions placed by another person. In the second type of catatonia, the person may exhibit purposeless or bizarre movements, echolalia (repeating others' words), or echopraxia (mimicking others' movements). The second type of catatonia is more serious than the motionless type. It is sometimes referred to as “malignant” catatonia and can rapidly be fatal if not treated immediately.
Are catatonic people conscious?
People in a catatonic state can move between several states of consciousness. Those that appear unresponsive or immobile are not necessarily unconscious. In many cases, individuals in a catatonic state are aware of their surroundings but are unable to respond or move. This lack of response can be misinterpreted as unconsciousness, even if they know what is happening around them. It is difficult to determine exactly what level of consciousness a person with catatonia is experiencing, especially if other medical conditions or psychiatric disorders are involved.
Do catatonic people have thoughts?
It is likely that catatonic people have thoughts and move between various levels of consciousness. Because they cannot regulate speech or movement properly, a catatonic person may not be able to indicate their thoughts or how aware they are of their surroundings. Predicting a catatonic person’s thoughts can be further complicated by the presence of other medical problems or mental health conditions, which can both cause and exacerbate the symptoms of catatonia.
How are catatonic patients treated?
Catatonic patients are most commonly treated through the use of clinical psychopharmacology. Benzodiazepines, such as lorazepam, are often the first line of treatment. These drugs can quickly reduce catatonic symptoms. When diagnosing and treating catatonia, medical practitioners often stop all medications that might be contributing to the condition and administer a “lorazepam challenge,” observing the treatment response. Lorazepam is administered slowly via IV, and catatonia symptoms are observed. If the symptoms decrease, a dosing schedule for lorazepam is determined to prevent symptoms from reappearing.
If lorazepam or another benzodiazepine is ineffective, medical providers may try other types of medications, such as mood stabilizers or antiepileptic medication. If pharmacological therapy fails, the American Psychiatric Association recommends the use of electroconvulsive therapy (ECT). ECT treatments apply controlled electrical stimulation to the patient’s brain under the supervision of medical professionals.
Treatment also typically involves ongoing diagnosis to identify underlying conditions. Supportive care is also important to ensure that symptoms do not return. Regular monitoring and follow-up are essential to adjust the treatment plan and manage the condition effectively.
How long can a person live in a catatonic state?
The duration of a catatonic state can vary widely depending on the underlying cause and the effectiveness of treatment. Some individuals may experience catatonic episodes that last for hours or days, while others might remain in a catatonic state for weeks or even longer without appropriate treatment. Clinical manifestations can vary widely, as can the severity of the catatonic symptoms.
The length of a catatonic episode varies based on the underlying cause. For example, catatonia due to a treatable psychiatric condition like major depression may resolve relatively quickly with appropriate medication and therapy. However, if catatonia is a symptom of a more chronic or severe neurological condition, it might persist for longer.
If someone is in a catatonic state, it is important to get them medical attention immediately. In some cases, catatonia rapidly progresses to become fatal, and it is important to remember that catatonia is not a typical symptom of any illness. The presence of catatonia indicates that a significantly more severe underlying problem may be present.
Can you go catatonic from stress?
Catatonia is strongly associated with mood disorders, such as depression and bipolar disorder. Stress is known to worsen the symptoms of mood disorders, making it likely that stressful live events can increase the possibility of catatonic symptoms. In some cases, catatonia is attributed to only the psychiatric condition, while in other cases, it may have different underlying causes. For example, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM), lists major depressive disorder with catatonic features as a specifier for major depression, which means that the depression is so severe that a person is unable to move or speak for long periods.
What happens if catatonia is not treated?
Untreated catatonia is a potentially lethal condition. The most common type, characterized by disordered motion and speech, is considered to be less dangerous than the type associated with bizarre or excessive movement. Catatonia can rapidly progress to a lethal state if left untreated, although the decline is likely quicker in those exhibiting the second type of catatonia. Regardless of the exact symptoms a person presents, catatonia should always be considered a medical emergency and treated by medical professionals.
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