Filed under: Amazing Mind
Catatonic schizophrenia is one of several types of schizophrenia, a
chronic mental illness in which a person loses touch with reality
(psychosis). Catatonic schizophrenia includes episodes of behavior at
extreme opposite ends of the spectrum. You may seem like you're in
coma-like daze — unable to speak, move or respond — or you may talk and
behave in a bizarre, hyperactive way. Catatonic episodes may last for a
month or longer without treatment.
Catatonic schizophrenia is rare today because of improved schizophrenia
treatment. In fact, being in a state of catatonia is more likely to
occur with certain other health problems, including both physical and
mental illnesses. With effective treatment, you can manage the symptoms
of catatonic schizophrenia and work toward leading a happier, healthier
Signs and symptoms of catatonic schizophrenia fall into several categories of catatonic behaviors, including:
* Physical immobility. You may be completely unable to move or
speak, or you may stare, hold your body in a rigid position and seem to
be unaware of your surroundings (catatonic stupor). You may also have a
form of immobility known as waxy flexibility; for example, if your arm
is moved into a certain position, it will stay in that position for
* Excessive mobility. Rather than being unable to move, you may move
in an excited manner that appears to have no purpose. You may pace in a
frenzy, turn in circles, flail your arms or make loud noises.
* Extreme resistance. You may not respond to instructions, may resist any attempt to be moved or may not speak at all.
* Peculiar movements. You may have inappropriate or unusual
postures, grimace for long periods or use strange mannerisms. You may
also mechanically repeat certain behaviors (stereotyped behaviors), such
as repeating words, obsessively following a routine or always arranging
objects exactly the same way.
* Mimicking speech or movement. You may repeatedly say a word just
spoken by someone else (echolalia) or repeatedly copy a gesture or
movement made by someone else (echopraxia).
Although you may appear to be without emotion during a catatonic episode, you may actually feel extreme anxiety.
Other signs and symptoms of catatonic schizophrenia
Although the main symptoms of catatonic schizophrenia are catatonic
behaviors, you may also have some of the other common signs and symptoms
of schizophrenia, such as:
* Having beliefs not based on reality (delusions)
* Seeing or hearing things that don't exist (hallucinations), especially voices
* Incoherent speech
* Neglect of personal hygiene
* Apparent lack of emotions
* Emotions inappropriate to the situation
* Angry outbursts
* Trouble functioning at school or work
* Social isolation
* Clumsy, uncoordinated movements
Catatonic episodes are likely to last at least a day and may last for longer than 30 days without effective treatment.
When to see a doctor
If you have any symptoms of catatonic schizophrenia, you may not be able
to seek medical help on your own. And during periods when your symptoms
subside, you may not believe you need treatment. Family and friends, or
people at work or school, may suggest you seek help. In some cases, you
may be taken to the hospital by emergency personnel.
If you're not ready to seek treatment, try to work up the courage to
confide in someone, whether it's a friend or loved one, a health care
professional, a faith leader or someone else you trust. He or she can
help you take the first steps to successful treatment.
Helping someone who may have catatonic schizophrenia
If you have a loved one you think may have symptoms of catatonic
schizophrenia, have an open and honest discussion about your concerns.
You may not be able to force someone to seek professional help, but you
can offer encouragement and support and help your loved one find a
qualified doctor or mental health provider.
If your loved one poses a danger to himself or herself or to someone
else, you may need to call the police or other emergency responders for
help. In some cases, emergency hospitalization may be needed. Laws on
involuntary commitment for mental health treatment vary by state.
Catatonic schizophrenia and other forms of schizophrenia are brain
disorders. Genetics and environment likely both play a role in causing
Catatonia is much more commonly associated with other conditions. Some
of the health problems that can lead to catatonia include other mood
disorders, such as depression and bipolar disorder, and medical
conditions that affect the central nervous system.
Doctors don't know why some people with schizophrenia develop catatonic
symptoms, but one or more underlying problems with the brain are likely
responsible. For example, problems with certain naturally occurring
brain chemicals called neurotransmitters appear to play a role. Imaging
studies show differences in the brain structure of people with
schizophrenia, but the significance of these changes is unclear.
Although the precise cause of catatonic schizophrenia isn't known,
certain factors seem to increase the risk of developing or triggering
catatonic schizophrenia, including:
* Having a family history of schizophrenia
* Exposure to viruses while in the womb
* Poor nutrition while in the womb
* Stressful life circumstances
* Older paternal age
* Taking psychoactive drugs during adolescence
Signs and symptoms of schizophrenia typically develop between the teenage years and the mid-30s.
Left untreated, catatonic schizophrenia can result in severe emotional,
behavioral, health, and even legal and financial problems that affect
every area of your life. Complications that catatonic schizophrenia may
cause or be associated with include:
* Suicidal thoughts and behavior
* Self-destructive behavior
* Poor nutrition
* Inability to perform daily activities, such as bathing, dressing or preparing meals
* Abuse of alcohol, drugs or prescription medications
* Family conflicts
* Inability to work or attend school
* Being a victim or perpetrator of violent crime
* Heart and lung disease related to smoking
Preparing for your appointment
In some cases, a health care provider, family member, friend or another
acquaintance may ask about your behavior, thoughts and mood or suggest
that you be evaluated by a mental health provider. Or you may decide on
your own to schedule an appointment with your family doctor or mental
health provider to talk about your concerns. In some cases, you may be
taken to a hospital for an emergency psychiatric evaluation.
What you can do
Being an active participant in your care can help your efforts to manage
your condition. One way to do this is by preparing for a planned
medical or psychiatric appointment. Think about your needs and goals for
treatment. Also, write down a list of questions to ask. These questions
* Why do you think I have catatonic schizophrenia?
* How do you treat catatonic schizophrenia?
* How could treatment change things for me?
* What do medications for this condition actually do?
* How could counseling help me?
* How long will I need treatment?
* What can I do to help myself?
* Are there any brochures or other printed material that I can take home with me? Or can you recommend reliable websites?
In addition to your prepared questions, don't hesitate to ask questions
during your appointment if you don't understand something.
What to expect from your doctor
During your appointment, your doctor or mental health provider is likely
to ask you a number of questions about your thoughts, behavior and
mood. You may be asked such questions as:
* What are your signs and symptoms?
* When did these signs and symptoms start happening?
* Do you notice the same signs and symptoms that other people notice in you?
* How is your daily life affected by your symptoms?
* Do you hear or see things other people don't seem to?
* Do you have certain special mental abilities that other people don't?
* What have you tried on your own to feel better or to control your symptoms?
* What things make you feel worse?
* Have friends or family commented on your thoughts or behavior?
* Have any of your relatives had a mental illness?
* Do you ever have thoughts of harming yourself or others?
* Do you smoke? How much?
* Do you use alcohol or recreational drugs? How much?
* What medications or over-the-counter herbs and supplements do you take?
Tests and diagnosis
If your doctor or mental health provider believes you may have catatonic
schizophrenia or another mental illness, he or she typically runs a
series of medical and psychological tests and exams. These can help
pinpoint a diagnosis, rule out other problems that could be causing your
symptoms and check for any related complications.
These exams and tests generally include:
* Physical exam. This may include measuring height and weight,
checking vital signs, such as heart rate, blood pressure and
temperature, listening to your heart and lungs, and examining your
* Laboratory tests. These may include a complete blood count (CBC),
screening for alcohol and drugs, and a check of your thyroid function.
* Psychological evaluation. A doctor or mental health provider will
talk to you about your thoughts, feelings and behavior patterns, if this
is possible. He or she will ask about your symptoms, including when
they started, how severe they are, how they affect your daily life and
whether you've had similar episodes in the past. You'll also discuss any
thoughts you may have of suicide, self-harm or harming others. Your
doctor may also want to talk to family or friends, if possible. If
you're unresponsive or your behavior seems inappropriate, your doctor
will check for catatonic symptoms.
Diagnostic criteria for catatonic schizophrenia
To be diagnosed with catatonic schizophrenia, you must meet certain
symptom criteria spelled out in the Diagnostic and Statistical Manual of
Mental Disorders (DSM). This manual is published by the American
Psychiatric Association and is used by mental health providers to
diagnose mental conditions and by insurance companies to reimburse for
Diagnostic criteria for catatonic schizophrenia include:
* Being unable to move
* Being unable to speak
* Remaining in the same position for long periods
* Excessive or overly excited behavior with no clear purpose
* Resisting instructions or attempts to move you
* Peculiar movements, such as grimacing or unusual postures
* Mimicking words and movements of others
It can sometimes be difficult to diagnose catatonic schizophrenia
because catatonic behavior is often a symptom of other conditions,
including severe depression, mania, drug intoxication, autism and
seizure disorders. Be sure to stick with it until you get an accurate
diagnosis, though, so that you can get appropriate treatment.
Treatments and drugs
Catatonic schizophrenia is a chronic condition that requires lifelong
treatment, even during periods when you feel better and your symptoms
have lifted. You may feel as if you don't need treatment, and you may be
tempted to ignore treatment recommendations. But effective treatment
can help you take control of your condition and enjoy a happier and
Treatment options are similar for all types of schizophrenia. But the
specific treatment approach that's best for you depends on your
particular situation and the severity of your symptoms.
Schizophrenia treatment is usually guided by a psychiatrist skilled in
treating the condition. But you may have others on your treatment team
as well because the condition can affect so many areas of your life.
Your treatment team can help make sure that you're getting all of the
treatment you need and that your care is coordinated among all of your
health care providers.
The team involved in treatment of catatonic schizophrenia may include your:
* Family or primary care doctor
* Family members
* Case worker
* Psychiatric nurse
* Social worker
Main treatment options
The main treatments for catatonic schizophrenia are:
* Electroconvulsive therapy (ECT)
* Vocational skills training
Medications for catatonic schizophrenia
Medications, together with electroconvulsive therapy (ECT), are key
catatonic schizophrenia treatments. Medications most commonly prescribed
for catatonic schizophrenia include:
* Benzodiazepines. These medications, also called anti-anxiety
medications, are sedatives. They are generally the medication of choice
to treat catatonic schizophrenia. Benzodiazepines, which may be injected
in a vein — especially if you're in a state of catatonia — are
typically fast acting, helping relieve catatonic symptoms quickly. They
may cause dependency with long-term use. These medications may also help
if you have anxiety along with catatonic schizophrenia. You may need to
take benzodiazepines for a period of days or weeks to relieve your
* Other medications. It's common to have other mental health issues
along with catatonic schizophrenia. Antidepressants can be helpful if
you have symptoms of depression. And mood-stabilizing medications may
help with aggression or hostility.
* Antipsychotic medications. These are generally the medication of
choice for schizophrenia. However, they aren't used as often for the
catatonic type of schizophrenia because they can actually worsen
Choosing a medication
In general, the goal of treatment with medications is to effectively
control signs and symptoms at the lowest possible dosage. Which
medication is best for you depends on your individual situation.
Benzodiazepines may help quickly relieve your catatonic state and may be
used on an emergency basis in the hospital. But it can take several
weeks after first starting other medications to notice an improvement in
your other symptoms, such as depression or anxiety.
If one medication doesn't work well for you or has intolerable side
effects, your doctor may recommend combining medications, switching to a
different medication or adjusting your dosage. Don't stop taking your
medication without talking to your doctor, even if you're feeling
better. You may have a relapse of psychotic symptoms if you stop taking
your medication. In addition, some medications need to be tapered off,
rather than stopped abruptly, to avoid withdrawal symptoms.
Electroconvulsive therapy (ECT) for catatonic schizophrenia
Electroconvulsive therapy (ECT) is a procedure in which electric
currents are passed through your brain to trigger a brief seizure. This
seems to cause changes in brain chemistry that can reduce symptoms of
certain mental illnesses. Electroconvulsive therapy is used to treat all
types of schizophrenia, but appears to most quickly improve signs and
symptoms of catatonic schizophrenia.
Together with benzodiazepine medications, ECT is the primary treatment
for catatonic schizophrenia. Your doctor may recommend ECT after you
finish a course of benzodiazepines, or you may be treated with both
Hospitalization for catatonic schizophrenia
During crisis periods or times of severe catatonic symptoms,
hospitalization may be necessary. This can help ensure your own safety
and that of others, and make sure that you're getting proper treatment,
nutrition, sleep and hygiene. Partial hospitalization and residential
care also may be options.
Psychotherapy for catatonic schizophrenia
Although medications and ECT are important catatonic schizophrenia
treatments, counseling (psychotherapy) also is essential. Psychotherapy
Individual therapy. Psychotherapy with a skilled mental health
provider can help you learn ways to cope with the distress and daily
life challenges brought on by catatonic schizophrenia. One approach,
called cognitive behavioral therapy, has proved to be especially helpful
in the treatment of catatonic schizophrenia. In cognitive behavioral
therapy, a mental health provider helps you recognize — and change —
harmful ideas and behaviors. As part of this process, your therapist
will help you look back on your personal history. Together you're likely
to gain insights into when, and why, you may have started to form those
ideas and behaviors. Then, building from this new understanding, your
therapist can help you start to change those patterns.
Psychotherapy can help reduce the severity of your symptoms and
improve communication skills, relationships, your ability to work and
your motivation to stick to your treatment plan. Learning about
catatonic schizophrenia can help you understand it better, cope with
lingering symptoms and understand how medications could be helpful.
Therapy can also help you cope with stigma surrounding catatonic
* Family therapy. Both you and your family may benefit from therapy
that provides support and education to families. Your symptoms have a
better chance of improving if your family members understand your
illness, can recognize stressful situations that might trigger a
relapse, and can help you stick to your treatment plan. Family therapy
can also help you and your family communicate better with each other and
understand family conflicts. Family therapy can also help family
members cope and reduce their distress about your condition.
Social and vocational skills training for catatonic schizophrenia
Training in social and vocational skills to live independently is an
important part of recovery from catatonic schizophrenia. With the help
of a therapist, you can learn such skills as good hygiene, cooking and
better communication. Many communities have programs that can help you
with jobs, housing, self-help groups and crisis situations. If you don't
have a case manager to help you with these services, ask your doctors
about getting one.
Treatment challenges in catatonic schizophrenia
When you have appropriate treatment and stick to your treatment plan,
you have a good chance of leading a productive life and functioning well
in daily activities. But be prepared for challenges that can interfere
For one thing, you, like many others with schizophrenia, may find it
hard to follow your treatment plan. You may believe that you don't need
medications or other treatment. Also, if you're not thinking clearly,
you may forget to take your medications or to go to therapy
appointments. Talk to your doctors about tips to stick to your treatment
plan, such as taking an antipsychotic medication that's available in a
long-lasting injectable form. Even with good treatment, you may have a
relapse. Have a plan in place to deal with a relapse.
Smoking, often heavy smoking, is common when you have schizophrenia. If
you smoke, you may need a higher dose of antipsychotic medication
because nicotine interferes with these medications. Be honest with your
doctors about your smoking habits. And be sure you understand the
serious health risks of smoking.
Using alcohol and drugs can make catatonic schizophrenia symptoms worse.
If you have a problem with alcohol or substance abuse, you may benefit
from treatment programs that include care for both schizophrenia and
Lifestyle and home remedies
Catatonic schizophrenia isn't an illness that you can treat on your own.
But you can do some things for yourself that will build on your
* Take your medications as directed. Even if you're feeling well,
resist any temptation to skip your medications. If you stop,
schizophrenia symptoms are likely to come back.
* Pay attention to warning signs. You and your caregivers may have
identified things that may trigger your catatonic schizophrenia
symptoms, cause a relapse or prevent you from carrying out your daily
activities. Make a plan so that you know what to do if symptoms return.
Contact your doctor or therapist if you notice any changes in symptoms
or how you feel. Involve family members or friends in watching for
warning signs. Addressing schizophrenia symptoms early on can prevent
the situation from worsening.
* Avoid drugs and alcohol. Alcohol and illegal drugs can worsen
schizophrenia symptoms. Get appropriate treatment for a substance abuse
* Check first before taking other medications. Contact the doctor
who's treating you for catatonic schizophrenia before you take
medications prescribed by another doctor or before taking any
over-the-counter medications, vitamins, minerals or supplements. These
can interact with your schizophrenia medications.
Coping and support
Coping with catatonic schizophrenia can be challenging. Medications can
have unwanted side effects, and you may feel angry or resentful about
having a condition that requires lifelong treatment. During periods when
you feel better, you may be tempted to stop treatment, which can
trigger a relapse. Here are some ways to cope with catatonic
* Learn about catatonic schizophrenia. Education about your
condition can empower you and motivate you to stick to your treatment
* Join a support group. Support groups for people with schizophrenia
can help you reach out to others facing similar challenges.
* Stay focused on your goals. Recovery from catatonic schizophrenia
is an ongoing process. Stay motivated by keeping your recovery goals in
mind. Remind yourself that you're responsible for managing your illness
and working toward your goals.
* Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
* Structure your time. Plan your day and activities. Try to stay
organized. You may find it helpful to make a list of daily tasks.
There's no sure way to prevent catatonic schizophrenia. Some signs of
schizophrenia may be present from early childhood or even infancy. Early
identification and treatment for people at risk of schizophrenia,
perhaps starting in childhood, may help get symptoms under control
before serious complications develop and may help improve the long-term
outlook. Also, sticking with your treatment plan can help prevent
relapses or worsening of catatonic schizophrenia symptoms.