What is catatonia and how is it treated?

People who are suddenly paralyzed and in a vegetative state, absent and unable to react. Their bodies appear rigid, like strange mannequins that others can move at will. Few conditions are more unique than catatonia, a neuropsychiatric syndrome with alterations in consciousness, affect and thinking.

Despite the fact that this clinical reality was first described in 1874 by the German physician Karl Kahlbaum, the art world and cultural tradition saw in affected people a source of inspiration to evoke the face of horror and despair.

In fact, in the Middle Ages many of the patients suffered tragic endings, since the disease was related to evil possessions. In any case, today it is a well-known condition. Even for neuroscience it is one of the most interesting alterations.

And although its impact is serious and completely alters the lives of those who suffer from it, the modern clinic has several effective treatments to counteract this alteration. What else should you know about it? We will detail it in the following space.

Types of catatonia

Catatonia, although rare, forms a type of clinical picture that can lead to serious complications. In recent years neurobiology and psychiatry have focused much more interest on it.

Thus, studies, such as the one carried out at the University of Cambridge, are examples of how an attempt is made to specify the diagnostic criteria so as not to see it only as a type of schizophrenia.

He Diagnostic and Statistical Manual of Mental Disorders (DSM-5) already describes it as a condition that can appear linked to a large number of psychiatric disorders. Let's see, therefore, what are the main types of catatonia.

  • Akinetic catatonia. It is the most common, the one that manifests itself with sudden interruptions, such as being unable to speak and not responding to stimuli. Suddenly, the person sits or lies down, staying in a rigid and strange position.
  • Excited catatonia. In this typology the patient can move, but he does so impulsively, agitated and even violently. You may be defensive and suddenly show mimetic behavior. That is, they imitate the movements of others.
  • Malignant catatonia. In these cases, the catatonia itself is compounded by other serious conditions, such as heart or respiratory problems. It is then when serious situations occur, in which the person suffers dehydration, kidney failure and risk of having heart attacks.

In addition to mobility problems, catatonia can cause speech difficulties.

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Common symptoms of catatonia

When identifying this disorder of neurological origin, it is convenient to start from a series of diagnostic criteria. They can be physical or psychological. We detail them below.

Physical symptoms

The person is unable to perform any type of movement. Evidence of striking muscle stiffness that completely limits movement and contraction. She is "petrified", she cannot move her joints and, on average, they are left in unnatural and very conspicuous postures.

  • Their gazes are fixed on the void.
  • They suffer from a forced grasp reflex. That is, their fingers are stiff and hold tightly to what is put on their hand.
  • They also show states of stereotypes, agitation and stupor.
  • Likewise, To proceed with the diagnosis, what is known as waxy flexibility must appear. It consists of a state of passive resistance, in which they cannot flex their joints by themselves. However, when being manipulated and moved by other people, it is possible to change your posture and position.
  • They can become self-injurious.

Psychological symptoms

In many cases, catatonia is linked to depression. The patient shows some very common and striking alterations in his state of mind.

  • Recurring feelings of sadness appear.
  • Loss of interest in their responsibilities, hobbies, social relationships, etc.
  • Feelings of helplessness, dejection or irritability.
  • They feel unable to take control of their own life. They cannot think, concentrate, or make decisions.
  • Intense emotionality is also common, that is, they present sudden mood swings, such as going from euphoria to absolute sadness.

On the other hand, their problems with language are striking. They suffer echolalia (repeating what others say), mutism (they stop talking), or else they show excessive verbiage.

Some of the experts in this type of condition suggest that, perhaps, it is these psychological symptoms that cause motor inactivation and those catatonic positions.

What Causes Catatonia?

Catatonia is a disorder of neurological origin. This means that the triggers can be multiple if the alterations in the central nervous system are taken into account.

Dysfunctions in different areas of the brain

Exploring the possible triggers at the neuroanatomic level, it has been possible to observe, for example, alterations in the right posterior parietal cortex. Also in the prefrontal area and in the medial orbitofrontal region. All these structures are related to the motor aspect and emotional alterations.

Neurochemical factors

At the hormonal and neurochemical level, they have been different dysfunctions in amino acids as important as GABA, the main inhibitor of the central nervous system. Patients with catatonia have a lower level of adherence and a lower amount of this critical element.

On the other hand, alterations have been observed in the production and functioning of glutamate, serotonin and dopamine.

Mental illnesses and disorders

Beyond the neurochemical or neuroanatomical causes, there are other organic and psychiatric factors that can explain catatonia. Studies, such as the one carried out by Dr. Jonathan P. Rogers at the University of California, show that attention must be paid to immune aspects. These would be some examples:

  • Bacterial meningitis or encephalitis.
  • Cerebral malaria.
  • Unspecified central nervous system infection.

On the other hand, It is also possible to develop catatonia from the following conditions:

  • Brain tumors.
  • Cerebrovascular accidents
  • Drug addiction.
  • Schizophrenia.
  • Parkinson's disease.
  • Brief psychotic disorder.
  • Mood disorders such as bipolarity or depression.
  • Posttraumatic stress.

Catatonia is a disorder of neurological origin. Medications such as benzodiazepines are usually chosen for its treatment.

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Treatments available

The most decisive thing when choosing the treatment for catatonia is to know what causes it. A patient with schizophrenia is not the same as a person with meningitis. Therefore, it is best to follow the following guidelines:

  • Hospital admission of the patient to make an adequate diagnosis with the pertinent clinical and psychiatric tests.
  • Choice of drugs. In general, benzodiazepines such as Lorazepam are usually the most suitable.
  • Psychological therapy to treat the emotional and social aspect and, above all, to educate the patient and family about this neurological disorder. They need to understand its characteristics and impact.
  • Tracing.
  • In case of not perceiving progress, it opts for the electroconvulsive therapy (ECT). To this day, this treatment is highly effective. It should be noted, however, that it is a very different approach to that practiced in past decades. It is based on sending controlled electrical impulses to stimulate certain areas of the brain.

Facts about catatonia

Catatonia has an incidence in the population that ranges between 5 and 10%. It rarely appears in children or adolescents. In general, it has multiple neurological and psychiatric origins. It can appear as a consequence of encephalitis, or as an effect of drug use.

It is important in all cases to proceed to a correct diagnosis. Likewise, it is essential to request clinical attention as soon as the symptoms presented here appear. It is a serious condition that, in certain cases, can be fatal.

It is recommended that anyone with catatonia attend occupational therapy or psychoeducation sessions to better understand their reality and know how to act and prevent their attacks.