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Medicine knows catatonia as a psychomotor complex of behavioral, emotional and motor symptoms. Catatonic symptoms can occur in schizophrenia, depression, and neurological disorders. If drug treatment fails, electroconvulsive therapy is performed.

What is catatonia?

Catatonia is a special case for emergency physicians. If an affected person shows the symptoms of catatonia, an emergency physician must be alerted and first aid measures initiated.

Catatonia is a psychomotor syndrome that can occur in the context of major depression, catatonic schizophrenia or metabolic disorders and neurological diseases. The syndrome was first described in the 19th century by Kahlbaum, who associated it as a symptom complex with depression. Kraepelin and Bleuler later described catatonia as a sub-form of schizophrenia. See AbbreviationFinder for abbreviations related to Catatonia.

A special form of catatonia is pernicious or malignant catatonia, which can become life-threatening if left untreated. In addition to depressive and schizophrenic states, excitement can also be catatonic. This catatonic excitement is also known as catatonic raptus and manifests itself in the opposite way to catatonic depression. In all cases of catatonia, the patients show symptoms on an emotional level, as well as behavioral problems and physiological limitations, which primarily affect motor skills.

The complex was described by Kahlbaum, who first described it, as a mental and muscular state of tension that can be triggered by depression. Today, medicine knows that catatonia is not directly linked to a specific diagnosis.

Causes

The causes of catatonia are varied. The syndrome can occur, for example, in the context of primary diseases such as AIDS. Especially in the neurological form of the disease, patients often show catatonic traits. Other neurological diseases are also possible causes. In this case, a physiological change in the brain tissue causes the symptoms.

Alcohol consumption or the influence of drugs can also trigger catatonia. Another conceivable cause is a metabolic disorder. When schizophrenia triggers catatonia, environmental, genetic, and psychodynamic factors are believed to be at play. If depression can be uncovered as the cause of the catatonia, the main causes are losses, stress and excessive demands.

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 can also occur in the context of a dissociative neurotic disorder.

Symptoms, Ailments & Signs

In catatonia, the entire body cramps into a state of tension with increased muscle tone. Patients remain in a rigid position that is held for several hours. They usually participate in passive movements, maintaining their body position for hours after the movement. Waxy muscle resistance is exhibited during passive movement. In addition, mutism is usually present.

This means that those affected no longer speak or only repeat what they have heard. In this context, there is also talk of echolalia. Some patients mainly repeat words and sentences that have a special sound and, for example, rhyme. What is asked of them, catatonic people either do mechanically or engage in negativism.

In doing so, they are doing the exact opposite of what was asked of them. In the case of catatonic schizophrenia, symptoms can range from intense excitement to extreme passivity. For example, in catatonic excitement, patients throw themselves on the floor, grimace, and exhibit aimless aggressive behavior. The voluntary movements are angular and disharmonious.

Diagnosis & course of disease

The doctor diagnoses catatonia primarily through observation and passive movements. An MRI may be required to rule out neurological disorders as a cause. During the anamnesis, the doctor finds out whether psychological abnormalities have already occurred in the past. Using this knowledge, he assesses the catatonia in the context of a primary disease.

Complications

Catatonia causes a variety of symptoms. Those affected suffer from severe psychological stress and motor impairments, which significantly reduce the quality of life of the affected person. Those affected may also be dependent on the help of other people in their everyday lives.

The patient’s body is very tense and strained, so that relaxation often does not occur. Likewise, the muscles can no longer be easily moved and the patients can no longer speak properly. It is not uncommon for what other people have said to be repeated. Catatonia can also lead to aggressive behavior.

Therefore, in some cases, the treatment of this disease must also take place in a closed clinic. Self-injurious behavior can also occur. Due to the neurological limitations, breathing difficulties or fever often occur.

The treatment of catatonia, however, proves to be relatively difficult, since the psychological symptoms in particular cannot be completely restricted in every case. Complete healing of the patient is often not possible. Should epileptic seizures occur, these must also be limited. If so, the life expectancy of the person affected may be reduced.

When should you go to the doctor?

Catatonia is a special case for emergency physicians. If an affected person shows the symptoms of catatonia, an emergency physician must be alerted and first aid measures initiated. If people show stiffness all over their body, they need urgent medical attention. If an unnatural position of the body is observed that is frightening to outsiders, where no part of the body can be moved at will, a doctor should be called. If the person concerned is suddenly no longer able to speak or to react meaningfully to being spoken to directly, he needs medical care as soon as possible.

If there is a slower reaction to instructions or if the opposite of what is desired is carried out, these are indications of existing health irregularities. Some patients in a state of catatonia speak in rhymes or with a particular sound rhythm. Since only medically trained personnel can react adequately to the condition of the catatonia and the existing underlying disease, a doctor must be present immediately.

Those affected often remain in a stiff position for several hours and cannot ingest food or sufficient liquid to supply the organism. A doctor should be contacted within minutes of the onset of catatonia. If movements are initiated from the outside, there is often a waxy perception of the patient’s muscles.

Treatment & Therapy

Catatonia can sometimes be life-threatening. The patients take neither food nor liquid. Therefore, catatonic phenomena must be reacted to as quickly as possible. If left untreated, catatonia can progress to malignant catatonia. A high fever occurs without any signs of inflammation or infection. The muscle tension destroys the muscles bit by bit as part of this phenomenon.

In addition, vegetative dysregulations can occur, which result in respiratory insufficiency, for example. In order for the patient to be spared this life-threatening form of catatonia, the attending physician carries out psychopharmacological therapy. This therapy mainly corresponds to the administration of GABAergic substances. If a mental disorder is suspected as the cause, the primary disease is also treated in a targeted manner. 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 regress despite all efforts, electroconvulsive therapy is carried out. Electrical impulses are given to the patient under anesthesia, which last for several seconds. The impulses trigger a minimal epileptic seizure. Electroconvulsive therapy is usually performed eight to twelve times over a period of two to three days.

Outlook & Forecast

Catatonia represents a life-threatening condition for the patient. In severe cases, the affected person dies prematurely, since important vital functions cannot take place adequately in this physical condition. Without the fastest possible and intensive medical care, the affected person has little chance of alleviating their existing symptoms. Complications and secondary diseases are to be expected, which lead to a severe impairment of the quality of life.

Even with the fastest possible medical care, long-term impairments and health problems can be expected. Catatonia is a symptom of an existing underlying disease. This is usually severe and can only be treated with long-term therapies. In many cases, a permanent or long-term clinical stay of the person concerned takes place because of a mental disorder. The patient is not in a position to take responsibility for shaping his or her lifestyle. The existing symptoms do not allow this even after the catatonia has been dealt with.

Due to the present cause of catatonia, the overall condition of the affected person must always be taken into account when making a prognosis. Although the muscle tension has been successfully managed and the state of health has stabilized, the patient cannot be discharged from treatment as recovered. Further follow-up treatments and daily medical attention are necessary for people who have developed catatonia.

Prevention

The causes of catatonia are varied. Although intoxication catatonia may be preventable, neurological catatonia specifically is not preventable.

Aftercare

In most cases, those affected by catatonia have very few and only very limited measures and options for direct aftercare. First and foremost, therefore, a quick and, above all, early diagnosis must be made in order to prevent the occurrence of other complications and symptoms. Self-healing is also not possible.

Most of those affected are dependent on taking various medications in order to permanently and properly relieve the symptoms. Care should always be taken to ensure that it is taken regularly and that the dosage is correct in order to permanently limit the symptoms. If anything is unclear or if you have any questions or side effects, you should always contact a doctor first.

Likewise, many of those affected by catatonia depend on the help of their own families 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 mental upsets. The disease may also reduce the life expectancy of the person affected, since it cannot always be completely cured. Contact with other patients can also be useful.

You can do that yourself

In the case of catatonia, the person affected has no opportunity to help themselves or to optimize their everyday life due to the symptoms present. The body cannot be moved and consequently in this state no changes can be made that contribute to an improvement in general well-being.

The patient is dependent on medical care from doctors, relatives or nursing staff. As far as they can, they can implement small things for the sick person in the organization of everyday life. Since the relatives of a patient are often emotionally overwhelmed by the situation, they often need help and support in everyday life. You can join a support group for family members. There is an opportunity to intensively exchange ideas and experiences with others affected. This contributes to an emotional relief. The relatives can count on mutual support in a self-help group and receive tips for dealing with the circumstances.

The use of relaxation techniques is also advisable. With proven methods such as yoga, meditation, autogenic training or breathing techniques, family members can reduce stress and at the same time gain new strength to cope with everyday life. Whenever possible, you should not attempt to care for a person with catatonia alone.