What Is Catatonic Schizophrenia? Symptoms and Treatments

Schizophrenia is a severe mental illness that affects a person’s thoughts and movement and can lead to psychosis, or lost touch with reality. Doctors may further divide schizophrenia into subtypes, such as catatonic, disorganized, paranoid, residual, or undifferentiated.

This article will focus on what is catatonic schizophrenia.

Catatonic schizophrenia is a subtype of schizophrenia where a person experiences distinct changes to their movements and behavior. They can no longer control their movements or behavior, nor do they respond to commands. If left untreated, this condition can have serious — and potentially deadly — consequences.

What Is Catatonic Schizophrenia?

An estimated 7.6 percent of those with schizophrenia have catatonic symptoms. To diagnose a person with catatonic schizophrenia, they must have at least three of the 12 symptoms:

  • Agitation that isn’t related to any outside stimulus
  • Catalepsy
  • Echolalia
  • Echopraxia
  • Grimacing
  • Mutism
  • Negativism
  • Odd mannerisms
  • Posturing
  • Stereotypies, or repetitive movements
  • Stupor
  • Waxy flexibility

Catatonia does not exclusively appear in those with schizophrenia. Those with mood disorders or some medical illnesses (such as an infection or trauma to the brain) can also experience catatonia.

What Causes Catatonic Schizophrenia?

While doctors identified catatonic schizophrenia symptoms more than 100 years ago, they haven’t yet fully determined what causes catatonic schizophrenia. Several theories exist, including:

  • Gamma-aminutbutyric acid (GABA): Some doctors believe a disruption of the neurotransmitter GABA can cause catatonic symptoms. GABA is responsible for regulating mood and thought in the body.
  • Orbitofrontal cortex: A lack of GABA leads to negative (absence of) emotions that inhibits the orbitofrontal cortex in the brain.
  • Dysregulation in the brain: Inhibition at the orbitofrontal cortex can lead to further disruptions in the brain, including in the dorsolateral prefrontal cortex. It’s at this location where doctors think catatonic symptoms ultimately arise.

What Triggers Catatonia in Schizophrenia?

Doctors believe triggers for catatonia in schizophrenia are multiple. These may include medical conditions, neurological changes, or psychiatric triggers. Currently, there is no known single trigger for catatonic schizophrenia.

Examples of Catatonia in Schizophrenia

The DSM-5-TR further classifies catatonia in schizophrenia under three types: akinetic, hyperkinetic, and malignant catatonia.1 Some symptoms of each catatonic schizophrenia type include:1

  • Akinetic: Also known as stuporous catatonia, this condition causes immobility, problems following commands, and echolalia (continually repeating another person’s words).
  • Hyperkinetic: Also known as excited catatonia, a person may have symptoms such as bizzare, hyperactive behavior and pacing. This type is less common than akinetic.
  • Malignant: Also known as Stauder’s lethal catatonia, this type causes extreme excitability that can be deadly.

Treatment and Prognosis

Catatonia can be harmful for a person with schizophrenia because they may not eat or drink as they normally would. Those with catatonia are vulnerable to dehydration, malnutrition, and pneumonia. Sometimes, a person may require intravenous (IV) fluids or tube feedings to ensure they can stay nourished and hydrated.

Another measure for catatonia treatment is discontinuing anti-psychotic medications as these may worsen catatonia until a person’s more severe symptoms have passed. A doctor will then treat a person with benzodiazepines, such as lorazepam, (first-line treatment) and sometimes electroconvulsive therapy (ECT). Doctors usually only prescribe ECT in those who do not respond to benzodiazepines.

Fortunately, if a person can receive catatonia treatment, their prognosis is usually favorable. However, they are vulnerable to relapse of their symptoms, and a doctor may recommend continuing ECT to reduce relapse risk.

Ready to take an in-depth look at catatonic schizophrenia? Symptom Media’s course, “Catatonia Associated With Schizophrenia” provides a deeper view into catatonia symptoms, diagnostic criteria, and treatments.