What Is Catatonic Schizophrenia? Symptoms and Treatments

Catatonic schizophrenia is a subtype of schizophrenia, characterized by significant disruptions in motor behavior and extreme psychological disturbances. Although not classified as a distinct diagnosis in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), catatonia remains a specifier that can occur in various psychiatric and medical conditions, including schizophrenia.

What Is Catatonia in Schizophrenia?

Catatonia involves abnormal movements, behaviors, and speech patterns. In people with schizophrenia, catatonia can manifest in two primary forms:

Motor immobility: A lack of movement or response to external stimuli, resulting in an almost trance-like state.

Excessive motor activity: Excessive and agitated motor activity appears purposeless or without external stimuli.

Key Symptoms of Catatonic Schizophrenia

The defining characteristics of catatonic schizophrenia involve extreme motor disturbances, but emotional and cognitive symptoms related to schizophrenia may also be present. Some hallmark symptoms include:

Catalepsy: Muscular rigidity; remaining in fixed, rigid postures for long periods without moving or speaking.
Mutism: A refusal or inability to speak, despite the physical capability to do so.
Waxy flexibility: When someone’s limbs remain in any position they are placed in by others, even if unnatural or uncomfortable.
Stupor: Lack of psychomotor activity.
Echolalia: Repeating words or phrases spoken by others.
Echopraxia: Mimicking the movements of others.
Agitation: Excessive movement or extreme restlessness that appears purposeless.
Negativism: Resistance to instructions or the active opposition to movement or requests, despite no apparent motive.
Posturing: Spontaneous and actively maintaining posture against gravity.
Mannerisms: Odd portrayals of normal actions.
Stereotypes: Repetitive and frequent unintentional movements.
Grimacing

What Causes Catatonic Schizophrenia?

Schizophrenia, including catatonic presentations, is thought to stem from a complex interaction of genetic, biological, and environmental factors. Some potential causes include:

Genetics: A family history of schizophrenia or other mental health conditions can increase risk.
Brain chemistry: Imbalances in neurotransmitters like dopamine and glutamate are strongly linked to schizophrenia symptoms.
Trauma or stress: Severe trauma or stress, particularly early in life, can contribute to the onset of schizophrenia.

Diagnosis of Catatonic Schizophrenia

While catatonic schizophrenia is no longer a separate diagnostic category in the DSM-5-TR, catatonia can still be specified in individuals diagnosed with schizophrenia or other psychiatric conditions. A thorough evaluation by a psychiatrist or mental health professional is necessary for diagnosis, including a thorough assessment of medical history, including onset and duration of symptoms, along with a complete neurologic examination. Other medical or neurological conditions, substance abuse, or medication side effects should also be ruled out as potential factors. Diagnostic testing such as neuroimaging, blood chemistries, blood count, serum iron, and lumbar puncture for autoimmune antibodies may also be considered.

A benzodiazepine challenge lasting 3-7 days is typically used for diagnosis, with a resolution of symptoms seen approximately 10 minutes after a benzodiazepine medication is administered.

Treatment Options for Catatonic Schizophrenia

Managing catatonia in schizophrenia requires an individualized approach that often combines medication, therapy, and supportive care. Key treatment strategies include:

Benzodiazepines: These anti-anxiety medications, like lorazepam, are frequently used as a first-line treatment for catatonic symptoms due to their calming effects.
Electroconvulsive therapy (ECT): ECT can be highly effective, particularly for individuals who do not respond to medication.
Antipsychotic medications: Although antipsychotics can help manage underlying schizophrenia, some individuals with catatonia may initially worsen with certain antipsychotics. Therefore, these medications must be carefully administered and monitored.
Supportive therapy: Psychotherapy and occupational therapy can help individuals regain social, emotional, and functional skills. Supportive care from family and healthcare providers is also crucial.

Outlook and Prognosis

The prognosis for catatonic schizophrenia varies widely depending on the severity of symptoms, the timing of treatment, and the individual’s overall health. Early intervention and appropriate treatment can significantly improve outcomes, helping individuals regain functioning and reduce the impact of catatonic episodes. Patients and families should be educated regarding the symptoms of catatonic schizophrenia, as relapse and remission of symptoms are common.

Catatonic schizophrenia, although no longer classified as a distinct subtype, remains a significant and challenging presentation of schizophrenia that involves severe motor and behavioral disturbances. Proper diagnosis and timely treatment are crucial for managing symptoms and improving quality of life.

By understanding the complexities of catatonia in schizophrenia, individuals, families, and healthcare professionals can work together to create effective treatment plans tailored to the individual’s needs.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Huang, M. W., Gibson, R. C., Jayaram, M. B., & Caroff, S. N. (2022). Antipsychotics for schizophrenia spectrum disorders with catatonic symptoms. Cochrane Database of Systematic Reviews, 2022(7). https://doi.org/10.1002/14651858.cd013100.pub2

Jain, A., & Mitra, P. (2023, July 24). Catatonic Schizophrenia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563222/

Jauhar, S., Johnstone, M., & McKenna, P. J. (2022). Schizophrenia. The Lancet, 399(10323), 473–486. https://doi.org/10.1016/s0140-6736(21)01730-x

Elissa Singson, MSN, APRN, PHN, CPNP-AC is an infectious disease pediatric nurse practitioner, health writer, and mother of two. She writes content to empower healthcare professionals, patients, and families with health and medical knowledge. She also loves to share tips on work productivity and efficiency to prevent healthcare provider burnout.