Catatonic SchizophreniaThis is a featured page

Classification:
Catatonic schizophrenia is a subtype of schizophrenia. A very rare form of schizophrenia, catatonic schizophrenia is
"characterized by severe disturbances in motor behavior." [1] Because this type of schizophrenia is characterized by motor symptoms, it is sometimes mistaken for a psychotic mood disorder. [3]

Definition:
Catatonic schizophrenia is "a type of schizophrenia marked by symptoms such as rigidity, stupor, excitement, or mania." Patients with catatonic schizophrenia generally display two types of behaviors - excitement or stupor. "Those experiencing catatonic excitement will exhibit manic behaviors such as babbling or speaking incoherently, while those experience catatonic stupor remain in a stupor for extended periods of time."[3]
Catatonic Schizophrenia - Uncle Wundt
Woman with Catatonic Schizophrenia [13]

Catatonic Schizophrenia - Uncle Wundt
Still image from Schizophrenia: Catatonic Type by Stanley Jackson (1951) [14]

Who & When:

Men "usually experience their initial catatonic episode in their teens or 20s, while women usually experience first episodes in their 20s or early 30s." [2] Catatonic schizophrenia "seldom occur after age 45 and only rarely before puberty." Research indicates that catatonic schizophrenia "affects men and women equally and occurs at similar rates in all ethnic groups around the world." [4]

Causes:

* Psychological problems.
* Biological ( Early brain development)
* Brain abnormality.
* Environmental factors.
* Signs and Symptoms of Catatonic Schizophrenia
* Common Sign and Symptoms of Catatonic Schizophrenia
* Social withdrawal.
* Unusual behaviors.
* Anxiety.
* Decline in daily functional abilities.
* Loss of interest or volition.
* Persecutory thoughts.
* Poor hygiene. [5]

Symptoms:

Early signs of schizophrenia, "such as social withdrawal, unusual behaviors, anxiety and decline in daily functional abilities, may begin gradually before the primary symptoms of schizophrenia," - known as psychosis.
Distinguishing features of catatonic schizophrenia include:
* Physical Immobility: People may be completely immobile and appear to be unaware of their surroundings. They may exhibit a partial immobility known as "waxy flexibility" (for example, if a person's arm is moved into a certain position, it will stay there for some time). This type of behavior is called catatonic stupor.
*Excessive Immobility: These motor activities (such as frenzied pacing, turning around in circles, flailing arms or making loud noises) appear to have no purpose or motivating factors. This kind of behavior is called catatonic excitement.
* Extreme Resistance: Without any apparent motivation, people with catatonic schizophrenia may not respond to instruction, may resist any attempt to be moved or may not speak at all. This kind of behavior is called negativism.
*Peculiar Movements: People may assume inappropriate or unusual postures, grimace for long periods or adopt unusual mannerisms. They may also exhibit habits known as stereotyped behaviors, such as repeating words, obsessively following a routine or always arranging objects exactly the same way.
*Mimicking Speech/Movement:
A person may repeatedly say a word just spoken by someone else (echolalia) or repeatedly copy a gesture or movement made by someone else (echopraxia).
*Other:
* Hearing voices or experiencing other sensory events that aren't real (hallucinations)
* Holding untrue beliefs about reality (delusions)
* Disorganized thinking
* Grossly disorganized, irrational behavior
* Absent or inappropriate emotional expression
* Inability to initiate plans [2]

Treatments:
Catatonic schizophrenia is a chronic disease. It can often be managed with coordinated treatments, including:
* Sedatives
* Antipsychotic medications that may prevent the recurrence or lessen the intensity of psychotic episodes
* Psychotherapy that complements drug treatment
* Electroconvulsive therapy
* Training in social and vocational skillsFor patients who don't respond to treatments, they may also need services, supervision or specialized care for potential problems such as:
* Difficulty taking medications as directed
* Risk of injury to self or others during severe catatonic stupor or excitement
* Generally unhealthy lifestyle
* Poor management of other medical conditions
* Risk of dehydration, malnutrition, exhaustion and extremely high fever
* Neglect of personal hygiene [6]

Therapies:
* Cognitive Behavioral Therapy: This is useful for patients with symptoms that persist even when they take medication. The cognitive therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, and how to shake off the apathy that often immobilizes them. This treatment appears to be effective in reducing the severity of symptoms and decreasing the risk of relapse.
*Self-help Groups: Although professional therapists are not involved, the group members are a continuing source of mutual support and comfort for each other, which is also therapeutic. People in self-help groups know that others are facing the same problems they face and no longer feel isolated by their illness or the illness of their loved one. The networking that takes place in self-help groups can also generate social action. Families working together can advocate for research and more hospital and community treatment programs, and patients acting as a group may be able to draw public attention to the discriminations many people with mental illnesses still face in today's world.

Case Study #1:
Subject: 21 year-old Asian man
History: First presented to psychiatric services as an out-patient (A patient who goes to a hospital or clinic for treatment but does not have to stay overnight) at 19. Had been using cannabis (The botanical name for the plant from which marijuana comes, used sometimes for medical purposes) in the two years prior to presentation.
Symptoms: Two month history of social withdrawal associated with paranoid ideation, delusions of reference and delusions of thought interference.
Test Results: CT brain scanning, EEG and routine blood testing were all normal. - a diagnosis of probable paranoid schizophrenia was made.
Follow-up: His condition continued to deteriorate. Over the next two months he became retarded and mute, and was admitted to hospital. He was also exhibiting several abnormalities of movement and behaviour including posturing, grimacing, rigidity, negativism and ambitendency. His therapy was changed to olanzapine 10mg per day and diazepam 5mg on an as required basis for agitation. After two months there was a significant improvement and he was discharged home. However, he was readmitted six months later with prominent signs of mutism and movement disorder. He was noted to be walking backwards and exhibited the distinctive facial expression of schnauzkrampf. At this point his diagnosis was changed to that of catatonic schizophrenia. [7]

Case Study #2:
One patient who postured every morning during shaving. He started to shave himself and remained then, with the razor in his hand and a lifted arm, for hours in that position until his wife came in and "depositioned" him. Another example is a woman who, every morning by opening her wardrobe, remained in a position with a lifted arm keeping the door of the wardrobe in her hand.
Both patients were admitted into clinic where they did neither speak nor move at all. On admission it was possible to "position" their limbs in the most bizarre and uncomfortable positions against gravity without any resistance by the patients themselves. Once the examiner positioned the limbs into one particular position they remained in that position without showing even the slightest change.
These cases are typical examples of posturing and catalepsy where patients are well able to initate and execute movements but seem to be unable to return to the initial or resting position in order to start a new movement. [12]
Catatonic Schizophrenia - Uncle Wundt
"Active posturing" in a group of catatonic patients [12]

Related Disorders:
* Autistic Spectrum Disorder: This can be associated with Catatonic Schizophrenia through a range of physical and psychological conditions. They are best regarding as effects of underlying causes and not as causal entities. They share the fuzziness inherent in concepts defined only by a mix of behavioural features, even when operational criteria have been standardised, as with the ICD-10 classification. There is a marked overlap of the behavioural features of the two disorders. For example, motor stereotypies, mannerisms, rituals, mutism, echolalia and negativism, among others. [8]
* Bipolar Disorder I & II: Both catatonic schizophrenia and bipolar disorder are categorized under Catatonia. [9] [15]
* Major Depression: 5%-50% of cases of catatonic schizophrenia occur in association with Mood Disorders. [10]
* Encephalitis Lethargica: In the early 1900s, a condition known variously as epidemic encephalitis, encephalitis lethargica, or Von Economo's disease was described. Case descriptions reported during this time bear striking similarities to our modern definitions of catatonia. [11]
* Schizophrenia: A lot of treatments/therapies offered for patients with catatonic schizophrenia are also used for other types of schizophrenia since a lot of the symptoms overlap.

Works cited:
[1] Catatonic Disorders
[2] Catatonic Scizophrenia
[3] About.com: Catatonic Schizophrenia
[4] Medicine.net: Schizophrenia Symptoms
[5]Catatonic Schizophrenia Causes Symptoms Information With Treatment
[6] Mental Health: Catatonic Schizophrenia Treatments
[7] Catatonic Schizophrenia and the Options for Treatment
[8] Catatonia in Autistic Spectrum Disorders
[9] About.com: What Are Catatonic Features?
[10] Major Depressive Disorder Specifiers
[11] Malignant Catatonia Secondary to Sporadic Encephalitis Lethargica
[12] What Catatonia Can Tell Us About "Top-down Modulation": A Neuropsychiatric Hypothesis
[13] Schizophrenia: Public Journal
[14] NFB: Collection
[15] Catatonia


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