CATATONIA: meaning, symptoms, causes and treatment

Catatonia is a syndrome that can depend on both organic and psychic pathologies, commonly characterized by mutism, stupor, refusal to eat or drink, posture, and excitement or hypokinesia. Although catatonia has been associated with schizophrenia throughout the 20th century, thus affecting the first editions of major diagnostic manuals, it is often caused by affective disorders and medical illnesses or neurological.

With this Psychology-Online article we will try to describe this complex disease as well as possible, explaining it in a simple way and understandable for everyone, also for non-specialists, without neglecting the important and necessary theoretical references and scientific. We'll see the meaning, symptoms, causes and treatment of catatonia.

Index

1. What is catatonia according to psychology
2. Catatonia symptoms
3. Difference between catatonia and catalepsy
4. Causes of catatonia
5. Catatonia treatment

To better understand catatonia, we must go back to 1874, when the psychiatrist Karl Kahlbaum coined the term (katatonia) detecting it in patients with serious medical conditions, psychotic and with mood disorders: to the German doctor was, in effect, a disorder with behavioral and motor manifestations such as negativism, mutism, immobility, rigidity, mannerisms or stereotypes, accompanied by affective, cognitive and neurovegetative symptoms (Luchini et al., 2015).

Later, other psychiatrists such as Kraepelin and Bleuler redefined catatonia as a subtype of dementia praecox (Kraepelin, 1919) and the schizophrenia (Bleuler, 1911), a definition that influenced the entire clinic of the 20th century until the 1980s and 1990s, when numerous studies suggested that catatonic syndromes could be also implicated in affective disorders and in various medical conditions such as metabolic, endocrine, neurological, rheumatological and infectious (Luchini et al., 2015).

New discoveries and scientific evidence that have convinced the authors of the latest versions of the most important diagnostic classification systems to shift their focus to catatonia (Luchini et al., 2015). In particular, the International Classification of Diseases (ICD-10) has added the ability to diagnose a "organic catatonic disorder"(F06.1), while with the latest and fifth edition of the DSM (the diagnostic and statistical manual of mental disorders of the American Psychiatric Association) the syndrome has finally acquired a descriptive autonomy, thus being able to appear within other disorders (psychotic, depressive, medical etc.).

Catatonia is a syndrome characterized by a well-defined clinical picture, although it manifests with extremely variable signs and symptoms (Luchini et al., 2015). Have a stable course, and not malignant as thought in the past, described by various researchers as a generally cyclical disorder, with episodes of arousal, depression, and psychosis (Luchini et al., 2015).

Let's see then the descriptive criteria of the MDE-5 (APA, 2013), for which catatonia is defined by the presence of three or more of the following symptoms:

• Catalepsy, a momentary loss of mobility, voluntary and involuntary, and of the sensation of the body.
• Waxy flexibility, a decreased response to stimuli and a tendency to remain in a motionless posture.
• Stupor, a lack of critical cognitive function and level of consciousness.
• Agitation, not influenced by external stimuli.
• Mutism, a minimal or no verbal response (not applicable with aphasia).
• Negativism, that is, to oppose or not respond to external stimuli or instructions.
• Position, a spontaneous and active maintenance of the posture against gravity.
• Mannerisms, that is to say weird caricatures of ordinary stocks.
• Stereotypes, such as repetitive, frequent and non-targeted movements.
• Silly faces.
• Echolalia, that is, repeating the words spoken by another person.
• Echopraxia, the imitation of movements made by another person.

The authors of the manual have considered all the hypotheses and suggestions proposed in the field of catatonia in the last two decades, making a great effort to improve the utility and applicability of the clinical diagnosis of catatonia (Luchini et al, 2015). Indeed, for a possible diagnosis of catatonia according to the MDE-5 (APA, 2013), we have:

• Catatonia due to a general medical condition.
• Specifier "with catatonia”: schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, substance-induced psychotic disorder.
• Specifying with other mental disorder (i.e. neurodevelopmental disorder, bipolar disorder, major depressive disorder, other mental disorders).
• Catatonia disorder NOS (not otherwise specified).

The catalepsy, that is, the passive induction of a maintained posture against gravity (APA, 2013), can be considered as one of the many symptoms of catatonia, that it is a syndrome (a complex, more or less characteristic, of symptoms), and that precisely because of this it can also occur in non-catatonic patients: therefore, a catatonic may have catalepsy, but those with catalepsy are not necessarily catatonic.

The exact causes of catatonia are not yet fully understood: its epidemiological prevalence is unknown, but catatonia is believed to be common. catatonia caused by a medical condition, although it is most likely a syndrome underdiagnosed by psychiatrists and other doctors (Daniels, 2009). The renewal of interest in catatonia has led to a deepening of knowledge about the neurobiological bases of the phenomenon, although these are still insufficient for the formulation of a complete pathophysiological interpretation of the disorder (Bartolommei et al., 2012).

• Has been associated injury to various regions of the brain with the appearance of catatonic manifestations, but subjects with focal brain lesions located in these places rarely develop a catatonic syndrome (Bartolommei et al., 2012).
• Catatonic symptoms are common in combination with neurological diseases widely affecting the central nervous system, a finding that seems to support the hypothesis that catatonia is the result of neuronal circuit dysfunction involving multiple structures, rather than focal alterations (Bartolommei et al., 2012).
• Besides, the dysfunction of various neurotransmitter systems It has also been implicated in the pathogenesis of catatonic symptoms: since current pharmacological interventions modify the systems of the y-aminobutyric acid (GABA) -A, glutamate and dopamine, it is considered that the dysregulation of each of these neurotransmitter systems may be involved in catatonia (Daniels, 2009).

Once diagnosed, catatonia responds to specific treatments, although due to its correlation with schizophrenia, has induced the potentially harmful use of antipsychotics (Luchini et al, 2015). Despite the evolution in recent years of knowledge about the psychopathology and neurobiology of catatonia, however, many problems remain unsolved related to the diagnostic definition and its location in healthcare, a persistence of uncertainties that have an impact on daily clinical practice (Bartolommei et al., 2012).

The catatonic patient should be assisted by a multidisciplinary and integrated specialized team, and the correct management of the syndrome requires, above all, the identification and treatment of any medical condition (internist, neurological, toxic) responsible for the condition clinical, together with immediate and adequate support measures to reduce morbidity and mortality, associated with immobility and malnutrition, often present (Bartolommei et al., 2012). If not recognized immediately, catatonia can be complicated by serious somatic conditions, such as malnutrition, infections, muscle contractures, pressure ulcers and thromboembolism (Luchini et al, 2015).

To avoid complications

1. The first steps to prevent possible medical complications are anticoagulant treatmentwith subcutaneous heparin, in urinary catheterization and in adequate nursing care (Bartolommei et al., 2012).
2. We must bear in mind that catatonic patients generally refuse to feed and may experience a severe state of malnutrition and dehydration: in such a case, a hydration and one feeding adequate (Bartolommei et al., 2012).

To treat symptoms

Currently, the elective treatment of catatonic symptoms is:

• the administration of benzodiazepines intravenously: the most commonly used benzodiazepine is lorazepam, with which catatonic remission rates of 70% have been reported;
• conducting a cycle of therapy electroconvulsive (ECT): Electroconvulsive therapy appears effective in 85% of patients (Bartolommei et al., 2012).

Given their synergistic effect, the two treatments can be used together, although the dose of benzodiazepines should be reduced, as they can increase the seizure threshold (Luchini et al, 2015). Recent recent research has published some and little positive data on the treatments with GAbA-A agonists (Zolpidem) and NMDA antagonists (memantine, amantadine) (Luchini et al, 2015).

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Catatonia: meaning, symptoms, causes and treatment, we recommend that you enter our category of Clinical psychology.

• American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington DC: American Psychiatric Publishing.
• Bartolommei, N., Lattanzi, L., Callari, A., Cosentino, L., Luchini, F. & Mauri, M. (2012). Catatonia: a critical review and therapeutic recommendations. Journal of Psychopathology 2012;18:234-246.
• Daniels, J. M. D. (2009). Catatonia: Clinical Aspects and Neurobiological Correlates.The Journal of Neuropsychiatry and Clinical Neuroscience Fall 2009, 21: 4: 371-380.
• Luchini, F., Bartolommei, N., Benvenuti, A., Mauri, M. & Lattanzi, L. (2015). Catatonia from the first descriptions to DSM 5. Journal of Psychopathology 2015;21:145-151.