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Catatonic schizophrenia: What is it,Symptoms,Test & treatment(2023)

Catatonic schizophrenia is a subtype of schizophrenia characterized by motor disturbances and a range of abnormal behaviors.

Table of Contents

Catatonic schizophrenia : Signs & Symptoms

symptoms-signs-of-catatonic-schizophrenia
symptoms-signs-of-catatonic-schizophrenia

1.Motor Abnormalities:

  • Paranoia: A state of decreased responsiveness, immobility, and unresponsiveness to the environment.
  • Catalepsy: waxy flexibility, where the person can maintain a rigid posture even when physically uncomfortable or being held for an extended period of time.
  • Mutism: Lack of speech or minimal verbal responses.
  • Posture: assuming a fixed and abnormal body position held for an extended period of time.
  • Movement: Purposeless, excessive, or repetitive motor activity.
  • Negativism: Resisting or refusing instructions or maintaining resistance to attempts to move or be placed in position.
  • Stereotypes: Repetitive, seemingly purposeless movements, gestures, or vocalizations.

2.Disturbances in volition and behavior:

  • Apathy: Low motivation, lack of interest or enthusiasm.
  • Social withdrawal: Avoidance of social interaction and isolation.
  • Emotional disturbances: flattened affect (reduced emotional expression) or inconsistent emotional responses.
  • Disorganized behavior: Displaying unusual or unpredictable behavior patterns.
  • Echolalia: Repeating or echoing words or phrases spoken by others.
  • Echopraxia: Imitating or copying the movements or gestures of others.

Diagnosis:

To diagnose catatonic schizophrenia, mental health professionals follow the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). major criteria for schizophrenia, which are as follows:

1.Two or more of the following present for a significant portion of time during a one-month period (or less if successfully treated):

  • Confusion
  • nightmare
  • disorganized speech
  • highly disorganized or catatonic behavior
  • negative symptoms (eg, reduced emotional expression)
  • Social or occupational impairment: Symptoms must have a significant impact on the person’s ability to function in daily life.

2.Social & Occupational Dysfunction: The symptoms must have a significant impact on the person’s ability to function in daily life.

3.Duration: Persistent signs of disturbance persist for at least six months, including at least one month of active-phase symptoms

4.Rule out other conditions: symptoms are not better explained by other conditions or substances

Catatonic Schizophrenia Causes:

Like other subtypes of schizophrenia, the exact cause of catatonic schizophrenia is not fully understood. It is likely that a combination of genetic, environmental, and neurobiological factors contribute to the development of the disorder. Here some of them are mentioned below–

Neurochemical imbalances:

Schizophrenia is associated with an imbalance in certain brain chemicals, particularly dopamine and glutamate. These neurotransmitters are involved in the regulation of mood, perception, and cognition, and abnormalities in their functioning may contribute to the symptoms of catatonic schizophrenia.

Genetic Factors:

closeup-of-genetic-predisposition
closeup-of-genetic-predisposition

Schizophrenia, including catatonic schizophrenia, tends to run in families, suggesting a genetic component. Certain genes and gene variations have been identified as potential risk factors. However, it is important to note that having a genetic predisposition does not guarantee the development of the disorder.

Structural and Functional Brain Abnormalities:

People with schizophrenia, including those with the catatonic subtype, often have structural and functional abnormalities in the brain. These may include changes in brain volume, altered connectivity between brain regions, and abnormal activity in specific areas of the brain. These abnormalities may affect the processing of information and may contribute to the symptoms seen in catatonic schizophrenia.

Environmental Factors:

While genetics plays an important role, environmental factors may also influence the development of catatonic schizophrenia. Prenatal factors such as maternal infection, complications during birth, and exposure to certain toxins or substances during pregnancy have been implicated. Additionally, stressful life events, childhood trauma, and social factors may contribute to the onset and exacerbation of symptoms.

It is important to note that these factors are not deterministic, and not everyone with genetic or environmental risk factors will develop catatonic schizophrenia. The interplay between these factors and individual susceptibility is complex and still not fully understood. Ongoing research aims to shed more light on the causes of catatonic schizophrenia and to improve our understanding and treatment of the condition.

Catatonic Schizophrenia :Test/Diagnosis

There is no specific test to diagnose catatonic schizophrenia. The diagnosis is made on the basis of a comprehensive evaluation by a qualified mental health professional, usually a psychiatrist. Assessment includes an observation of the person’s symptoms, medical history, and family history, as well as their behavior and functioning. The diagnostic process may include:

1.Clinical Interview:

That psychiatrist will conduct a detailed interview to gather information about the person’s symptoms, their onset, duration, and impact on daily life. They will also inquire about any family history of mental illness and other relevant factors.

2.Medical and Physical Examination:

The psychiatrist may conduct a physical exam and order medical tests to rule out any underlying medical conditions that may be causing or contributing to the symptoms. Certain medical conditions, such as brain tumors or metabolic disorders, can sometimes present with catatonic schizophrenia-like symptoms.

3.Psychological assessments:

Additional psychological assessments or tests may be performed to assess cognitive functioning, social functioning, and to gather more information about the individual’s overall mental health.

Early Signs Of Catatonic Schizophrenia:

The early symptoms of catatonic schizophrenia, like other subtypes of schizophrenia, can vary from person to person. However, there are some common early signs and symptoms that may indicate the presence of the condition. It is important to note that experiencing these signs does not necessarily mean that the person has catatonic schizophrenia, but they may warrant further evaluation by a mental health professional. Some early signs include

Social Withdrawal:

A person may begin to isolate themselves from social interactions, withdraw from friends or family, and show a decline in their interest and participation in social activities.

Changes In Behaviour:

Early signs may include involuntary changes in behavior, such as decreased motivation, decreased ability to perform daily tasks or responsibilities, or a decline in personal hygiene.

Unusual beliefs or experiences:

Early signs may include the development of abnormal beliefs, such as paranoid thoughts or feelings of being seen, as well as experiences of perceptual abnormalities such as hearing voices or seeing things that others do not.

Cognitive Difficulties:

Difficulties may emerge with thinking, memory, and concentration, which can lead to problems with decision making, problem solving, or organizing thoughts. Early signs may include a change in the person’s emotional expression or affect. They may display low emotional expression, appear emotionally flat, or have inappropriate or inconsistent emotional responses.

Changes in sleep patterns, such as insomnia or excessive sleepiness, may be present in the early stages of catatonic schizophrenia.

Medications For Catatonic Schizophrenia

>Antipsychotic Medications:

Antipsychotic drugs, also known as neuroleptics, are a class of drugs primarily used to treat psychotic symptoms associated with various mental health conditions, including schizophrenia and catatonic schizophrenia. These drugs work by targeting and regulating neurotransmitters in the brain, particularly dopamine and sometimes serotonin. There are two main categories of antipsychotic drugs

1.Typical Antipsychotics (First-Generation)

  • Haloperidol (Haldol)
  • Chlorpromazine (Thorazine)
  • Fluphenazine (Prolixin)
  • Perphenazine (Trilafon)

Typical antipsychotics primarily block dopamine receptors in the brain, specifically the D2 receptor. While effective in managing positive symptoms (such as hallucinations and delusions), they may have more side effects than atypical antipsychotics.

2.Atypical Antipsychotics (Second-Generation)

  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Clozapine (Clozaril)

Atypical antipsychotics have a broad receptor-binding profile, targeting both dopamine and serotonin receptors. They are effective in managing both positive and negative symptoms of schizophrenia, and generally have a lower risk of extrapyramidal side effects (such as muscle stiffness or tremors) than typical antipsychotics.Clozapine is particularly useful for treatment-resistant cases, but requires careful monitoring because of the risk of agranulocytosis (a blood disorder).

>Benzodiazepines:

Benzodiazepines are a class of drugs commonly prescribed for their sedative, anxiolytic (anti-anxiety), muscle relaxant and anticonvulsant properties. While they are not typically used as a primary treatment for schizophrenia, including catatonic schizophrenia, they may sometimes be prescribed for specific purposes or as adjunctive therapy. Some commonly prescribed benzodiazepines include:

  • Lorazepam (Ativan)
  • Diazepam (Valium)
  • Clonazepam (Klonopin)
  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Oxazepam (Serax)

Benzodiazepines work by increasing the effects of a neurotransmitter in the brain called gamma-aminobutyric acid (GABA), which has inhibitory properties and can help reduce anxiety, induce relaxation, and relieve muscle tension. They may be useful in some conditions associated with catatonic schizophrenia, such as:

  • Catatonic Excitement
  • Catatonic Rigidity/posture
  • Anxiety or Panic symptoms

It is important to note that while benzodiazepines may provide short-term symptom relief, they are generally not recommended as a long-term treatment due to the risk of dependence, tolerance, and potential for abuse. They should be used with caution and under the supervision of a healthcare professional.

The decision to prescribe a benzodiazepine for catatonic schizophrenia or any other condition should be made by a qualified healthcare provider, taking into account the individual’s specific needs, potential risks, and benefits. Regular monitoring and follow-up appointments are important to assess the effectiveness of the drug and reduce potential side effects.

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