Sometimes, severely ill patients diagnosed with psychological disorders suffer from acute comorbidities. Often common in psychiatric conditions like schizophrenia, patients might remain stagnant in a fixed position for a long time or follow repetitive movements or mutism patterns. In such cases, it becomes very difficult to get through the patients' diagnosis that they cannot provide care. Such a condition is known as catatonia.
Catatonia entails a group of symptoms such as lack of movement and communication, anxiety, disorientation, and restlessness. It was regarded as a kind of schizophrenia until recently. With medical science advances, it is now known that various physical ailments and other mental disorders can also cause an individual to become catatonic. It became evident in recent decades, as stated by the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) that catatonia and schizophrenia are distinct.
DSM-5 lists the diagnosis of catatonia syndrome as a specifier to mood disorders, psychotic disorders, general medical conditions, and catatonia not otherwise specified, and with this, catatonia is a highly comorbid condition. Retarded and enthusiastic catatonia are two common subtypes of catatonia. While enthusiastic catatonia is characterized by restlessness or agitation with increased blood pressure and heart rate, the retarded catatonia is characterized by sluggish movement and unresponsiveness.
A thorough assessment for the primary and secondary indications of catatonia is required in patients with behavior disorders who exhibit an abrupt onset of mutism, negativism, posturing, and rigidity. The existence of two or more symptoms over 24 hours constitutes a sufficient premise for the diagnosis.
Its major symptoms include:
Stupor - Stupor is a state in which no one around the individual can detect any conscious mental activity.
Catalepsy - A locked or frozen posture due to catalepsy.
Waxy flexibility - Little, undetectable resistance to physical manipulation.
Mutism - Little to no verbal reaction, which aphasia cannot account for.
Negativism - The opposition or inability to follow directions or external stimuli.
Echolalia - The imitation of another's speech.
Echopraxia - Replicates another's motions.
Mannerism - Exaggerated or routine facial expressions or movements
Grimacing - Having distorted facial expressions.
Stereotypy - The act of repeating actions without a clear reason.
Agitation is emotional restlessness that is unrelated to environmental influences.
Catatonia does not have a single cause; rather, it is frequently linked to another mental or physical problem. Catatonia can occur in people with severe traumatic experiences and those with psychiatric conditions such as schizophrenia, bipolar disorder, and major depressive disorder.
Catatonia can result from or accompany several medical illnesses, including encephalitis and neurodegenerative diseases. The illness may also be accompanied by infections, severe vitamin B12 deficiency, autism, or exposure to toxins. Additionally, catatonia might be brought on by medication side effects, dysfunctional neurotransmitter activity in the brain, or an unidentified etiology.
Benzodiazepine drugs such as lorazepam are frequently used to treat catatonia. Benzodiazepines have a soothing impact by acting on the brain and nerves and can be used to treat anxiety, alcohol withdrawal symptoms, and insomnia. In many situations, catatonia is accompanied by anxiety; benzodiazepines relieve anxiety by boosting the effects of the GABA and controlling abnormal brain nerve activity. In many cases, healing signs might be seen within a few hours. It is advised that people suffering from catatonia continue taking benzodiazepines until any underlying conditions are cured to avoid relapsing into a catatonic state. In some cases, patients may need to continue taking the drug indefinitely to keep the condition under control.
In order to treat catatonia, electroconvulsive treatment (ECT) is also used. ECT should be used as a secondary therapy option since patient permission in a catatonic condition may be challenging. After several days, people who do not respond to benzodiazepines typically respond to ECT. However, early therapy with ECT may be preferred in some circumstances, especially if the patient has malignant catatonia.
Once the patient is asleep, ECT is administered painlessly in a monitored medical environment. The brain receives an electric shock, resulting in a brief seizure that lasts around a minute. As a result, the neurotransmitter flow in the brain is altered, which can lessen the symptoms of catatonia. In some circumstances, patients may get anesthetic painkillers or nutrients in the case of co-occurring illnesses like vitamin insufficiency. The prognosis for recovery is good, especially for those having catatonia in conjunction with mood problems. Catatonia can be severe and potentially fatal, but with quick and appropriate treatment, catatonia can be controlled.
Catatonia can occur as a single episode or as recurrent episodes over several months or years—people who have the illness experience severe distress, which often affects their relationships and occupational functioning. When suffering from catatonia, a person will be unresponsive, may seem to be in a trance, and may also adopt odd postures or expressions. Severe catatonia can put a person in danger of self-harm and hyperthermia. People who have affective symptoms may go through protracted phases of catatonia remission. While symptoms may occasionally appear in conjunction with the neuroleptic malignant syndrome, people with schizophrenia often experience catatonia as a chronic illness. Once diagnosed, catatonia can be treated, and people typically respond well to the treatment. Several treatments may be provided to regulate the condition, typically in the form of medicine or electroconvulsive therapy.