Catatonic Schizophrenia

What is Catatonic Schizophrenia?

Schizophrenia is one of the most talked about diseases in all of medical history, but many people have inaccurate ideas about the symptoms of schizophrenia.

Most people who think of schizophrenia imagine an eccentric, unkempt, and irrational individual, but schizophrenia often includes many other symptoms that many people simply aren’t aware of. A particularly devastating symptom of schizophrenia is catatonia. Often leading to the severely debilitating catatonic form of schizophrenia, this is considered one of the most dangerous symptoms of schizophrenia. Many people with catatonic schizophrenia find performing even basic tasks for themselves incredibly difficult to do. This bears an incredible toll on them and their families.

Overview of Catatonic Schizophrenia

Catatonic schizophrenia is essentially a form of schizophrenia in which a person remains in an inactive, almost vegetative state. In this state, known as catatonia, the person will often lay around doing nothing for long periods of time. The emotions of the catatonic are often affected as well with many experiencing anhedonia, or a lack of desire to do the things they enjoy.

Catatonic schizophrenics often neglect their health and well being as a result of the symptoms. They may not eat properly, fail to take care of their hygiene or take care of responsibilities. The result of these complications often leave catatonic schizophrenics unable to find employment and this often results in many becoming homeless. However, good support networks and medical treatment can help catatonic schizophrenics mitigate the issues surrounding their condition.

Catatonic schizophrenia is often confused with many other diseases. Many people falsely identify bipolar disorder and other psychiatric illnesses as catatonic schizophrenia, but these disorders simply are not related. The failure to correctly identify catatonic schizophrenia has caused many people to form inaccurate beliefs and stereotypes. Fortunately, doctors and catatonic schizophrenic patients are working to correct these false beliefs.

Symptoms of Catatonic Schizophrenia

The symptoms of catatonic schizophrenia are characterized by immobility and strange behavior.

Many people who witness the symptoms of catatonia believe the person afflicted is in a sort of stupor and is unable to respond to others. Delusions and paranoia are often seen as well although they may not necessarily occur right alongside the immobility. The primacy of catatonia and the less frequently observed or reduced severity of symptoms such as hallucinations and delusions distinguishes this disease from its counter psychotic schizophrenia. Although catatonic schizophrenia is different from psychotic schizophrenia, it may share a common origin with psychotic schizophrenia on a biological level.

The immobility associated with catatonic schizophrenia is not physical but rather neurological. Many patients believe they are unable to move because of supernatural or alien forces. For instance, a catatonic schizophrenic may believe that government agents have implanted a device in him or that invisible demons are keeping him restrained. These symptoms frequently lead to the hospitalization of patients if they persist.

During an episode of catatonic schizophrenia, a patient may exhibit a number of unusual behaviors. For instance, a patient may mimic the behavior or voice patterns of others. Outside of immobility, the patient may move in odd stereotyped ways such as walking with a “robotic” gait or moving their arms in broad strokes. The patient is sometimes not aware of the movements they are making.

Catatonic schizophrenia is a chronic disease and it tends to gradually damage the cognition of those who are afflicted with it. Particularly, the stupor is known to cause deficits related to verbal and spatial reasoning. Poverty of speech, a manner of talking in which sentences fail to express additional content, is a great example of this. Patients will generally find these symptoms easy to handle early on in their disease, but over time they will eventually find themselves unable to handle many important tasks as they age. Some patients do experience these issues as they grow older due to naturally better cognition overall, but they will still see a decline in the long term.

Generally, catatonic schizophrenia is an episodic disease which afflicts people over the course of their lifetime. The onset is usually some time in their teens or early 20s with the symptoms appearing gradually before a full blown episode happens. When an episode happens, they tend to last for weeks to months before the patient reaches a normal state again. Fortunately, for most patients, the symptoms will become much less frequent in older age, but significant damage can be observed.

Catatonic Schizophrenia Causes

The causes of catatonic schizophrenia are generally biological.

Research involving twin studies has shown schizophrenia is remarkably genetic, although the manifestations of symptoms may be influenced by environment. Genes associated with catatonic schizophrenia typically involve the production of dopamine and glutamate. In addition to genes, there is also a notable impact derived from gene expression. Epigenetics, the study of how environment affects gene expression, is yielding incredible new insights into how catatonic schizophrenia arises. Events affecting a family member in the past can have a profound effect on offspring later. For example, the children of Holocaust survivors have higher rates of schizophrenia compared to the general population.

Dopamine is an essential neurotransmitter involved in motivation, aggression, and other stimulative emotions. While schizophrenia, in general, is associated with high levels of dopamine, catatonia is associated with low levels of dopamine. The reasons behind this apparent paradox are an area of active research. Many researchers believe that the extremely high levels of dopamine associated with schizophrenia can eventually lead to a “dulling” that prevents dopamine receptors from accepting any further stimulation. The damage to the dopamine receptors eventually causes the symptoms associated with catatonia.

Other neurotransmitters believed to be involved in catatonic schizophrenia have been investigated, but the results of this research indicate mixed perceptions by medical professionals. Glutamate, a neurotransmitter involved in memory and reasoning, offers some promise as glutamate agonists often produce symptoms similar to those found in catatonic schizophrenics such as idleness and contortions. However, glutamate antagonists, which cause the opposite effect of glutamate agonists, are not frequently used for treating catatonic schizophrenia. Acetylcholine, a neurotransmitter associated with intelligence, has also been investigated as well. Apparently, drugs that reduce acetylcholine levels improve symptoms in catatonic schizophrenics.

An interesting finding in catatonic schizophrenic patients is the presence of “physical” symptoms. Catatonic schizophrenics suffer from a number of physical ailments such as diabetes and heart disease at markedly higher rates than the general population. However, there are also certain diseases that patients are less likely to suffer from than the general population. Even though persons with catatonic schizophrenia smoke at much higher rates, they are far less likely to experience lung cancer.

These physical symptoms are creating an entirely new way to look at catatonic schizophrenia and giving doctors key insights into the causes of schizophrenia. Research is now indicating insulin and stress hormones such as cortisol may play a role in catatonic schizophrenia. Persons with catatonic schizophrenia have markedly higher levels of these biomarkers. While this may give some insight into new factors involved in the disease, it is still a subject of controversy. A consensus on the role of these biomarkers has not been officially recognized by the medical community.

Treatments for Catatonic Schizophrenia

The treatment of catatonic schizophrenia is incredibly difficult.

While symptoms such as hallucinations and delusions are usually treated with dopamine antagonists, the catatonic aspects aren’t as easily alleviated. One major reason behind the poor treatment options is the lack of understanding of those symptoms.

While the treatment options for catatonic schizophrenia aren’t particularly great, there are nonetheless effective ways of alleviating catatonia. A particularly common way of helping patients is to prescribe anxiolytics such as benzodiazepines. Benzodiazepines often help patients contend with the various symptoms of the disease, but they come with many serious side effects such as withdrawals and memory loss.

A promising future treatment option for catatonic schizophrenia are glutamate antagonists. Particularly, glutamate antagonists that target the NMDA receptors. These receptors appear to be damaged in schizophrenics and the damage they present is strongly correlated with the severity of symptoms. Trials are still being held and patient outcomes aren’t clearly understood. Current research indicates glutamate antagonists can reduce catatonic symptoms, but they can aggravate the psychotic issues often present with the disorder. Other networks of glutamate receptors, such as AMPA receptors, are currently being researched.

When everything else appears to fail, many psychiatrists will try to treat catatonic schizophrenia with electric shock therapy. This extreme method of treatment can produce some of the most effective results against catatonic schizophrenia, but the potential risks involved are considered far more than most psychiatrists are willing to risk. Many patients treated with electroshock therapy find themselves unable to perform the task they were able to before, or experience personality changes. Extreme care is needed in order to make sure that patient is not affected in any harmful way.

Catatonic Schizophrenia Prevention

As a strongly genetic disease, catatonic schizophrenia is not considered a preventable disease by current standards.

However, this is changing over time as new research reveals epigenetic factors involved in catatonic schizophrenia. While environmental factors are probably not seriously involved in the emergence of catatonic schizophrenia, the expression of genes most certainly is. Controlling these epigenetic factors is going to prove critical in trying to prevent catatonic schizophrenia in the future.

One of the most common examples of epigenetics playing a role in catatonic schizophrenia is the influence traumatic experiences of the mother plays in schizophrenia. Mothers who experience influenza during pregnancy are more likely to give birth to schizophrenic sons than those who don’t. This implies that the presence of pathogens in the prenatal environment plays an important role in the likelihood of the disease.

Another important factor in the development of schizophrenia is the methylation of genes. Folic acid plays an important role in the structure of genes by adding a special chemical component known as the methyl group. The presence of this group will affect how genes are expressed and may turn them off if the methylation is not present. Many persons with catatonic schizophrenia lack methylation of glutamate related genes. Researchers are currently looking for ways to control these two factors in order to find a certain manner to prevent catatonic schizophrenics.

Although prevention of catatonic schizophrenia is hypothetical at this point, currently diagnosed patients can find ways to prevent the progress of their disease from reaching a more severe point. Medication can go a long way in helping patients prevent the symptoms of their disease from reaching a much worse point, but lifestyle changes can also help them a great deal as well. Stress plays a major role in the severity of symptoms and the duration of episodes. By finding a way to live a less stressful lifestyle, many catatonic schizophrenic patients may find it possible to prevent the disease from getting any worse.

Resources
Last Reviewed:
September 25, 2017
Last Updated:
November 29, 2017
Content Source: