A single copy of this article may be reprinted for personal, noncommercial use only.
Catatonic schizophreniaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/catatonic-schizophrenia/DS00863
Catatonic schizophrenia is one of several types of schizophrenia, a chronic mental illness in which a person loses touch with reality (psychosis). Catatonic schizophrenia includes episodes of behavior at extreme opposite ends of the spectrum. You may seem like you're in coma-like daze — unable to speak, move or respond — or you may talk and behave in a bizarre, hyperactive way. Catatonic episodes may last for a month or longer without treatment.
Catatonic schizophrenia is rare today because of improved schizophrenia treatment. In fact, being in a state of catatonia is more likely to occur with certain other health problems, including both physical and mental illnesses. With effective treatment, you can manage the symptoms of catatonic schizophrenia and work toward leading a happier, healthier life.
Signs and symptoms of catatonic schizophrenia fall into several categories of catatonic behaviors, including:
- Physical immobility. You may be completely unable to move or speak, or you may stare, hold your body in a rigid position and seem to be unaware of your surroundings (catatonic stupor). You may also have a form of immobility known as waxy flexibility; for example, if your arm is moved into a certain position, it will stay in that position for hours.
- Excessive mobility. Rather than being unable to move, you may move in an excited manner that appears to have no purpose. You may pace in a frenzy, turn in circles, flail your arms or make loud noises.
- Extreme resistance. You may not respond to instructions, may resist any attempt to be moved or may not speak at all.
- Peculiar movements. You may have inappropriate or unusual postures, grimace for long periods or use strange mannerisms. You may also mechanically repeat certain behaviors (stereotyped behaviors), such as repeating words, obsessively following a routine or always arranging objects exactly the same way.
- Mimicking speech or movement. You may repeatedly say a word just spoken by someone else (echolalia) or repeatedly copy a gesture or movement made by someone else (echopraxia).
Although you may appear to be without emotion during a catatonic episode, you may actually feel extreme anxiety.
Other signs and symptoms of catatonic schizophrenia
Although the main symptoms of catatonic schizophrenia are catatonic behaviors, you may also have some of the other common signs and symptoms of schizophrenia, such as:
- Having beliefs not based on reality (delusions)
- Seeing or hearing things that don't exist (hallucinations), especially voices
- Incoherent speech
- Neglect of personal hygiene
- Apparent lack of emotions
- Emotions inappropriate to the situation
- Angry outbursts
- Trouble functioning at school or work
- Social isolation
- Clumsy, uncoordinated movements
Catatonic episodes are likely to last at least a day and may last for longer than 30 days without effective treatment.
When to see a doctor
If you have any symptoms of catatonic schizophrenia, you may not be able to seek medical help on your own. And during periods when your symptoms subside, you may not believe you need treatment. Family and friends, or people at work or school, may suggest you seek help. In some cases, you may be taken to the hospital by emergency personnel.
If you're not ready to seek treatment, try to work up the courage to confide in someone, whether it's a friend or loved one, a health care professional, a faith leader or someone else you trust. He or she can help you take the first steps to successful treatment.
Helping someone who may have catatonic schizophrenia
If you have a loved one you think may have symptoms of catatonic schizophrenia, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional help, but you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider.
If your loved one poses a danger to himself or herself or to someone else, you may need to call the police or other emergency responders for help. In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state.
Catatonic schizophrenia and other forms of schizophrenia are brain disorders. Genetics and environment likely both play a role in causing catatonic schizophrenia.
Catatonia is much more commonly associated with other conditions. Some of the health problems that can lead to catatonia include other mood disorders, such as depression and bipolar disorder, and medical conditions that affect the central nervous system.
Doctors don't know why some people with schizophrenia develop catatonic symptoms, but one or more underlying problems with the brain are likely responsible. For example, problems with certain naturally occurring brain chemicals called neurotransmitters appear to play a role. Imaging studies show differences in the brain structure of people with schizophrenia, but the significance of these changes is unclear.
Although the precise cause of catatonic schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering catatonic schizophrenia, including:
- Having a family history of schizophrenia
- Exposure to viruses while in the womb
- Poor nutrition while in the womb
- Stressful life circumstances
- Older paternal age
- Taking psychoactive drugs during adolescence
Signs and symptoms of schizophrenia typically develop between the teenage years and the mid-30s.
Left untreated, catatonic schizophrenia can result in severe emotional, behavioral, health, and even legal and financial problems that affect every area of your life. Complications that catatonic schizophrenia may cause or be associated with include:
- Suicidal thoughts and behavior
- Self-destructive behavior
- Poor nutrition
- Inability to perform daily activities, such as bathing, dressing or preparing meals
- Abuse of alcohol, drugs or prescription medications
- Family conflicts
- Inability to work or attend school
- Being a victim or perpetrator of violent crime
- Heart and lung disease related to smoking
Preparing for your appointment
In some cases, a health care provider, family member, friend or another acquaintance may ask about your behavior, thoughts and mood or suggest that you be evaluated by a mental health provider. Or you may decide on your own to schedule an appointment with your family doctor or mental health provider to talk about your concerns. In some cases, you may be taken to a hospital for an emergency psychiatric evaluation.
What you can do
Being an active participant in your care can help your efforts to manage your condition. One way to do this is by preparing for a planned medical or psychiatric appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These questions may include:
- Why do you think I have catatonic schizophrenia?
- How do you treat catatonic schizophrenia?
- How could treatment change things for me?
- What do medications for this condition actually do?
- How could counseling help me?
- How long will I need treatment?
- What can I do to help myself?
- Are there any brochures or other printed material that I can take home with me? Or can you recommend reliable websites?
In addition to your prepared questions, don't hesitate to ask questions during your appointment if you don't understand something.
What to expect from your doctor
During your appointment, your doctor or mental health provider is likely to ask you a number of questions about your thoughts, behavior and mood. You may be asked such questions as:
- What are your signs and symptoms?
- When did these signs and symptoms start happening?
- Do you notice the same signs and symptoms that other people notice in you?
- How is your daily life affected by your symptoms?
- Do you hear or see things other people don't seem to?
- Do you have certain special mental abilities that other people don't?
- What have you tried on your own to feel better or to control your symptoms?
- What things make you feel worse?
- Have friends or family commented on your thoughts or behavior?
- Have any of your relatives had a mental illness?
- Do you ever have thoughts of harming yourself or others?
- Do you smoke? How much?
- Do you use alcohol or recreational drugs? How much?
- What medications or over-the-counter herbs and supplements do you take?
Tests and diagnosis
If your doctor or mental health provider believes you may have catatonic schizophrenia or another mental illness, he or she typically runs a series of medical and psychological tests and exams. These can help pinpoint a diagnosis, rule out other problems that could be causing your symptoms and check for any related complications.
These exams and tests generally include:
- Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
- Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
- Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns, if this is possible. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide, self-harm or harming others. Your doctor may also want to talk to family or friends, if possible. If you're unresponsive or your behavior seems inappropriate, your doctor will check for catatonic symptoms.
Diagnostic criteria for catatonic schizophrenia
To be diagnosed with catatonic schizophrenia, you must meet certain symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Diagnostic criteria for catatonic schizophrenia include:
- Being unable to move
- Being unable to speak
- Remaining in the same position for long periods
- Excessive or overly excited behavior with no clear purpose
- Resisting instructions or attempts to move you
- Peculiar movements, such as grimacing or unusual postures
- Mimicking words and movements of others
It can sometimes be difficult to diagnose catatonic schizophrenia because catatonic behavior is often a symptom of other conditions, including severe depression, mania, drug intoxication, autism and seizure disorders. Be sure to stick with it until you get an accurate diagnosis, though, so that you can get appropriate treatment.
Treatments and drugs
Catatonic schizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have lifted. You may feel as if you don't need treatment, and you may be tempted to ignore treatment recommendations. But effective treatment can help you take control of your condition and enjoy a happier and healthier life.
Treatment options are similar for all types of schizophrenia. But the specific treatment approach that's best for you depends on your particular situation and the severity of your symptoms.
Schizophrenia treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well because the condition can affect so many areas of your life. Your treatment team can help make sure that you're getting all of the treatment you need and that your care is coordinated among all of your health care providers.
The team involved in treatment of catatonic schizophrenia may include your:
- Family or primary care doctor
- Family members
- Case worker
- Psychiatric nurse
- Social worker
Main treatment options
The main treatments for catatonic schizophrenia are:
- Electroconvulsive therapy (ECT)
- Vocational skills training
Medications for catatonic schizophrenia
Medications, together with electroconvulsive therapy (ECT), are key catatonic schizophrenia treatments. Medications most commonly prescribed for catatonic schizophrenia include:
- Benzodiazepines. These medications, also called anti-anxiety medications, are sedatives. They are generally the medication of choice to treat catatonic schizophrenia. Benzodiazepines, which may be injected in a vein — especially if you're in a state of catatonia — are typically fast acting, helping relieve catatonic symptoms quickly. They may cause dependency with long-term use. These medications may also help if you have anxiety along with catatonic schizophrenia. You may need to take benzodiazepines for a period of days or weeks to relieve your catatonic symptoms.
- Other medications. It's common to have other mental health issues along with catatonic schizophrenia. Antidepressants can be helpful if you have symptoms of depression. And mood-stabilizing medications may help with aggression or hostility.
- Antipsychotic medications. These are generally the medication of choice for schizophrenia. However, they aren't used as often for the catatonic type of schizophrenia because they can actually worsen catatonic symptoms.
Choosing a medication
In general, the goal of treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Which medication is best for you depends on your individual situation. Benzodiazepines may help quickly relieve your catatonic state and may be used on an emergency basis in the hospital. But it can take several weeks after first starting other medications to notice an improvement in your other symptoms, such as depression or anxiety.
If one medication doesn't work well for you or has intolerable side effects, your doctor may recommend combining medications, switching to a different medication or adjusting your dosage. Don't stop taking your medication without talking to your doctor, even if you're feeling better. You may have a relapse of psychotic symptoms if you stop taking your medication. In addition, some medications need to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.
Electroconvulsive therapy (ECT) for catatonic schizophrenia
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through your brain to trigger a brief seizure. This seems to cause changes in brain chemistry that can reduce symptoms of certain mental illnesses. Electroconvulsive therapy is used to treat all types of schizophrenia, but appears to most quickly improve signs and symptoms of catatonic schizophrenia.
Together with benzodiazepine medications, ECT is the primary treatment for catatonic schizophrenia. Your doctor may recommend ECT after you finish a course of benzodiazepines, or you may be treated with both together.
Hospitalization for catatonic schizophrenia
During crisis periods or times of severe catatonic symptoms, hospitalization may be necessary. This can help ensure your own safety and that of others, and make sure that you're getting proper treatment, nutrition, sleep and hygiene. Partial hospitalization and residential care also may be options.
Psychotherapy for catatonic schizophrenia
Although medications and ECT are important catatonic schizophrenia treatments, counseling (psychotherapy) also is essential. Psychotherapy may include:
Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the distress and daily life challenges brought on by catatonic schizophrenia. One approach, called cognitive behavioral therapy, has proved to be especially helpful in the treatment of catatonic schizophrenia. In cognitive behavioral therapy, a mental health provider helps you recognize — and change — harmful ideas and behaviors. As part of this process, your therapist will help you look back on your personal history. Together you're likely to gain insights into when, and why, you may have started to form those ideas and behaviors. Then, building from this new understanding, your therapist can help you start to change those patterns.
Psychotherapy can help reduce the severity of your symptoms and improve communication skills, relationships, your ability to work and your motivation to stick to your treatment plan. Learning about catatonic schizophrenia can help you understand it better, cope with lingering symptoms and understand how medications could be helpful. Therapy can also help you cope with stigma surrounding catatonic schizophrenia.
- Family therapy. Both you and your family may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse, and can help you stick to your treatment plan. Family therapy can also help you and your family communicate better with each other and understand family conflicts. Family therapy can also help family members cope and reduce their distress about your condition.
Social and vocational skills training for catatonic schizophrenia
Training in social and vocational skills to live independently is an important part of recovery from catatonic schizophrenia. With the help of a therapist, you can learn such skills as good hygiene, cooking and better communication. Many communities have programs that can help you with jobs, housing, self-help groups and crisis situations. If you don't have a case manager to help you with these services, ask your doctors about getting one.
Treatment challenges in catatonic schizophrenia
When you have appropriate treatment and stick to your treatment plan, you have a good chance of leading a productive life and functioning well in daily activities. But be prepared for challenges that can interfere with treatment.
For one thing, you, like many others with schizophrenia, may find it hard to follow your treatment plan. You may believe that you don't need medications or other treatment. Also, if you're not thinking clearly, you may forget to take your medications or to go to therapy appointments. Talk to your doctors about tips to stick to your treatment plan, such as taking an antipsychotic medication that's available in a long-lasting injectable form. Even with good treatment, you may have a relapse. Have a plan in place to deal with a relapse.
Smoking, often heavy smoking, is common when you have schizophrenia. If you smoke, you may need a higher dose of antipsychotic medication because nicotine interferes with these medications. Be honest with your doctors about your smoking habits. And be sure you understand the serious health risks of smoking.
Using alcohol and drugs can make catatonic schizophrenia symptoms worse. If you have a problem with alcohol or substance abuse, you may benefit from treatment programs that include care for both schizophrenia and substance abuse.
Lifestyle and home remedies
Catatonic schizophrenia isn't an illness that you can treat on your own. But you can do some things for yourself that will build on your treatment plan:
- Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, schizophrenia symptoms are likely to come back.
- Pay attention to warning signs. You and your caregivers may have identified things that may trigger your catatonic schizophrenia symptoms, cause a relapse or prevent you from carrying out your daily activities. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Involve family members or friends in watching for warning signs. Addressing schizophrenia symptoms early on can prevent the situation from worsening.
- Avoid drugs and alcohol. Alcohol and illegal drugs can worsen schizophrenia symptoms. Get appropriate treatment for a substance abuse problem.
- Check first before taking other medications. Contact the doctor who's treating you for catatonic schizophrenia before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals or supplements. These can interact with your schizophrenia medications.
Coping and support
Coping with catatonic schizophrenia can be challenging. Medications can have unwanted side effects, and you may feel angry or resentful about having a condition that requires lifelong treatment. During periods when you feel better, you may be tempted to stop treatment, which can trigger a relapse. Here are some ways to cope with catatonic schizophrenia:
- Learn about catatonic schizophrenia. Education about your condition can empower you and motivate you to stick to your treatment plan.
- Join a support group. Support groups for people with schizophrenia can help you reach out to others facing similar challenges.
- Stay focused on your goals. Recovery from catatonic schizophrenia is an ongoing process. Stay motivated by keeping your recovery goals in mind. Remind yourself that you're responsible for managing your illness and working toward your goals.
- Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
- Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily tasks.
There's no sure way to prevent catatonic schizophrenia. Some signs of schizophrenia may be present from early childhood or even infancy. Early identification and treatment for people at risk of schizophrenia, perhaps starting in childhood, may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Also, sticking with your treatment plan can help prevent relapses or worsening of catatonic schizophrenia symptoms.
- Schizophrenia. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Sept. 29, 2010.
- Schizophrenia. Skodol AE, et al. Specific personality disorders. In: Hales RE, et al., eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Association; 2008. http://www.psychiatryonline.com. Accessed Sept. 29, 2010.
- Jibson MD. Schizophrenia: Clinical presentation, epidemiology, and pathophysiology. http://www.uptodate.com/home/index.html. Accessed Sept. 29, 2010.
- Gejman PV, et al. The role of genetics in the etiology of schizophrenia. Psychiatric Clinics of North America. 2010;33:3.
- Schizophrenia. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/schizophrenia/complete-publication.shtml.Accessed Sept. 29, 2010.
- Jibson MD. Schizophrenia: Diagnostic evaluation and treatment. http://www.uptodate.com/home/index.html. Accessed Sept. 29, 2010.
- Huey LY, et al. Families and schizophrenia: The view from advocacy. Psychiatric Clinics of North America. 2007;30:549.
- Rathod SR, et al. Cognitive behavioral therapy for schizophrenia. Psychiatric Clinics of North America. 2010;33:3.
- Staying well when you have a mental health condition. Mental Health America. http://www.nmha.org/go/mental-health-month/staying-well-when-you-have-a-mental-illness. Accessed Sept. 29, 2010.
- Daniels J. Catatonia: Clinical aspects and neurobiological correlates. The Journal of Neuropsychiatry and Clinical Neurosciences. 2009;21:371.
- Thirthalli J, et al. Does catatonic schizophrenia improve faster with electroconvulsive therapy than other subtypes of schizophrenia? The World Journal of Biological Psychiatry. 2009;10:772.
- Rosebush PI, et al. Catatonia and its treatment. Schizophrenia Bulletin. 2010;362:239.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 14, 2010.