The predominant clinical features seen in the catatonic subtype of schizophrenia involve disturbances in a person’s movement. Affected people may exhibit a dramatic reduction in activity, to the point that voluntary movement stops, as in catatonic stupor. Alternatively, activity can dramatically increase, a state known as catatonic excitement.
Other disturbances of movement can be present with this subtype. Actions that appear relatively purposeless but are repetitively performed, also known as stereotypic behavior, may occur, often to the exclusion of involvement in any productive activity.
Patients may exhibit an immobility or resistance to any attempt to change how they appear. They may maintain a pose in which someone places them, sometimes for extended periods of time. This symptom sometimes is referred to as waxy flexibility. Some patients show considerable physical strength in resistance to re-positioning attempts, even though they appear to be uncomfortable to most people.
Affected people may voluntarily assume unusual body positions, or manifest unusual facial contortions or limb movements. This set of symptoms sometimes is confused with another disorder called tardive dyskinesia, which mimics some of these same, odd behaviors. Other symptoms associated with the catatonic subtype include an almost parrot-like repeating of what another person is saying (echolalia) or mimicking the movements of another person (echopraxia). Echolalia and echopraxia also are seen in Tourette’s Syndrome.
How Is It Diagnosed?
The general criteria for a diagnosis of schizophrenia must be satisfied. Temporary and isolated catatonic symptoms may occur in the context of any other subtype of schizophrenia, but for a diagnosis of catatonic schizophrenia one or more of the following behaviors should dominate the clinical picture:
- a. stupor (marked decrease in reactivity to the environment and in spontaneous movements and activity) or mutism;
- b. excitement (apparently purposeless motor activity, not influenced by external stimuli);
- c. posturing (voluntary assumption and maintenance of inappropriate or bizarre postures);
- d. negativism (an apparently motiveless resistance to all instructions or attempts to be moved, or movement in the opposite direction);
- e. rigidity (maintenance of a rigid posture against efforts to be moved);
- f. waxy flexibility (maintenance of limbs and body in externally imposed positions); and
- g. other symptoms such as command automatism (automatic compliance with instructions), and perseveration of words and phrases.
In people who are uncommunicative and where it appears the person might have catatonic schizophrenia, the diagnosis of schizophrenia may have to be provisional until adequate evidence of the presence of other symptoms is obtained. Keep in mind that not all catatonic symptoms means that a person has schizophrenia. A catatonic symptom may also be provoked by an organic brain disease, metabolic disturbances, or alcohol and drugs, and may also be seen occasionally in certain mood disorders, like depression.