Catatonia and schizophrenia – though separate conditions – can exist together, and there are ways to manage both.
Before 2013, catatonic schizophrenia was recognized as a subtype of schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
In the most recent manual, the DSM-5, catatonic schizophrenia was combined under the general category of schizophrenia. It now describes someone living with schizophrenia but also meets the criteria for a catatonia diagnosis.
Catatonia and schizophrenia are separate conditions, but they can be linked together.
Schizophrenia is characterized by a breakdown in the relationship between thought, emotion, and behavior. Catatonia in itself is a psychomotor syndrome, meaning it involves unusual levels and styles of movement.
For some people with catatonia, their movements can appear as extreme restlessness or agitation. For others, they may not move at all. Catatonia can last for several minutes, or it can last hours or even days.
Catatonia doesn’t always occur with schizophrenia. In other words, just because a person has catatonia doesn’t mean they have schizophrenia.
Research on how often catatonia occurs with schizophrenia is varied. Some studies have found that
Due to the number of treatments available for symptoms of catatonia, it is seen far less in people with schizophrenia than it was decades ago.
Catatonia typically presents in one of two ways: an “akinetic” form or an “excited” form.
The akinetic form, which is more common, makes a person nonresponsive even though they are awake. The less common “excited” form can present as a person in a frenzy. It may include periods of excitement, aggression, and impulsivity.
A severe and potentially life-threatening form is called
Catatonia may include the following symptoms:
- mutism: verbally unresponsive
- stupor: lower response to external behavior, hypoactive behavior
- immobility: loss of normal ability to move muscles, resistance to being moved
- waxy flexibility: slight resistance to being moved
- posturing: maintaining a position for a long time
- echolalia: repeating other people’s words
- echopraxia: mimicking others’ movements
- excitement: extreme restlessness and movement
- staring: fixed gaze
- catalepsy: passively allowing someone to posture you
- grimacing: distorted facial expressions
- stereotypy: abnormal repetitive non-goal-directed movements
- negativism: persistent resistance to suggestions of others
- agitation: inner tension and unease
- mannerisms: carrying out typical actions in a peculiar manner
Along with these, a person might also have the following symptoms of schizophrenia:
- delusions: fixed false beliefs that persist despite evidence to the contrary
- hallucinations: perceives things not consistent with objective reality, may include visual, auditory (hearing), tactile (feeling), taste, or olfactory (smelling)
- thought disorder: exhibits disorganized thinking that can reflect in unusual ways of communicating
- lack of motivation: reduces or stops engaging in everyday activities, such as showering and cooking
- poor emotional expression: may not react to happy or sad events, or react inappropriately
- social withdrawal: pulls away from social activities
- poor insight: may not have awareness of their illness
- cognitive difficulties: poor concentration, memory organization, and planning skills
The causes of catatonia are not clear. Researchers believe that changes in certain neurotransmitters – GABA (gamma-aminobutyric acid), glutamate, and dopamine – appear to be associated with the syndrome.
Researchers believe that GABA plays the biggest role due to changes in GABA activity seen in the brain imaging scans of some people with catatonia. However, this research is still ongoing, as some people with catatonia weren’t able to consent to the brain scans, nor were they able to handle the scan.
Catatonia may also occur as a result of withdrawal from benzodiazepines and alcohol, both of which act on GABA receptors.
In some cases, catatonia can be triggered by antipsychotics, the medications used to treat schizophrenia.
Genetics might also play a role in the development of catatonic schizophrenia. A recent
Research about the causes of catatonia in people with schizophrenia is still ongoing.
To diagnose catatonia in people with schizophrenia, a physician might review the person’s psychiatric history and conduct a complete neurological exam. If a person is taking an antipsychotic, it’s necessary to rule that out as a possible cause of symptoms.
Blood tests may also be performed. In more severe cases, a lumbar puncture – a procedure that tests the fluid around the brain and spinal cord – is done.
The doctor may also use a catatonia rating scale that lists the many symptoms of catatonia, such as staring, posturing, and grimacing.
A test known as the benzodiazepine challenge might also be conducted. Catatonia is diagnosed if the person positively responds to 2 milligrams of lorazepam within 10 minutes or so. However, catatonia in schizophrenia isn’t nearly as responsive to this method compared to catatonia in mood disorders.
Other tests that may be done include:
- magnetic resonance imaging (MRI) scan
- computerized tomography (CT) scan
- electroencephalogram (EEG)
- physical examination
An EEG is not often done alone because the result can be “normal” even when catatonia is present.
People with catatonia symptoms who have schizophrenia often have malnutrition and dehydration, so in an emergency, IV fluids or a nasogastric tube – which carries food and medication to the stomach through the nose – are started right away.
Typically, the first medication given is a benzodiazepine – such as lorazepam (Ativan) – and is injected either intravenously (IV) or intramuscularly (IM). These medications are believed to work because they act on GABA receptors.
Other benzodiazepines that may be given include:
ECT might be needed if symptoms do not improve after benzodiazepines. However, similar to benzodiazepines,
If the person is taking an antipsychotic medication, it’s often recommended that these are stopped, because they can contribute to symptoms of catatonia.
Anti-NMDA agents – like amantadine (Symmetrel) and memantine (Namenda) – have been studied in
Since catatonia can cause complete immobility, it can lead to serious complications. A retrospective
- sepsis (severe response to infection)
- urinary tract infection
- rhabdomyolysis (serious syndrome resulting from the death of muscle fibers and release of protein into the bloodstream)
- disseminated intravascular coagulation (serious condition that causes abnormal blood clotting)
- deep venous thrombosis (blood clot in a deep vein)
- urinary retention (condition where you can’t empty the urine from your bladder)
- pulmonary embolism (blood clot in a lung artery)
- arrhythmia (irregular heartbeat)
- bed sores
- kidney failure
- hypernatremia (too much sodium in blood)
- liver dysfunction
Schizophrenia with catatonia is a serious condition. Watching someone you know with schizophrenia experience symptoms of catatonia can be scary, but there is hope.
You’ve taken the first step: Educating yourself about the condition. If you notice symptoms, you can seek help right away.
Though schizophrenia is a lifelong condition, episodes of catatonia can be treated.