Catatonia: Causes, Symptoms And Treatment Of This Syndrome
It is possible that we have ever seen in a movie, read in a book or even seen in real life some psychiatric patients who remain in a state of absence, rigid and immobile, mute and unreactive, and can be placed by third parties at any time. imaginable posture and remaining in said posture like a wax doll.
This state is what is called catatonia. a mainly motor syndrome of diverse causes that affects patients with different types of mental and medical disorders.
Catatonia is a neuropsychological syndrome in which a series of psychomotor symptoms occur, often accompanied by cognitive, consciousness and perception alterations.
The most characteristic symptoms of this syndrome are the presence of catalepsy or inability to move due to a state of muscle rigidity which prevents muscle contraction, waxy flexibility (a state of passive resistance in which the subject does not flex the joints on his own, remaining as he is if placed in a certain way with the same posture and position unless changed and in which the members of the body remain in any position in which another person leaves them), mutism, negativism when trying to make the subject perform any action, ecosymptoms (or automatic repetition/imitation of the actions and words carried out by the interlocutor), stereotypies, perseveration , agitation, lack of response to the environment or stupor.
Its diagnosis requires at least three of the symptoms mentioned above. for around at least twenty-four hours. As a general rule, anosognosia occurs with respect to motor symptoms.
Some psychological symptoms
Subjects with this alteration They often present intense emotionality difficult to control, both positively and negatively. Although motor immobility is characteristic, sometimes patients emerge from it in a highly intense emotional state with a high level of movement and agitation that can lead them to self-harm or attack others. Despite their anosognosia regarding their motor symptoms, they are nevertheless aware of their emotions and the intensity with which they occur.
catatonia can occur in different degrees of greater or lesser severity producing alterations in the patient’s vital functioning that can make it difficult to adapt to the environment.
Yes ok The prognosis is good if treatment begins soon. in some cases it can be chronic and can even be fatal in certain circumstances.
Presentation patterns
Two typical presentation patterns can be observed, one called stuporous or slowed catatonia and another known as agitated or delirious catatonia.
The first of them is characterized by a state of stupor in which there is an absence of relationship functions with the environment; The individual remains paralyzed and absent from the environment, the common symptoms being catalepsy, waxy flexibility, mutism and negativity.
Regarding agitated or delusional catatonia, it is characterized by symptoms more linked to arousal such as ecosymptoms, the performance of stereotyped movements and states of agitation.
Possible causes of catatonia
The causes of catatonia can be very diverse. When considered as a neuropsychological syndrome the presence of alterations in the nervous system must be taken into account.
Research shows that patients with catatonia They have some type of dysfunction in part of the right posterior parietal cortex which is consistent with the fact that people with catatonia are able to correctly initiate movements (so that the supplementary motor area usually remains preserved) and the fact that there is anosognosia regarding motor symptoms. The inferior lateral prefrontal of these subjects also usually presents alterations, as well as the medial orbitofrontal, which also explains the presence of occasional raptus and emotional alterations.
At the hormonal level, the role of GABA is explored, which has been revealed to be altered in patients with catatonia as it presents a lower level of binding to brain structures. Glutamate, serotonin and dopamine also seem to play a relevant role in this disorder, but A higher level of research is needed regarding how exactly they influence.
Potential organic causes
One of the first causes that must be explored first is organic, as catatonia is a symptom present in a large number of neurological disorders. In this sense we can find that temporal lobe epilepsy, encephalitis, brain tumors and strokes There are possible causes of this syndrome that must be treated immediately.
In addition, infections such as sepsis or those caused by tuberculosis, malaria, syphilis or HIV can also cause this condition. Liver and kidney failure, hypothyroidism, severe complications of diabetes such as ketoacytosis or even severe hypothermia are other conditions that have been linked to the appearance of catatonia.
Other biological causes may arise from the consumption and/or abuse of psychoactive substances be they drugs or psychotropic drugs. For example, catatonia frequently appears in neuroleptic malignant syndrome, a serious and potentially fatal syndrome that in some cases appears after the administration of antipsychotics.
Causes from psychodynamics
In addition to the above causes, some authors related to the Freudian tradition have proposed that in some cases catatonia may have psychological aspects of a symbolic nature as a cause.
Specifically, it has been proposed that catatonia may appear as regression to a primitive state as a defense mechanism against traumatic or frightening stimuli. The explanation is also used that it can also occur as a dissociation response (which is in fact observed in some patients with post-traumatic stress disorder).
However, it must be kept in mind that these explanations are based on an epistemology that is far from scientific, and therefore they are no longer considered valid.
Mental disorders in which it appears
Catatonia has long been a syndrome that has been identified with a subtype of schizophrenia, catatonic schizophrenia. However, the presence of this syndrome has also been observed in numerous disorders, both mental and organic in origin.
Some of the different disorders to which it has been linked are the following.
1. Schizophrenia and other psychotic disorders
This is the type of condition to which catatonia has traditionally been linked, to the point where catatonia has been considered a specific subtype of schizophrenia. Apart from schizophrenia It can appear in other disorders such as brief psychotic disorder.
2. Mood disorders
Although it has been linked almost from its beginnings to schizophrenia, the different studies carried out regarding catatonia seem to indicate that a high number of catatonic patients present some type of mood disorder, especially in manic or depressive episodes. It can be specified in both depressive and bipolar disorders.
Post-Traumatic Stress Disorder has also sometimes been associated with catatonic states.
4. Substance consumption, intoxication or withdrawal
The uncontrolled administration or cessation of certain substances with an effect on the brain, it can generate catatonia.
5. Autism spectrum disorder
Some children with developmental disorders such as autism may manifest catatonia comorbidly.
Consideration today
Today the latest revision of one of the main diagnostic manuals of psychology, the DSM-5, has removed this label as a subtype of schizophrenia to convert catatonia into an indicator or modifier of the diagnosis of both this and other disorders (such as mood disorders). Likewise, the classification as a neuropsychological syndrome has been added separately from other disorders.
Treatment to apply
Because the etiology (causes) of catatonia can be diverse, the treatments to be applied will depend largely on what causes it. Its origin must be analyzed and acted differently depending on what it is. Aside from this, the symptoms of catatonia can be treated in different ways.
At a pharmacological level The high usefulness of benzodiazepines has been proven, which act as GABA agonists in acute cases. The effects of this treatment can reverse the symptoms of most patients. One of those that has shown the most effectiveness is lorazepam, which is in fact the first choice treatment.
Although it may seem due to its link with schizophrenia that the application of antipsychotics can be useful, the truth is that it can be harmful (remember that catatonia can appear in neuroleptic malignant syndrome that is precisely caused by the administration of such drugs).
Another therapy used is electroconvulsive therapy. although it is usually applied if treatment with benzodiazepines does not cause a response. The possibility of using benzodiazepines and electro-convulsive therapy together is also proposed, as the effects can be enhanced.
On a psychological level Occupational therapy can be performed to stimulate the patient, as well as psychoeducation for the patient and their environment in order to provide them with information and strategies for action and prevention. The treatment of affective symptoms is also of great help, especially in cases derived from psychiatric disorders.
