Catatonia: causes, symptoms and treatment of this syndrome

Psychiatric patients may have been seen in a movie, read in a book, or even seen in real life, who remain absent, rigid and motionless, mute and reactive, and can be placed by others in n any position imaginable and staying in that position as a wax doll.

This condition is called catatonia, A mainly motor syndrome of various causes and which affects patients with different types of disorders, both mental and doctors.

    Catatonia as a syndrome: concept and symptoms

    Catatonia is a type of neuropsychological syndrome in which a series of psychomotor symptoms occur, often accompanied by alterations in cognition, consciousness and perception.

    The most characteristic symptoms of this syndrome are the presence of catalepsy or an inability to move due to a condition of muscle stiffness which prevents muscle contraction, flexibility ceria (A state of passive resistance in which the subject does not flex the joints on their own, remaining as they are if placed in a certain way with the same posture and position unless they are is modified and in which the members of the body remain in any position in which another person leaves them), silence, negativity in the face of the attempt to make the subject perform any action, ecosystems (or automatic repetition / imitation of actions and words spoken by his interlocutor), stereotypes, perseverance, agitation, lack of response to the environment or stupor.

    Its diagnosis requires at least three of the symptoms mentioned above, For at least twenty hours. Typically, anosognosia is presented in relation to motor symptoms.

    Certain psychological symptoms

    Topics with this modification they often present an intense emotionality, Difficult to control, both positively and negatively. While motor immobility is characteristic, patients sometimes emerge in a state of high intensity emotionality with a high level of movement and restlessness that can lead them to self-harm or assault others. Despite their anosognosia vis-à-vis their motor symptoms, they are nonetheless aware of their emotions and the intensity with which they present themselves.

    Catatonia it can occur in varying degrees of varying severity, Producing alterations in the patient’s vital functioning which can make it difficult to adapt to the environment.

    even if the prognosis is good if you start treating it earlyIn some cases, it can be chronic and even fatal in some circumstances.

    Presentation templates

    They can observe two typical presentation patterns, one called stupefying or slowed catatonia and one called agitated or delusional catatonia.

    The first of these is characterized by a state of stupor in which there is an absence of function of relation with the environment; the individual remains paralyzed and absent from the environment, the common symptoms being catalepsy, grain flexibility, mutism and negativism.

    As for agitated or delusional catatonia, it is characterized by symptoms more related to activation such as ecosystems, performing stereotypical movements and states of restlessness.

    Possible causes of catatonia

    The causes of catatonia can be very diverse. When it is considered 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 kind of dysfunction in part of the right posterior parietal cortexThis is consistent with the fact that people with catatonia are able to initiate movements correctly (so that additional motor area is usually preserved) and the fact that there is anosognosia when it comes to motor symptoms. The inferior lateral prefrontal of these subjects also usually presents alterations, as well as the medial orbitalofrontal, which also explains the occasional presence of Raptus and emotional alterations.

    At the hormonal level, the role of GABA is explored, which has been shown to be altered in patients with catatonia by exhibiting a lower level of binding to brain structures. Glutamate, serotonin, and dopamine also appear to play an important role in this disorder, but a higher level of research is needed to find out how exactly they influence.

      Potential organic causes

      One of the first causes to be explored in the first place is that of the organic type, catatonia being 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 are possible causes of this syndrome that must be treated immediately.

      In addition to this, infections such as sepsis or those caused by tuberculosis, malaria, syphilis or HIV can also cause this disease. Liver and kidney errors, hypothyroidism, severe complications of diabetes such as ketoacidosis or even severe hypothermia are other conditions that have been linked to the onset of catatonia.

      Other biological causes they can be derived from the consumption and / or abuse of psychoactive substances, Whether it is drugs or psychotropic drugs. For example, catatonia is common in the severe and life-threatening neuroleptic malignant syndrome which in some cases occurs with antipsychotics.

      Causes of psychodynamics

      In addition to the above causes, some authors close to the Freudian tradition they proposed that in some cases catatonia may have psychological aspects of a symbolic nature as a cause.

      Specifically, it has been proposed that catatonia can appear like a regression to a primitive state as a defense mechanism against traumatic or terrifying stimuli. The explanation is also used, which can also be given as a dissociation response (which is actually seen in some patients with post-traumatic stress disorder).

      However, it should be kept in mind that these explanations are based on an epistemology very distant from the scientist, and are therefore 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 many disorders, both mental and organic.

      Some of the different disorders it has been linked to are as follows.

      1. Schizophrenia and other psychotic disorders

      This is the type of condition that catatonia has traditionally been linked to, to the point that catatonia has been considered a specific subtype of schizophrenia. Apart from schizophrenia it may appear in other disorders such as brief psychotic disorder.

        2. Mood disorders

        Although it has been linked to schizophrenia almost from the start, various studies of catatonia seem to indicate that a large number of catatonic patients suffer from some form of mood disorder. especially in manic or depressive episodes. It can be specified in both depressive and bipolar disorder.

        3. Post-traumatic stress disorder

        Post-traumatic stress disorder has also sometimes been associated with catatonic states.

        4. Substance use, intoxication or abstinence

        Uncontrolled administration or stopping certain substances with effect on the brain can generate catatonia.

        5. Spectrum disorder autistic

        Some children with developmental disabilities such as autism may experience catatonia in a comorbid manner.

          Consideration today

          Today, the latest revision of one of the leading diagnostic manuals in psychology, the DSM-5, removed this tag as a schizophrenia subtype make catatonia an indicator or diagnostic modifier for this disorder and other disorders (such as environmental disorders). Classification as neuropsychological syndrome has also been added separately from other disorders.

          Treatment to be applied

          Since the etiology (causes) of catatonia can be diverse, the treatments to apply will largely depend on what is producing it. Its origin must be analyzed and differentiated according to its origin. Apart from this, the symptoms of catatonia can be treated in a number of ways.

          At the pharmacological level the great utility of benzodiazepines has been proven, that act as GABA agonists in acute cases. The effects of this treatment can reverse symptoms in most patients. One of the most effective turned out to be lorazepam, which is actually the treatment of choice.

          While it may seem due to its connection to schizophrenia that the application of antipsychotics can be helpful, the truth is that it can be harmful (remember that catatonia can appear in neuroleptic malignant syndrome which is precisely caused by the administration of these drugs).

          Another therapy used is electro-convulsive therapy, Although usually applied if treatment with benzodiazepines does not get a response. The possibility of jointly using benzodiazepines and electro-convulsive therapy is also considered, in order to enhance their effects.

          At the psychological level can practice occupational therapy to stimulate the patient, as well as psychoeducation for the patient and his environment in order to provide him with information and strategies for action and prevention. The treatment of emotional symptoms is also very useful, especially in the case of psychiatric disorders.

          Bibliographical references:

          • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.

          • Arias, S. and Arias, M. (2008) Catatonia: Darkness, Dilemma, Contradiction. Spanish Journal of Movement Disorders; 9: 18-23.

          • Crespo, ML and Pérez, V. (2005). Catatonia: a neuropsychiatric syndrome. Colombian Journal of Psychiatry. flight. XXXIV, 2. Bogotá.

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