Catatonic schizophrenia: symptoms, causes and treatment

Schizophrenia is a mental disorder that can become very disabling, affecting between 0.3% and 7% of the world’s population. However, it is not a unique disorder, but there are different subtypes of schizophrenia. In this article, we will learn more about catatonic schizophrenia., Characterized by alterations in the engine.

In addition, we will see what are its usual characteristics, typical symptoms, the causes that can trigger it and the treatments applied.

    Schizophrenia: what is it?

    Schizophrenia is a psychotic disorder which causes two types of symptoms: the positive and the negative. Positive symptoms include “excessive” manifestations and negative symptoms, which are “default”.

    So while the positives include symptoms like hallucinations, delusions, and disorganized behavior, the negatives include emotional flattening, anhedonia, and apathy, among others.

    On another side, schizophrenia also causes cognitive symptoms, Such as attention difficulties or memory problems.

    Subtype

    However, there is no single type of schizophrenia, and already in the first descriptions of the disorder, played by Emil Kraepelin (German Psychiatrist), the author began to talk about different subtypes of schizophrenia. More specifically, I. Kraepelin differentiated three subtypes: paranoid schizophrenia, catatonic schizophrenia, and hebephrenic or disorganized schizophrenia.

    These subtypes are differentiated by the predominant symptom types in the picture; thus, paranoid schizophrenia mainly involves positive symptoms (hallucinations, delusions …), catatonic, motor symptoms such as catatonia, And hebephrenic and disorganized behavior and language.

    A little later, the Swiss psychiatrist Eugen Bleuler added a fourth subtype to those already proposed by Kraepelin: simple schizophrenia (with only negative symptoms).

    These schizophrenia subtypes (minus the simple) are listed in the DSM-IV-TR (Diagnostic Manual of Mental Disorders), but disappear in DSM-5 (where only schizophrenic disorder is found, among many other psychotic disorders, and simple schizophrenia in the appendages).

    This is not to say that these schizophrenia subtypes may not continue to appear in the clinical population. Additionally, note that the hebefrenic schizophrenia subtype is also currently in the ICD-10 (International Classification of Diseases), as well as uncomplicated schizophrenia.

      Catatonic schizophrenia: common features

      Catatonic schizophrenia, as we have seen, is a subtype of schizophrenia proposed by Emil Kraepelin. This type of schizophrenia is characterized by an average prognosis (between good and bad), placing it between the paranoid (good prognosis) and the disorganized (bad prognosis).

      It is a currently rare disorder in developed countries. The person with catatonic schizophrenia usually has ambivalent, motor-focused symptoms.

      In general, the subject automatically obeys orders (or the opposite can happen, which presents an extreme negativism and does not obey the orders or instructions of anyone); moreover, the individual usually acts with great perseverance as well. On the other hand, catatonic schizophrenia it usually also includes hallucinatory and delusional symptoms.

      Let us consider in detail the characteristic symptoms of this subtype of schizophrenia.

      symptoms

      Symptoms of catatonic schizophrenia mainly consist of motor disturbances. These translate into:

      1. Motor immobility

      Also called stuporMotor immobility renders the patient with catatonic schizophrenia unable to move. You can get “stuck” without moving or saying anything.

      2. Excessive motor activity

      However, the opposite symptom may occur and the patient may exhibit excessive motor activity, showing an inability to stand still, to move continuously and with some restlessness.

      3. Extreme negativism

      Extreme negativism this results in resistance, on the part of the subject, To follow any order he receives from another person; this resistance is apparently not motivated. It can also include maintaining a rigid stance against attempts to move by others, as well as silence.

      4. Special voluntary movements

      The patient with catatonic schizophrenia may voluntarily exhibit particular movements, such as mannerisms (or mannerisms), consisting of gestures “unique” to the individual, exaggerated (as if the person were acting), and generally repetitive and short. These gestures accompany normal activity, and they are simpler than stereotypes. They usually appear in schizophrenia.

      5. Ecolalia

      Ecolalia consists of repeating the last one the interlocutor said (The last word, sentence …). These, in turn, can be immediate (occur on time) or delayed (occur hours, days, or weeks after the individual has heard them).

      Echolalia, in addition to being typical of catatonic schizophrenia, also occurs very commonly in children with autism spectrum disorder (ASD).

        6. Ecopraxy

        Ecopraxies are similar to the above symptom, but in the motor or gestural domain; consist of the repetition, by the subject, of the gestures that the subject sees the interlocutor doing.

        the causes

        The causes of catatonic schizophrenia, like any other type of schizophrenia, they have been linked to multiple factors and multiple fields of study (It is a disorder of multifactorial origin).

        1. Biological theories

        Biological theories, in turn, suggest an important genetic component in the origin of schizophrenia, with a higher prevalence of schizophrenia in children of biological mothers with schizophrenia.

        2. Psychological theories

        Psychological theories they pose a vulnerability-stress model, When there is an interaction between a possible individual vulnerability of the patient and the level of stress undergone by the latter.

        Systemic theories, in turn, plan the double bond theory (Palo Alto School: Bateson et al.); this theory holds that the double bond is made up of conflicting messages and that they occur in an intense relationship that the patient cannot avoid or comment on.

        3. Neurochemical theories

        At the neurochemical level, we have talked about 1 subcortical dopaminergic hyperactivation in the mesolimbic tract (Related to the positive symptoms of catatonic schizophrenia, in this case, motor disorders).

        Regarding cerebral alterations, structural alterations detected by a CT scan present in people with schizophrenia (dilation of the third ventricle and lateral ventricles, cerebellar atrophy, inverted hemispherical asymmetry, cortical atrophy, decrease in the radio density of the tissue in various areas of the brain like the seahorse, etc.).

        Within these alterations, functional alterations were also found such as hypofrontality (dysfunction of the prefrontal-dorsolateral cortex) and dysfunction of the basal ganglia.

        4. Viral theories

        Viral infections have also been reported to be the cause of schizophrenia (although they have never been proven) and neurodevelopmental alterations.

        The latter include an alteration in the formation of the brain during pregnancy or infancy, which manifests itself only when the structures involved have fully matured and appear. a source of stress or hormonal changes important.

        treatment

        The treatment of catatonic schizophrenia should be directed towards the treatments used for the schizophrenia itself. Opt primarily for psychosocial treatment, Which aims at the reintegration (or insertion) of the individual into society, through sheltered employment procedures for example (and among others).

        On the other hand, the psychological therapies used (which will also ideally include families), focus on social skills training (EHS), psychoeducational intervention (at the family level), cognitive rehabilitation and belief modification therapies (treatment-oriented). delusions and hallucinations).

        In addition, in psychotherapy, it seeks to improve patient coping strategies, In addition to promoting their self-esteem, their self-image and their autonomy.

        In the case of catatonic schizophrenia, furthermore, pharmacological treatment (which should always be regulated, regardless of the schizophrenia subtype in question), will aim to relieve or alleviate the motor symptoms typical of this schizophrenia subtype. . This is why treatment adherence should always work, through psychoeducational techniques and positive reinforcement, for example.

        Bibliographical references:

        • American Psychiatric Association -APA- (2002). DSM-IV-TR Diagnostic and Statistical Manual. Barcelona: Masson.
        • American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.
        • Belloch, A, Sandín, B. and Ramos, F. (2010). Manual of psychopathology. Volumes I and II. Madrid: McGraw-Hill.
        • Crespo, ML and Pérez, V. (2005). Catatonia: a neuropsychiatric syndrome. Catalan Society of Psychiatry, 34 (2): 251-266.

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