Next up in the ‘what is…’ series is something I’m intimately familiar with: catatonia.
What is Catatonia?
Catatonia is a state of advanced psychomotor retardation, whereby a person (usually) enters “stupor” which involves being unresponsive to most stimuli, usually with an impaired level of consciousness. Someone with catatonia may show signs such as:
- Cataplexy or a posture held against gravity. One example of this is how some people with catatonia lay down but keep their heads slightly raised as if on an invisible pillow.
- Waxy flexibility, whereby someone can position the limbs and body of the catatonic person, who then maintains that position.
- Negativism – where, upon given a command by someone, the person will instead do the opposite or otherwise not respond
- Posturing, similar to waxy flexibility but the person takes a sudden and active roles in positioning themselves against gravity
- Stereotypy – frequent and repetitive actions that serve no real purpose (often seen in autistic people)
- Echolalia (imitating the speech of another)
- Echopraxia (imitating the motions of another)
There are three subtypes of catatonia, each more dangerous than the last.
- Stupor: as shown by the picture above, this is the most recognised form of catatonia, which involves the absence of motor activity and symptoms such as posturing and mutism. This is associated with dehydration and nutritional deficiencies and can lead to renal failure. It may require feeding tubes and/or intravenous fluids.
- Catatonic excitement: This state is characterised by extreme purposeless movement, excitement and agitation. It may involve psychosis. Catatonic excitement is considered to be extremely dangerous to the individual with fever and hyperthermia being common.
- Malignant catatonia: This involves autonomic instability, fever and delirium. If not treated correctly and quickly, it is often fatal.
Who gets catatonia?
Catatonia was originally highly linked to schizophrenia, however the causes of it have broadened in recent years as a result of clinical experience. It is now associated with.
- Schizophrenia/psychotic spectrum disorders
- Bipolar disorder
- Autistic spectrum disorders
How is it treated?
The first-line treatment for catatonia is benzodiazepines, such as valium (diazepam) and ativan (lorazepam). This seems to work particularly well for stupor as it relaxes the muscles and some doctors use the effectiveness of this as a diagnostic tool, e.g. if it stops when given benzos, it’s probably catatonia. This is usually given via an injectable as many will be unable to take oral medication. The next stage if benzos don’t work (and usually first-line for malignant catatonia) is ECT (electro-convulsive therapy).
My experiences with catatonia
I have had catatonia twice, which puts me at risk of developing it again. Once before onset I was very depressed, in both cases, I was also psychotic. I displayed stupor, mutism, waxy flexibility and cataplexy. Because catatonia alters your level of consciousness, I am not able to tell you much about what it was like to have. I have been asked “what does it feel like?” but it’s almost like going to sleep for a period, although I have hazy recollections, snapshots here and there of what was going on – a kindly nurse whose hand I couldn’t relax enough to stop gripping, the hospital walls which I must have stared at for hours. In both cases I was hospitalised and in both cases I responded very well to benzodiazepine treatment, which I was given three times a day. It was like waking up from a weird dream. My body ached all over from being held in weird positions for a long time, and I was confused and disorientated. My psychosis also needed to be treated afterwards. In some ways I am lucky to respond so well to drug treatment but I always fear that if there’s a next time, I will wake up after being given ECT without my consent.
As always, I hope this was helpful and informative. If you have any questions, don’t hesitate to ask!