Immobility, staring, and repeating someone else’s speech are just a few of the possible symptoms seen with catatonia in schizophrenia.
Catatonia is a complex neurological and psychiatric syndrome. It features symptoms of unusual behavior, movement, and mood that typically fall into two categories:
- Stuporous: A person becomes unresponsive, resistant, and unreactive. They may stare for long periods of time, become immobile, or stop speaking.
- Excitatory: A person becomes extremely agitated and restless and may repeat others’ words and mimic behaviors.
In the past, experts considered catatonia to be a subtype of schizophrenia. Schizophrenia is a mental health diagnosis featuring symptoms of psychosis like hallucinations, delusions, and disorganized thinking. But it’s understood now that catatonia can occur in a broad spectrum of psychiatric and medical conditions.
Although catatonia and schizophrenia can exist as separate conditions, they are closely tied to one another. The first medical acknowledgment of catatonic behavior involved people living with schizophrenia. A 2021 study estimates that as many as 35% of people living with schizophrenia will experience catatonia symptoms at some point in time.
At one time, catatonia in schizophrenia was called “catatonic schizophrenia.” In the latest editions of diagnostic manuals, the term has changed to reflect a new understanding of catatonia as it appears in other medical conditions.
In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), for example, mental health professionals diagnose catatonia in schizophrenia as “schizophrenia with catatonia.” Catatonia is a specifier in the DSM-5-TR. Specifiers are medical terms attached to a diagnosis to add clarity and specificity about symptoms.
People with catatonic symptoms in schizophrenia exhibit a spectrum of behavior and mood changes, and they experience unusual states of physical movement that can range in severity.
For example, if you have received a diagnosis of catatonia, you may move your body erratically and restlessly — or not at all. You may appear unresponsive, or you might rapidly repeat words and phrases. This state can continue for minutes, hours, or even days. During that time, symptoms
Symptoms of catatonic schizophrenia may include:
Stuporous catatonia
- stupor (a state close to unconsciousness)
- catalepsy (trance seizure with rigid body)
- waxy flexibility (limbs stay in the position another person puts them in)
- mutism (lack of verbal response)
- negativism (lack of response stimuli or instruction)
- posturing (holding a posture that fights gravity)
Excitatory catatonia
Catatonia in schizophrenia isn’t a “fixed state,” where symptoms remain the same. It’s possible to experience polar opposite behaviors in catatonia. For example, someone with catatonia may experience brief episodes of both:
- unexplained excitability
- defiance
In rare cases, catatonia in schizophrenia can be severe enough to be a medical emergency. This is known as “malignant catatonia,” and features symptoms like fever, muscle rigidity, and instability in autonomic functions like heart rate, blood pressure, respiration, and body temperature.
Even if a person has catatonic symptoms, it doesn’t mean that person is living with schizophrenia or another mental health condition. Researchers estimate that as many as 20% of people with catatonia experience it alongside a physical medical condition.
Causes of catatonia
The causes of catatonic disorders vary from person to person.
Other neurological, psychiatric, or physical conditions usually accompany catatonia.
Causes of schizophrenia
While the exact causes of schizophrenia aren’t clear,
- genetics
- brain chemistry
- environment
Schizophrenia itself is a risk factor for catatonia due to the way schizophrenia affects areas of your brain related to motor function, behavior, and mood.
Genetics may also play a role in your overall risk. If there’s a history of catatonia in your family, you may be predisposed to the condition through genetic variants passed down from your parents.
Your lifestyle and behavior might also affect risk. A 2022 study noted a link between catatonic schizophrenia episodes and substance misuse. Substance use disorders are common in people living with schizophrenia, which are estimated to affect between 20% and 65% of people living with this mental disorder.
Mind-altering substances can contribute to changes in brain chemistry. When combined with existing chemical imbalances in a person’s brain, the effect of drugs and alcohol can be strong.
When to see a doctor for catatonic schizophrenia
If you or someone you love is experiencing any symptoms of catatonic schizophrenia, you should see your doctor as soon as possible. If you believe that someone is having a catatonic episode, seek medical help immediately.
Only qualified medical and mental health professionals can diagnose catatonic schizophrenia. Medical doctors, psychiatrists, clinical psychologists, and psychiatric nurse practitioners are all examples of professionals who can diagnose schizophrenia with catatonia.
A mental health professional will take a detailed medical history from you and discuss your symptom patterns and severity. To confirm a suspected diagnosis, your doctor or mental health professional may perform some or all of the following tests:
- EEG (electroencephalogram)
- MRI scan
- CT scan
- physical examination
- psychiatric examination
Mental health professionals treat schizophrenia with catatonia is with a dynamic, multi-level approach, including:
- medications
- psychotherapy
- community support
- skill-building programs
The goal is to manage schizophrenia while also decreasing the symptoms of catatonia.
Medication
Typically, the first step in treating catatonic schizophrenia is medication. Antipsychotic medications can help with the symptoms of schizophrenia, while medications like lorazepam (Ativan) — a benzodiazepine — can reduce symptoms of catatonia.
Benzodiazepines are the first-line therapy for catatonia. You may take these medications orally or injected either intramuscularly (IM) or intravenously (IV). They can produce rapid and significant symptom relief by working on the neurotransmitter systems thought to underlie catatonia.
In addition to lorazepam, other benzodiazepines include:
- alprazolam (Xanax)
- diazepam (Valium)
- clorazepate (Tranxene)
- clonazepam (Klonopin)
- temazepam (Restoril)
You can also use Zolpidem, a common sleeping aid, to treat catatonia. Although this medication shares some similarities with benzodiazepines — both are sedatives — it is in its own class. It is often used when benzos treatment does not work for catatonia.
Psychotherapy
Psychotherapy, also known as “talk therapy,” is combined with medication to teach coping skills. This line of therapy can also help you better manage stressful situations.
Psychotherapy can be provided in different frameworks based on your individual needs. This treatment aims to help people restructure unhelpful ways of thinking and behaving while learning how to collaborate with their doctor to manage their diagnosis better.
Online therapy options
Read our review of the best online therapy options to find the right fit for you.
Although schizophrenia may be a lifelong condition in some cases, catatonic episodes can be effectively treated by an experienced psychiatric team. With treatment, people with catatonia have a positive and favorable outlook, with catatonia symptom relief in as many as
Catatonic schizophrenia is now formally known as schizophrenia with catatonia. If you’ve received a diagnosis of this condition, you’ll experience an array of motor, behavioral, and mood symptoms of catatonia in addition to symptoms of schizophrenia.
Catatonia can be effectively treated. Medications like benzodiazepines target the neurotransmitter systems thought to underlie catatonia and help reduce symptom frequency and severity. In addition to medications, psychotherapy, community support, and skill-building programs can help you successfully manage life with schizophrenia and catatonia.