Catatonic schizophrenia: symptoms, causes and treatment

Schizophrenia is a mental disorder that can be very disabling, affecting between 0.3% -0-7% 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 about catatonic schizophrenia, characterized by alterations at the motor level.

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

• Related article: "Catatonia: causes, symptoms and treatment of this syndrome"

Schizophrenia - what is it?

Schizophrenia is a psychotic disorder It causes two types of symptoms: positive and negative. The positive symptoms include the manifestations "by excess", and the negative symptoms, those that are "by default".

Thus, while the positives include symptoms such as hallucinations, delusions, and disorganized behavior, the negatives include affective flattening, anhedonia and apathy, among others.

On the other hand, schizophrenia also causes cognitive symptoms, such as attentional difficulties or memory problems.

Subtypes

However, there is no single type of schizophrenia, and already in the first descriptions of the disorder, performed by Emil Kraepelin (German psychiatrist), the author started talking about different subtypes of schizophrenia. Specifically, E. Kraepelin differentiated three subtypes: paranoid schizophrenia, catatonic schizophrenia, and hebephrenic or disorganized schizophrenia.

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

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

These subtypes of schizophrenia (except the simple one) are listed in the DSM-IV-TR (Diagnostic Manual of Mental Disorders), but disappear in the DSM-5 (where we can only find schizophrenia disorder, among the other psychotic disorders, and simple schizophrenia in annexes).

This is not to say that these subtypes of schizophrenia cannot continue to appear in the clinical population. In addition, it should be noted that hebephrenic subtype schizophrenia is also currently included in the ICD-10 (International Classification of Diseases), as well as simple schizophrenia

• You may be interested: "The 6 types of schizophrenia (and associated characteristics)"

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 having a medium prognosis (between good and bad), placing it between the paranoid (good prognosis) and the disorganized (bad prognosis).

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

Generally, the subject automatically obeys orders (or just the opposite may happen, showing extreme negativity and not obeying anyone's orders or instructions); in addition, the individual also tends to act with great perseverance. On the other hand, catatonic schizophrenia usually also includes hallucinatory and delusional symptoms.

We are going to see in detail the characteristic symptoms of this subtype of schizophrenia.

Symptoms

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

1. Motor immobility

Also called stupor, motor immobility makes the patient with catatonic schizophrenia unable to execute any type of movement. You can get "stuck" without moving or saying anything.

2. Excessive motor activity

However, the opposite symptom to the previous one may occur, and that the patient presents an activity excessive motor skills, showing himself incapable of staying still, moving continuously and with a certain agitation.

3. Extreme negativism

Extreme negativism translates into resistance, on the part of the subject, to follow any order you receive from another person; this resistance is apparently unmotivated. It can also include maintaining a rigid posture against attempts to move by others, as well as silence.

4. Peculiar voluntary movements

The patient with catatonic schizophrenia may present peculiar movements voluntarily, such as mannerisms (or mannerisms), consisting of "unique" gestures for the individual, exaggerated (as if the person were acting), and which are usually repetitive and short. These gestures accompany normal activity, and they are simpler than stereotypes. They typically appear in schizophrenia.

5. Echolalia

Echolalia consist of the repetition of the last thing the interlocutor said (the last word, sentence…). These, in turn, can be immediate (occur instantly) or delayed (occur hours, days, or weeks after the individual has heard them).

Echolalia, in addition to being typical in catatonic schizophrenia, also appear very frequently in children with an autism spectrum disorder (ASD).

• You may be interested: "Echolalia: what it is, causes and related disorders"

6. Ecopraxias

Ecopraxias are similar to the previous symptom, but in the motor or gestural field; its about the repetition, by the subject, of the gestures that the subject sees the interlocutor perform.

Causes

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

1. Biological theories

Biological theories, for their part, propose an important genetic component in the origin of the schizophrenia, the prevalence of schizophrenia being higher in children of biological mothers with schizophrenia.

2. Psychological theories

Psychological theories pose a vulnerability-stress model, where there is an interaction between a possible individual vulnerability in the patient and the level of stress suffered by the same.

Systemic theories, for their part, plan the double bind theory (Palo Alto School: Bateson & cols.); This theory maintains that the double bind is formed by contradictory messages and that they occur within an intense relationship that the patient cannot avoid or comment on.

3. Neurochemical theories

At the neurochemical level, there has been talk of a subcortical dopaminergic hyperarousal in the mesolimbic pathway (related to the positive symptoms of catatonic schizophrenia; in this case, motor disorders).

Regarding brain alterations, structural alterations detected by a CT scan present in people with schizophrenia (dilation of the third ventricle and of the lateral ventricles, cerebellar atrophy, inverted hemispheric asymmetry, cortical atrophy, decreased radiodensity of tissue in various areas of the brain such as the hippocampus, etc.).

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

4. Viral theories

Viral infections have also been reported as causing schizophrenia (although they have never been proven), and neurodevelopmental disorders.

The latter include an alteration in the formation of the brain during pregnancy or infancy, which does not appear until the structures involved have fully matured and appears a source of stress or major hormonal changes.

Treatment

Treatment of catatonic schizophrenia should be directed towards the treatments used for the schizophrenia itself. Mainly, psychosocial treatment is chosen, that seeks the reintegration (or insertion) of the individual in society, through sheltered employment procedures, for example (and among others).

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

Also, in psychological therapy, it seeks to enhance the patient's coping strategies, as well as promoting their self-esteem, self-concept and autonomy.

In the case of catatonic schizophrenia, in addition, pharmacological treatment (which must always be regulated, independently of the schizophrenia subtype in question), will be aimed at alleviating or softening the typical motor symptoms of this subtype of schizophrenia. That is why adherence to treatment should always be worked on, through psychoeducational techniques and positive reinforcement, for example.

Bibliographic references:

• American Psychiatric Association -APA- (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 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. Volume I and II. Madrid: McGraw-Hill.
• Crespo, M.L. and Pérez, V. (2005). Catatonia: a neuropsychiatric syndrome. Colombian Journal of Psychiatry, 34 (2): 251-266.