It is possible that we have ever seen in a movie, read in a book or even seen in real life some psychiatric patients who remain in a state of absence, rigid and immobile, mute and unreactive, being able to be placed by third parties at any time. imaginable posture and remaining in that posture like a wax doll.
This state is what comes to be called catatonia.a mainly motor syndrome of diverse causes and that affects patients with different types of both mental and medical disorders.
Catatonia as a syndrome: concept and symptoms
Catatonia is a 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 inability to move due to a state of muscular rigidity that prevents muscle contraction waxy flexibility (a state of passive resistance in which the subject does not flex the joints on its own, remaining as it is if it is placed in a certain way with the same posture and position unless it is changed and in which the members of the group body remain in any position that another person leaves them), mutism, negativism when trying to make the subject perform any action, echosymptoms (or automatic repetition/imitation of the actions and words carried out by the interlocutor), stereotypes, perseveration , agitation, lack of response to the environment or stupor.
Its diagnosis requires at least three of the aforementioned symptoms, for about at least twenty-four hours. As a general rule, there is anosognosia regarding the motor symptoms.
Some psychological symptoms
Subjects with this alteration often have intense emotionality, difficult to control, both positively and negatively. Although motor immobility is characteristic, sometimes patients come out of it in an emotional state of great intensity and with a high level of movement and agitation that can lead them to self-harm or assault others. Despite their anosognosia regarding their motor symptoms, they are nevertheless aware of their emotions and the intensity with which they are presented.
catatonia It can occur in different degrees of greater or lesser severity producing alterations in the vital functioning of the patient that can make it difficult for him to adapt to the environment.
Yes ok the prognosis is good if it starts to be treated soonin some cases it can be chronic and can even be fatal in certain circumstances.
Two typical presentation patterns can be observed, one called stuporous or slow catatonia and another known as agitated or delirious catatonia.
The first one is characterized by a stupor in which there is an absence of functions related to the environment; the individual remains paralyzed and absent from the environment, the common symptoms being catalepsy, waxy flexibility, mutism and negativism.
As regards agitated or delusional catatonia, it is characterized by symptoms more linked to arousal such as echosymptoms, performing stereotyped movements and states of agitation.
Possible causes of catatonia
The causes of catatonia can be very diverse. When considered as a neuropsychological syndrome the presence of alterations in the nervous system must be taken into account.
Research shows that patients with catatonia have some kind of dysfunction in part of the right posterior parietal cortex, which is consistent with the fact that people with catatonia are able to initiate movements correctly (so that the supplementary motor area usually remains preserved) and the fact that there is anosognosia regarding motor symptoms. The lateral inferior prefrontal of these subjects also tends to present alterations, as well as the medial orbitofrontal, which also explains the presence of occasional raptus and emotional alterations.
At the hormonal level, the role of GABA is explored, which has been revealed to be altered in patients with catatonia by presenting a lower level of union to brain structures. Glutamate, serotonin and dopamine also seem to play a relevant role in this disorder, but a higher level of research is needed as to exactly how they influence.
Potential organic causes
One of the first causes that should be explored in the first place is organic, since catatonia is 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 There are possible causes of this syndrome that must be treated immediately.
In addition to this, infections such as sepsis or those produced by tuberculosis, malaria, syphilis or HIV can also cause this state. Liver and kidney failure, hypothyroidism, severe complications of diabetes such as ketoacytosis, or even severe hypothermia are other conditions that have been linked to the appearance of catatonia.
Other biological causes may be derived from the consumption and/or abuse of psychoactive substances, be they drugs or psychoactive drugs. For example, catatonia is common in neuroleptic malignant syndrome, a severe and life-threatening syndrome that in some cases occurs with the administration of antipsychotics.
Causes from psychodynamics
In addition to the above reasons, some authors related to the Freudian tradition have proposed that in some cases catatonia may have symbolic psychological aspects as its cause.
Specifically, it has been proposed that catatonia may appear as a regression to a primitive state as a defense mechanism against traumatic or terrifying stimuli. The explanation that it can also occur as a dissociative response (which is actually seen in some patients with PTSD) is also used.
However, it must be borne in mind that these explanations are based on an epistemology that is far from scientific, and therefore are 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 numerous disorders, both mental and of organic origin.
Some of the different disorders to which it has appeared linked are the following.
1. Schizophrenia and other psychotic disorders
This is the type of condition with which catatonia has traditionally been linked, to the point of considering catatonia as a specific subtype of schizophrenia. Apart from schizophrenia may appear in other disorders such as brief psychotic disorder.
2. Mood disorders
Despite the fact that it has been linked almost from the beginning with schizophrenia, the different studies carried out regarding catatonia seem to indicate that a large number of catatonic patients present some type 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 been seen on occasions associated with catatonic states.
4. Consumption, intoxication or withdrawal of substances
The administration or uncontrolled cessation of certain substances with effect on the brain can cause catatonia.
5. Autism Spectrum Disorder
Some children with developmental disorders such as autism may have catatonia comorbidly.
Today the latest revision of one of the major diagnostic manuals in psychology, the DSM-5, has removed this label as a schizophrenia subtype to convert catatonia into a diagnostic indicator or modifier of both catatonia and other disorders (such as mood disorders). The classification as a neuropsychological syndrome separately from other disorders has also been added.
Treatment to apply
Because the etiology (causes) of catatonia can be diverse, the treatments to be applied will depend to a large extent on what causes it. Its origin must be analyzed and acted in a differentiated way depending on what it is.. Apart from this, the symptoms of catatonia can be treated in different ways.
At the pharmacological level the high utility of benzodiazepines has been proven, which act as GABA agonists in acute cases. The effects of this treatment can reverse the symptoms of most patients. One of the most effective has been shown to be lorazepam, which is in fact the first-choice treatment.
Although it may seem that the application of antipsychotics can be useful due to its link with schizophrenia, 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 such drugs).
Another therapy used is electroconvulsive therapy., although it is usually applied if treatment with benzodiazepines does not cause a response. The possibility of jointly using benzodiazepines and electroconvulsive therapy is also being considered, since the effects can be enhanced.
on a psychological level occupational therapy can be performed to stimulate the patient, as well as psychoeducation for the patient and their environment in order to provide them with information and action and prevention strategies. The treatment of affective symptoms is also of great help, especially in cases derived from psychiatric disorders.