What Is Waxy Flexibility?

When you have waxy flexibility, your limbs might resist a little when a doctor tries to move them. Then your muscles slowly release, like when you bend a warm candle. You usually keep the new position. For example, if the doctor raises one of your arms or legs, you’ll stay that way for a while. That’s called catalepsy.

Waxy flexibility is one of the less common symptoms of catatonia. That’s a condition that can make it hard for you to move and speak. Catatonic symptoms are most often linked to schizophrenia. But that’s only one of many causes. You can get them if you have another medical condition or serious mental illness, like bipolar disorder.

Your condition can be mild or severe. That’ll affect how hard it is to move your limbs and how long you’ll stay in certain poses. Waxy flexibility typically responds quickly to treatment. It’s important to see your doctor right away if you have it. Symptoms of catatonia can be life-threatening when they aren’t treated.

Symptoms

Waxy flexibility usually happens with other signs of catatonia, such as:

  • Mutism, when you don’t talk a lot or at all
  • Stupor, when you don’t respond to your environment, even pain
  • Negativism, when you strongly resist someone else moving your body
  • Posturing, when you move and hold that position for a while

If you have trouble moving, you’re more likely to:

That’s why it’s important to see a doctor right away if you have symptoms.

Who’s at Risk?

There aren’t exact numbers on how many people get waxy flexibility or catatonia. That’s partly because the symptoms may be diagnosed as something else. Other than schizophrenia, the most common conditions linked to catatonia are:

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What Causes It?

Experts aren’t exactly sure why waxy flexibility happens. But they think catatonic symptoms are caused by a problem with certain chemicals in your brain. These include gamma-aminobutyric acid (GABA-A) and glutamate.

Some brain scans show people with catatonia have problems in the area that controls muscle movement. Your genes and immune system may also play a role. But more research is needed to know for sure.

Diagnosis

A doctor will give you a physical exam to check for waxy flexibility. They’ll hold up your arm, and then they’ll ask you to relax. They’re looking to see how much resistance is in your muscles and how fast your arm will fall once they let it go. They’ll also check for other symptoms of catatonia.

Your doctor will see if something else that seems like catatonia is the issue. You may need a test called an electroencephalogram (EEG). It measures electrical activity in your brain.

Treatment

There are safe, fast, and effective ways to get better. The first thing your doctor will do is give you a sedative called a benzodiazepine. It’s an anti-anxiety drug. Lorazepam is used most often. Your doctor may put it under your tongue or give you a shot.

If you don’t feel better in 4-5 days, your doctor may try electroconvulsive therapy (ECT). They’ll put electrodes on both sides of your head. Then they’ll send brief electrical pulses through your brain. You’ll be asleep the whole time, so it won’t hurt. There’s evidence that waxy flexibility may respond faster to ECT than other catatonia symptoms do.

Experts are studying other treatment options, including:

  • Sleep drugs. Zolpidem is often prescribed.
  • NMDA receptor antagonists (amantadine/memantine). These medicines affect brain chemicals.
  • Repetitive transcranial magnetic stimulation. This is when magnetic pulses are used to stimulate your brain's nerve cells to help depression symptoms.

Doctors don’t recommend treating waxy flexibility with antipsychotic drugs. If you need an antipsychotic medicine to manage schizophrenia or another mood disorder, your doctor may take you off of it until your catatonia goes away.

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on January 16, 2020

Sources

SOURCES:

Max Fink, MD, professor of psychiatry and neurology emeritus, Stoney Brook University School of Medicine.

William T. Carpenter, MD, professor of psychiatry and pharmacology, University of Maryland.

Journal of Psychopathology: “Catatonia from the first descriptions to DSM 5.”

Journal of Neurology, Neurosurgery & Psychiatry: “Movement disorders in catatonia.”

The Lancet Psychiatry: “Structure and neural mechanisms of catatonia.”

Dementia & Neuropsychologia: “Catatonia, beyond a psychiatric syndrome.”

Journal of Neurosciences in Rural Practice: “Catatonia in a patient with bipolar disorder type 1.”

CNS Spectrums: “Catatonia.”

World Journal of Psychiatry: “Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology.”

Mayo Clinic: “EEG (electroencephalogram).”

Encephale: “Catatonia with schizophrenia: From ECT to rTMS.”

Neuropsychiatric Disease and Treatment: “Systematic review of catatonia treatment.”

American Psychiatric Association: “What is Electroconvulsive therapy (ECT)?”

European Archives of Psychiatry and Clinical Neuroscience: “Response rate of catatonia to electroconvulsive therapy and its clinical correlates.”

General Hospital Psychiatry: “Catatonia in Resource Limited Settings: A Case Series and Treatment Protocol.”

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