What Is Catatonia?
Catatonia is a group of symptoms that usually involve a lack of movement and communication but can also include agitation, confusion, and restlessness.
Until recently, doctors thought it was a type of schizophrenia. But they now understand that other mental illnesses and some conditions that throw off your body’s metabolism also can make you catatonic. About 1 in 10 people with a severe mental illness will have catatonia at some point.
Doctors can treat catatonia. If it’s not treated, it can lead to life-threatening problems.
Catatonia Symptoms
Here are the signs of catatonia:
- Not responding to other people or your environment (negativism)
- Not speaking (mutism)
- Holding your body in an unusual position (posturing)
- Resisting people who try to adjust your body (wavy flexibility)
- Acting upset or irritable (agitation)
- Repetitive, seemingly meaningless movement (mannerism)
- Mimicking someone else’s speech (echolalia)
- Mimicking someone else’s movements (echopraxia)
- Keeping the same facial expression, which sometimes looks like a stiff, inappropriate smile (grimacing)
- Repeated movements that don't seem to have a purpose, such as playing with your fingers or patting and rubbing your body (stereotypy)
Mutism
Mutism is when you're very quiet or don't talk at all. If you don't have another condition to explain it, doctors consider mutism a symptom of catatonia.
Catalepsy
Catalepsy is when you stay in a position another person puts you in. Someone may move you into different poses, and you'll hold them without changing.
Negativism
Negativism is when you either don't respond to what's happening around you or actively resist what's happening. This happens without a logical reason for your reaction.
Activity levels
Contrary to what many people think about catatonia causing little or no movement, it can cause unusual moves and behavior. The activity levels of catatonia are:
- Excited/hyperkinetic. People with this type are very active and restless. You might pace, become aggressive, or do strange things. You may also copy others' actions or words. It can even escalate to self-harm.
- Withdrawn/hypokinetic: This is the type people usually think of. You're awake but don't respond to your surroundings, seeming unaware. You're usually silent with little or no facial expression. You may hold unusual positions and resist anyone wanting to move you. You often don’t eat or drink and may lose control of your bladder or bowels.
- Mixed. This type includes qualities of both hyperkinetic and hypokinetic catatonia. You may suddenly switch from one form to the other.
Catatonia Types
There are three types of catatonia:
Akinetic catatonia. This is the most common. Someone with akinetic catatonia often stares blankly and doesn’t respond when you speak to them. If they do respond, it may only be to repeat what you said. Sometimes, they sit or lie in an unusual position and don’t move.
Excited catatonia. With this type, the person may move around, but their movement seems pointless and impulsive. They may seem agitated, combative, or delirious, or they may mimic the movements of someone who’s trying to help them.
Malignant catatonia. This type happens when the symptoms lead to other health problems, such as dangerous changes in blood pressure, body temperature, or breathing or heart rate. Someone who’s catatonic for a long time may be more likely to have problems such as dehydration, blood clots, or kidney failure as a result of the symptoms.
Catatonia Causes
Doctors aren’t sure exactly what makes someone catatonic. It happens most often with people who have mood disorders or psychotic disorders, such as depression, bipolar disorder, and schizophrenia. About a third of people who are catatonic have bipolar disorder too.
Several physical conditions can lead to catatonia in people who don’t have a mental illness. These include:
- Conditions that affect your body chemistry, such as kidney problems, diabetes, and thyroid conditions
- Parkinson’s disease, which attacks your body’s nervous system
- Encephalitis, an infection that affects your brain
How common is catatonia?
Most studies show that catatonia happens in 5%-20% of people in acute inpatient psychiatric hospitals.
Autistic catatonia
Catatonia is more common in people with autism than doctors previously thought. Studies show that around 12%-18% of people with autism have catatonia, but the actual number is likely higher because many cases go undiagnosed. When people with autism have catatonia, it’s often hard to tell what’s wrong because it doesn’t happen suddenly like it does in other people. In people with autism, it starts slowly and gets worse over time. This makes it challenging to figure out what’s happening, and often, people with autism get the wrong diagnosis or treatment. If doctors don't find catatonia early, it can become serious and even life-threatening.
It's important to look out for changes in:
- How someone moves
- How active they are
- How much they talk
- How well they can take care of themselves
Specific signs of catatonia in autism might include:
- Moving slower than usual
- Freezing up while doing things
- Doing the same movements over and over
- Having trouble starting or finishing things
- Talking less or not at all
- Relying on others to help them do things
- Doing the same things repeatedly
- Staying in the same posture
Catatonia Diagnosis
To diagnose catatonia, you need to show at least three signs of the condition. Doctors also look at other things such as how well you follow commands, if there are any changes in your body, and if you have a strong grasp reflex. While some of these symptoms are present in other conditions, things such as waxy flexibility, strange body positions, and following commands without thinking are more specific to catatonia.
It's always important to see a doctor if you think you or someone you know may have catatonia.
Catatonia Treatment
Doctors usually treat catatonia with a kind of sedative called a benzodiazepine , which is often used to ease anxiety.
Another treatment option is electroconvulsive therapy (ECT). It sends electrical impulses to your brain through electrodes placed on your head. You take medicine to sleep through the procedure. Your doctor may suggest ECT if:
- Sedatives don’t work
- The catatonia is severe
- You've had catatonia before
- Quick action is needed to save someone’s life
Catatonia Complications
It's important to find and treat catatonia quickly because it can get worse and cause other serious health problems. If doctors don’t treat catatonia right away, it can lead to:
- Infection
- A reaction to antipsychotic medications (neuroleptic malignant syndrome)
- A blood clot in your lung (pulmonary embolism)
Takeaways
Catatonia is a condition in which you may not move or talk much or show unusual behaviors such as holding strange positions or mimicking others. It can happen with various mental and physical health issues and affects about 5%-20% of people with serious mental illnesses. Treatment usually involves medication or electroconvulsive therapy (ECT), and it's important to address catatonia quickly to avoid further serious health problems.
Catatonia FAQs
How long does catatonic last?
How long catatonia lasts depends on the conditions it happens with and your treatment. Getting treatment quickly is important because catatonia becomes harder to treat the longer it lasts. Talk to your doctor about what you can expect.
