People who suddenly become paralyzed and vegetative, absent-minded and unable to react. Their bodies appear rigid, like strange mannequins that others can move at will. Few conditions are more unique than catatoniaa neuropsychiatric syndrome with alterations of consciousness, affects and thought.
Although this clinical reality was described for the first time in 1874 by the German doctor Karl Kahlbaum, the world of art and cultural tradition has seen in those affected a source of inspiration to evoke the face of horror and despair.
Indeed, in the Middle Ages many of the patients suffered tragic ends ever since sickness was associated with evil possessions. In any case, today is a already known condition. Also for neuroscience it is one of the most interesting alterations.
And although its impact is serious and completely alters the lives of those who suffer from it, the modern clinic has several effective treatments to counteract this alteration. What else should you know about it? We detail it in the following space.
types of catatonia
Catatonia, although rare, is a type of clinical picture that can lead to serious complications. In recent years, neurobiology and psychiatry have focused their interest on it much more..
AS, Education, such as the one made at the University of Cambridge, are examples of how we try to specify the diagnostic criteria so as not to see it only as a type of schizophrenia.
He Diagnostic and statistical manual of mental disorders (DSM-5) already describes it as a condition that may appear to be linked to a large number of psychiatric disorders. Let’s see, therefore, what are the main types of catatonia.
- Akinetic catatonia. It is the most common, the one that manifests itself with sudden interruptions, such as the inability to speak and not to respond to stimuli. Suddenly, the person sits or lies down, remaining in a stiff, awkward position.
- excited catatonia. In this typology the patient can move, but does so in an impulsive, agitated and even violent way. He may become defensive and suddenly exhibit mimetic behavior. That is, they imitate each other’s movements.
- malignant catatonia. In these cases, other serious conditions, such as heart or breathing problems, are added to the same catatonia. It is then that serious situations occur, where the person suffers from dehydration, kidney failure and risk of heart attacks.
Common symptoms of catatonia
In identifying this disorder of neurological origin it is convenient to start from a series of diagnostic criteria. They can be physical or psychological. Next, we detail them.
physical symptoms
The person is unable to perform any type of movement. Evidence of significant muscle stiffness that completely limits movement and contraction. She remains “petrified”, cannot move her joints and, on average, remain in unnatural and very showy postures.
- Their gazes remain fixed in space.
- They suffer from a forced grasp reflex. That is, their fingers are stiff and hold tightly what is put into their hand.
- They also show stereotyped states of agitation and awe.
- Furthermore, what is known as waxy flexibility must appear in order to proceed with the diagnosis. It consists of a state of passive resistance, in which the joints cannot flex by themselves. However, when being handled and moved by other people, it is possible to change posture and position.
- They can self-harm.
psychological symptoms
In many cases, catatonia is linked to depression. The patient shows some very common and surprising changes in his mood.
- Recurring feelings of sadness appear.
- Loss of interest in one’s responsibilities, hobbies, social relationships, etc.
- Feelings of helplessness, despondency, or irritability.
- They feel unable to take control of their lives. They cannot think, concentrate or make decisions.
- Intense emotionality is also common, i.e. they have sudden mood swings, such as going from euphoria to utter sadness.
On the other hand, his language problems are amazing. They suffer from echolalia (repeating what others say), mutism (they stop talking) or show excessive verbiage.
Some of the experts in this type of condition suggest that perhaps it is these psychological symptoms that are causing the motor inactivation and these catatonic positions.
What is the cause of catatonia?
Catatonia is a neurological disorder. This means that the triggering factors can be multiple if one takes into account the alterations of the central nervous system.
Dysfunctions in different areas of the brain
By exploring possible neuroanatomical triggers, it was possible to observe, for example, changes in the right posterior parietal cortex. Also in the prefrontal area and medial orbitofrontal region. All these structures are linked to the motor aspect and to emotional alterations.
neurochemical factors
On a hormonal and neurochemical level, different malfunctions in amino acids as important as GABA, the main inhibitor of the central nervous system. Patients with catatonia have a lower level of adherence and less of this crucial element.
Instead, alterations in the production and functioning of glutamate, serotonin and dopamine have been observed.
Mental illnesses and disorders
In addition to neurochemical or neuroanatomical causes, there are other factors, both organic and psychiatric, that may explain catatonia. Education, such as that performed by Dr. Jonathan P. Rogers at the University of California, states that attention should be paid to the immune aspects. These would be some examples:
- Bacterial meningitis or encephalitis.
- Cerebral malaria.
- Central nervous system infection, unspecified.
On the other hand, It is also possible to develop catatonia from the following conditions:
- Brain tumors.
- cerebrovascular accidents.
- Drug addiction.
- Schizophrenia.
- Parkinson’s disease.
- Brief psychotic disorder.
- Mood disorders such as bipolar or depression.
- Post traumatic stress.
treatments available
The most decisive thing in choosing treatment for catatonia is knowing what causes it. A patient with schizophrenia is not the same as a person with meningitis. Therefore, it is best to follow the following guidelines:
- Hospitalization of the patient make an adequate diagnosis with the relative clinical and psychiatric investigations.
- Choice of drugs. In general, benzodiazepines such as Lorazepam are usually best suited.
- Psychological therapy to treat the emotional, social and, above all, to educate the patient and family about this neurological disorder. It is necessary that they understand its characteristics and incidence.
- Following.
- In case of not perceiving progress, opt for the electroconvulsive therapy (ECT). To date, this treatment is highly effective. It should be noted, however, that this is a very different approach to that practiced in past decades. It is based on sending controlled electrical impulses to stimulate certain areas of the brain.
Facts about catatonia
Catatonia has an incidence in the population ranging between 5 and 10%. It rarely appears in children or adolescents. In general, it has multiple neurological and psychiatric origins. It can appear as a result of encephalitis or as a result of drug use.
It is important in all cases to make a correct diagnosis. Likewise, it is crucial to seek clinical attention as soon as the symptoms presented here appear. It is a serious condition which, in some cases, can be fatal.
It is recommended that all those suffering from catatonia attend occupational therapy or psychoeducation sessions to better understand their reality and know how to act and prevent their attacks.
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