When catatonia, a behavioral syndrome that in some cases can have serious health consequences if not treated, occurs in individuals with schizophrenia, it’s called schizophrenia with catatonia. Besides affecting individuals with schizophrenia, the syndrome also can be present in tandem with other disorders, notably, depression, bipolar disorder, and even autism.  The symptoms of schizophrenia with catatonia vary widely, experts say, which is why catatonic behavior in a patient can be a challenge to diagnose. Once a diagnosis is reached, catatonia treatment is generally effective—and it can work rapidly.

Schizophrenia with catatonia was one of five main subtypes of schizophrenia, explains Simon Rego, PsyD, chief psychologist at Montefiore Medical Center and associate professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine in New York City. Historically, within the general diagnosis of schizophrenia, five different subtypes were identified based on the predominant symptoms that a patient was experiencing, and catatonia was one of those subtypes, he explains. But these subtypes are no longer included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Dr. Rego notes, in part because patients often present with overlapping subtype symptoms. “People with schizophrenia with catatonia don’t necessarily persist in a catatonic state, but it can be prolonged and create some potentially serious complications,” he says.

Diagnosing Schizophrenia with Catatonia

Diagnosing schizophrenia with catatonia can be tricky because its symptoms can seem like the symptoms of other disorders. Often, catatonia presents as a disconnect between the patient’s consciousness and the outside world, says Stephen Rush, MD, assistant professor of clinical psychiatry in the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience. “What you see is the inability to move, to interact, and to make eye contact as someone would normally,” he says.

There are three forms of catatonia. The first is akinetic, which is also called retarded. The second is excited catatonia. Lastly, the third is malignant catatonia, Dr. Rush explains. In the first type, the patient may be mute, have slowed movements, resist movement of a body part by another, or respond opposite to a request to move—all without any apparent motive or purpose, he says. This type of catatonia may also involve a decrease in or absence of eating/drinking, urinary incontinence, and the person may appear to be in a stupor, Dr. Rush says. “Moving their limbs can feel like moving a candle that bends slowly when it’s almost at the melting point,” he says. Other symptoms may include a refusal to follow directions, staring, and repeating the postures of others. With excited catatonia, the person is restless and often combative. “This looks almost more like a manic situation in which a person is generally in a frenzy and highly impulsive,” Dr. Rush says. “The person may be swirling his arms around for no reason. This is known as hyperkinesis and is defined by excessive and purposeless motor activity in the arms and legs, restlessness and repetitive and purposeless movements.”

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In the third type, malignant catatonia, the person may have unstable vital signs with fast breathing and an increased heart rate. “Fever, delirium and severe rigidity of the muscles might also be seen,” Dr. Rush says. “This type of catatonia can have a sudden onset and progress to a severe state rapidly. In such a state, the body’s organs can begin to fail. Malignant catatonia can even be fatal.”

When diagnosing schizophrenia with catatonia, it’s crucial to rule out the side effects of an antipsychotic drug, says Stephen R. Marder, MD, a psychiatrist at the Resnick Neuropsychiatric Hospital at UCLA, at the Ronald Reagan UCLA Medical Center. “Some of these medications can cause stiffness and odd postures, and they can result in people being unable to move,” Dr. Marder explains. “So if a person is on an antipsychotic drug and has the symptoms of catatonia, the medication has to be considered.”

Treating Catatonic Schizophrenia

The first-line treatment is medication to address the catatonic state, Dr. Rego explains. “Often, one of the benzodiazepines will be used because it acts quickly, particularly if administered intravenously,” he says.

The benzodiazepines typically would be injected if the person is in a hospital setting, says Dr. Rush, but otherwise they are given orally. “You can give someone with catatonia an intramuscular injection of a medication, and 45 minutes later, the person is sitting up and eating,” he says. The intramuscular injection results in the rapid resolution of symptoms within 45 minutes as stated here, but treatment with oral medications afterward results in a more gradual improvement, Dr. Rush says.

If these injectable medications don’t work, the next line of treatment is electroconvulsive therapy (ECT), which is very effective. “ECT is used mostly for depression in the United States and it’s a very safe procedure,” says Georgios Petrides, MD, director of the division of ECT at Zucker Hillside Hospital in Glen Oaks, New York.” The most common side effect is temporary memory loss for events that happened around the time of treatment, he says.

Risk Factors for Schizophrenia

If you have a family history of schizophrenia, you are more likely to develop it yourself, Dr. Rego says, although genetics doesn’t mean that you are definitely going to get it. Additionally, some research shows that schizophrenia could be linked to particular stresses early in life. “It could be some combination of genetic vulnerability and other factors,” Dr. Rego says. “The older your parents are when you are born, the more likely you are to develop schizophrenia. And certain drugs—particularly cannabis, cocaine, LSD or amphetamines that people take in late adolescence and early adulthood—may trigger symptoms of schizophrenia in people who are already susceptible.”

In many cases, it’s just not clear why a particular individual presents with schizophrenia with catatonia. What’s crucial is to diagnose it, and then to treat it. “It’s important to diagnose it because the treatment is effective and can be lifesaving,” Dr. Petrides says.

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Last Updated: Oct 2, 2020