265 Schizophrenia, Catatonic Type (295.20)

DSM-IV-TR criteria

• A type of Schizophrenia where the clinical picture is dominated by two of the following:

1. Motor immobility as evidenced by catalepsy (including waxy flexibility) or stupor.
2. Excessive motor activity that is purposeless and not influenced by external stimuli.
3. Extreme negativism or mutism.
4. Peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing.
5. Echolalia or echopraxia

Associated features

• Those diagnosed with the Catatonic subtype of schizophrenia are characterized by extreme psychomotor dysfunctions. They experience physical immobility; this occurs when they are completely unable to move or speak.
• They also may go into a catatonic stupor, which includes a form of waxy flexibility. Waxy flexibility occurs when a patients arm is moved into a position and remains in that position for hours.
• A catatonic Schizophrenic may also experience fits of excessive movement or mobility. These movements seem to have no purpose; it could include pacing, turning in circles, flailing of the arms, or making loud noises.
• Another feature of catatonic Schizophrenia is extreme negativism or mutism. This is when the person exhibits extreme resistance to instructions or help. They will resist any attempt to be moved and may refuse to speak.
• Peculiar postures or movements are also common with Catatonic Schizophrenia. This includes things such as posturing, which is sitting odd or bizarre postures for long periods of time. This could also include grimacing or the adoption of odd mannerisms.
• Along with fore mentioned symptoms, stereotyped behaviors are common, such as repeating words, following a routine obsessively, or constantly arranging objects the same way.
• Catatonic Schizophrenics will often suffer from echolalia, which causes them to involuntarily repeat things that they hear. They also suffer from echopraxia, which is the involuntary copy of movements or gestures made by someone else.
• Some other symptoms along with the catatonic behaviors could include delusions, hallucinations, incoherent speech, angry outbursts, neglect of personal hygiene, social isolation, and clumsy, uncoordinated movements.
• Other associated symptoms would include cognitive deficits, such as difficulty with the processing of visual stimuli because they can only focus on one object, poor verbal and spatial memory, abstract reasoning, poor psycho motor speed, and very poor planning ability.
• Social and emotional deficits are also seen. There is an impaired ability to solve or understand social problems and issues. They have an impaired ability to recognize emotion expressed in others and also have an abnormal expression of emotions. For example, they do not always respond with the correct emotion, such as being happy when they should be sad.
• There are high rates of substance abuse seen. Around 80-90% use nicotine heavily and many use more than one substance, such as alcohol and nicotine.
• There are also high rates of attempted suicide. About 50-70% of schizophrenics attempt suicide and 10% succeed.

Child vs. adult presentation

• A very small number of Schizophrenics experience childhood onset. The DSM IV-TR uses the same criteria to diagnose children as it does adults. The treatments for children are very similar to the ones that are used on adults, but in children one must be very careful with the drug treatments because there is little data on the long-term outcomes of anti-psychotics on children. Children who have a schizophrenic onset will most likely have schizophrenia their entire life.

• Gender and cultural differences in presentation

• There does not seem to be much difference in schizophrenia across cultures. There is a slight difference between genders though, as slightly more males seem to have this disorder than females.

Epidemiology

• The prevalence rate for catatonic schizophrenia is about 3% of those that are diagnosed with schizophrenia.
• The prevalence rate for schizophrenia is about 1% of the general population.
• Some psychologists would like to consider Catatonic Schizophrenia to be very rare now compared to what it was in the past. A Study done in Monroe County in New York from 1960 to 1967 proved otherwise. The researchers concluded, “The seven-year prevalence of catatonic schizophrenia, based on the span of this study, is close to one per 1,000 county inhabitants. Far from being a vanishing entity, the catatonic type of schizophrenia now represents five percent of all first diagnosis of schizophrenia.”

Etiology

• Although no one is exactly sure what causes schizophrenia it definitely has something to do with genes, but not entirely. Many theorize that certain genes give someone a predisposition to schizophrenia, but a mixture of genes and environmental factors play a role.
• There is also the dopamine hypothesis. This theory suggests that a schizophrenic’s brain is producing too much dopamine at certain receptors, or that their receptors have become hypersensitive causing the dopamine neurons to fire off when they should not.

Empirically supported treatments

• The main treatments used for catatonic schizophrenia include medications, electro-convulsive therapy, hospitalization, psychotherapy, or vocational skills training.
• One medication available is Benzodiazepine. This sedative is usually the medication of choice for catatonic schizophrenia. It is usually injected into a vein, which is helpful if the patient is in a catatonic stupor, it is fast acting, and it helps to relieve the catatonic symptoms quickly. However, it may cause dependency over time.
• There are also Barbiturates. These are also sedatives that have a similar effect. They work quickly and relieve the catatonic symptoms, but they are not often used to treat catatonic schizophrenia.
• Antipsychotic medications, which are generally used with normal schizophrenia, are not recommended for those with catatonic type because they have a habit of make the catatonic symptoms worse.
• Electroconvulsive therapy is when they shoot electric currents through a patient’s brain. This is only used when symptoms are extreme and medications are not effective.