In Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (DSM-IV) it is not recognized as a separate disorder, but is associated with psychiatric conditions such as schizophrenia (catatonic type), bipolar disorder I and II, post-traumatic stress disorder, depression and other mental disorders,
as well as drug abuse or overdose (or both). It may also be seen in many medical disorders including infections (such as encephalitis), autoimmune disorders, focal neurologic lesions (including strokes), metabolic disturbances and abrupt or overly rapid benzodiazepine withdrawal.
It can be an adverse reaction to prescribed medication. It bears similarity to conditions such as encephalitis lethargica and neuroleptic malignant syndrome. There are a variety of treatments available; benzodiazepines are a first-line treatment strategy. Electro-convulsive therapy is also sometimes used. There is growing evidence for the effectiveness of NMDA antagonists for benzodiazepine resistant catatonia. Antipsychotics are sometimes employed but require caution as they can worsen symptoms and have serious adverse effects.
There are some possible symptoms of Catatonia or catatonic schizophrenia which may occur in, that are:
1.) Psychomotor Retardation
Psychomotor retardation is a visible slowing of physical activity such as movement and speech having a mental, not organic, cause. It is often a characteristic of clinical depression or bipolar depression. e.g. may include slow talking or long pauses before beginning to talk, taking a long time to cross a room or slow chewing of food and waiting longer than usual between bites.
2.) Psychomotor Agitation
Psychomotor agitation is an increase in activity brought on by mental tension. Symptoms may take the form of restlessness, pacing, tapping fingers or feet, abruptly starting and stopping tasks, meaninglessly moving objects around, and more. Psychomotor agitation is frequently, though not exclusively, associated with agitated depression.
3.) Extreme Negativism
Negativism is a behavior in which a patient resists all attempts to move him, or ignores all requests or commands to move. Negativism is a trait of catatonic stupor.
4.) Stupor
Stupor is lack of response to external stimuli. Motor activity is nearly non-existent. Individuals in this state make little or no eye contact with others and may be mute and rigid. One might remain in one position for a long period of time, and then go directly to another position immediately after the first position.
5.) Catalepsy
Catalepsy is a condition whose symptoms are lack of response to external stimuli and muscular rigidity that will keep the limbs in place after they are moved. A cataleptic state can appear in schizophrenia, Parkinson's disease and epilepsy, and has also been known to occur as a result of hysteria from a severe emotional shock.
6.) Echolalia
Echolalia or also known as echoprasia is the immediate repetition of words, phrases or sentences just spoken by others. It is involuntary, meaning there is no conscious decision to repeat what has just been heard, but is rather a parroting of sounds. Echolalia is also a symptom of schizophrenia, Tourette Syndrome and (most commonly) autism, Rubinstein-Taybi syndrome, Asperger syndrome, Alzheimer's disease, and may occur in Bipolar I Disorder if the patient is experiencing catatonia and delayed echolalia may occur in autistic patients.
7.) Echopraxia
Echopraxia which also known as echomotism is the involuntary repetition or imitation of the observed movements of another. It is closely related to echolalia, the involuntary repetition of another's speech. Even though it is considered a tic, it is a behaviour characteristic of some people with autism, Tourette syndrome, Ganser syndrome, schizophrenia (especially catatonic schizophrenia), some forms of clinical depression and some other neurological disorders
8.) Excessive motor activity with no purpose
9.) Mutism - being unable or unwilling to speak
10.) Inappropriate postures and grimacing
Initial treatment is aimed at providing relief from the catatonic state. Benzodiazepines are the first line of treatment, and high doses are often required. A test dose of 1–2 mg of intramuscular lorazepam will often result in marked improvement within half an hour. In France, zolpidem has also been used in diagnosis, and response may occur within the same time period. Ultimately the underlying cause needs to be treated.
Electroconvulsive therapy (ECT) is an effective treatment for catatonia as well as for most of the underlying causes (e.g. psychosis, mania, depression). Antipsychotics should be used with care as they can worsen catatonia and are the cause of neuroleptic malignant syndrome, a dangerous condition that can mimic catatonia and requires immediate discontinuation of the antipsychotic.
Excessive glutamate activity is believed to be involved in catatonia; when first-line treatment options fail, NMDA antagonists such as amantadine or memantine are used. Amantadine may have an increased incidence of tolerance with prolonged use and can cause psychosis, due to its additional effects on the dopamine system. Memantine has a more targeted pharmacological profile for the glutamate system, reduced incidence of psychosis and may therefore be preferred for individuals who cannot tolerate amantadine. Topiramate, is another treatment option for resistant catatonia; it produces its therapeutic effects by producing glutamate antagonism via modulation of AMPA receptors.
A version known as "catatonia-like deterioration" occurs in 12-17% of autistic young adults. This form is made worse by antipsychotics. Unlike catatonic stupors, this deterioration happens very gradually. The only way to cure it is to keep the patient constantly active and the activities must have an end goal or they will not work. Stress must be reduced by not pressurising, keeping life predictable and by limiting choice as making choices is very stressful for catatonics.
And there are possible complications of this catatonia, such as:
# Malnutrition
# Exhaustion
# Hyperpyrexia - an extremely high fever
# Self-inflicted injury
If you have a loved one you think may have those symptoms above, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional help, but you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider.
If your loved one poses a danger to himself or herself or to someone else, you may need to call the police or other emergency responders for help. In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state.
Sources
http://www.mayoclinic.com/
http://bipolar.about.com/
http://en.wikipedia.org/
