Catatonia: What Causes It?

WHAT IS CATATONIA?

One psychomotor disease that affects speech, body movement and one’s ability to get excited to stimulus is catatonia. These three symptoms are categorically called stupor. When someone has Catatonia, stupor is the hallmark. A catatonia person finds it really difficult to speak, move his or her body, or respond to body stimuli.

Violent behaviors and movements in the excessive pattern are also seen in such people.   

Catatonia has a time period – hours, days (10 days), several weeks or even years.

Stupor can be episodic after the first experience.

This disorder can be intrinsic or extrinsic. When it is intrinsic, it means it is caused by a condition that can be identified. But when it is intrinsic, it simply implies that its cause cannot be ascertained.

TYPES OF CATATONIA

For mental health experts, catatonia has been grouped into three:

  • Retarded catatonia: This is the commonest form (Coffey, 2013). It is characterized by body movements that is slow; awkward staring into the sky and; failure of reasonable speaking.
  • Malignant catatonia: Malignant catatonia is delirious and patients are often afflicted with raced blood pressure and heartbeat.
  • Excited catatonia: Aggressiveness, agitation and an appearance of being ‘sped up’ are markers of excited catatonia.

WHAT CAUSES CATATONIA?

It is commonly caused by;

  • Mental disorders.
  • Post-traumatic stress disorder.
  • Parkinson’s disease.

Since catatonia has been reportedly listed to be one of the side effects of certain medications used for the treatment of mental diseases, medications can be a rare cause for it.

Should you suspect you or a loved one has developed catatonia due to certain medications, medical help should be sought for immediately. The drug should also be stopped outright.

A typical example of drugs that potentiate catatonia includes clozapine.

People with thi disorder, based on several imaging studies, are found to be plagued with abnormalities of the thalamus and the frontal lobe region of the brain (Rajagopal, 2007). 

Other investigative studies have also purported that whenever there is either overproduction or underproduction of certain brain signaling chemicals called neurotransmitters, catatonia can ensue. Two neurotransmitters in the brain are been implicated from these studies. These two chemical substances are GABA (gamma-aminobutyric acid) and dopamine. A sharp reduction in these two neurotransmitters for whatever reason will result in this disorder

WHAT ARE RISK FACTORS FOR CATATONIA?

  • Gender: Women seem to be the more plagued folks compared to the men. Also, post-partum depression in women can also lead to catatonia development.
  • Age: Development of this disorder is directly linked to age. Elderly people, especially women are more susceptible to it than their younger ones. 
  • Psychiatric inpatients: About 10% of psychiatric inpatients that are acutely ill are likely to experience catatonia (Taylor and Fink, 2003).
  • Schizophrenia patients: They have been reportedly said to be more susceptible to catatonia than patients who are suffering from mood disorders (Rajagopal, 2007). Before now, catatonia had always been thought to be one of those symptoms of schizophrenia by Psychiatrists. But not anymore! It is now a distinct disorder. 
  • Cocaine: It has an inhibitory effect on GABA. When this happens, it means GABA will be useless to the functions of the brain it overseas especially in the coordination of body movements. 
  • Decreased blood concentration of salt.
  • Medications: A typical example is a ciprofloxacin.

WHAT ARE THE SYMPTOMS OF CATATONIA?

  • Stupor is the typical symptom. Stupor is a three-symptom complex comprising of inability to speak, move, and unusual staring into the sky.
  • A form of postural challenge that catatonia patient suffers from is called posturing, where the person remains at a spot without moving for a long time even when you try to make them move away from that spot. This is described as waxy flexibility.
  • Inability to feed: A patient will often experience this and its consequence will be dehydration and poor nourishment.
  • Echolalia: A person who is suffering from echolalia cannot engage in meaningful and mutual conversation because he or she will only be heard saying the same thing the other person has said.
  • People with excited catatonia will experience unusual movements in an excessive way. Typical examples of such movements are a frenzy, agitation, restlessness, and aimless movements.

For those with the malignant form, they have the worst symptoms. These symptoms are delirium, sweating, rigidity, and fever. Furthermore, body vital signs such as heart rate, breathing rate, and blood pressure become irregular and hence need to be urgently addressed.

Catatonia is one of those disorders that can mimic the symptoms of other conditions and they include:

  • neuroleptic malignant syndrome (NMS)
  • acute psychosis
  • encephalitis
  • non-convulsive status epilepticus

To, therefore, diagnose this disorder, there will have to be an ‘out-screening’ for these four diseases.

Also, to be diagnosed with this disorder, the person must present a minimum of two primary symptoms within 24 hours.

HOW IS CATATONIA DIAGNOSED?

For now, there is no specific test for this disorder.

In order to test for this disorder, other conditions that look like it must be ruled out by a physical examination and the Bush-Francis Catatonia Rating Scale (BFCRS) test.

In the BFCRS, there are 23 items on a scale which has a range of 0 to 3. When the scale is rated a “0”, the symptom of catatonia is not present. But when the rating is a “3”, it simply means the symptom of catatonia is present.

According to Carroll et al. (2008), people highly rated on the BFCRS will mostly respond pretty well to treatment with a benzodiazepine.

To further rule out any presence of electrolyte imbalances, a blood test would have to be carried out. Electrolyte abnormalities have a negative influence on mental functions.

The presence of clot in the blood vessels of the lungs, a condition known as pulmonary embolism, can also give off symptoms. In order to ascertain that this condition is not present, a fibrin D-dimer assessment of the blood must be conducted.

If the outcome of the test shows a concentration of 500 mg/mL of fibrin, then catatonia is rather present (Brasic, 2013). 

Still, on diagnosing the disorder, a simple magnetic resonance imaging (MRI) or a computed tomography (CT) scan can be used to be sure that swelling of the brain (a brain tumor) is not present.

HOW IS CATATONIA TREATED?

Medications

Medications are oftentimes the first line of treatment for catatonia. Some of these medications are:

  • Thyroid hormone.
  • Benzodiazepines (i.e. clonazepam, lorazepam, and midazolam): They are always the first drugs used to manage catatonia. The act by improving the concentration of GABA in the brain.
  • Amobarbital.
  • Tricyclic antidepressants.
  • Carbamazepine.
  • Lithium carbonate.
  • Bromocriptine.
  • Muscle relaxants.
  • Zolpidem
  • Reserpine.

If symptoms go on for say, five days, other treatment options will be utilized especially electroconvulsive treatment (ECT). 

Alternative Therapies

Electroconvulsive therapy (ECT) is one painless procedural treatment for patients and is usually carried out in the hospital by a medical doctor.

To carry out this procedure, the patient will be put to sleep (i.e. sedated) after which electrical shock is transmitted to the brain via a machine specially made for that purpose.

Once the electric shock gets to the brain, it will induce a seizure in a matter of 1-2 minutes. The seizure will then properly redirect the movement of chemical signaling molecules called neurotransmitters in such a way as to enhance the symptoms of this disorder.

OUTLOOK

A patient who is receiving treatment ought to respond well and quickly to it.

In instances when a patient is not responsive to a particular treatment, other options will be opted for until responsiveness is recorded and symptoms improved.

For a patient who undergoes an ECT, the chances of a relapse are quite high and that within the space of one year (Rajagopal, 2007).

PREVENTING CATATONIA

This disorder really has no way it can be prevented since its specific cause is oftentimes not really known. Nevertheless, the use of excess neuroleptic medications like Thorazine can trigger it.

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