Catatonic Schizophrenic

Catatonic schizophrenia is quite rare, particularly in industrialized countries. It is one of the different types of schizophrenia, and is characterized by a variety of unusual symptoms, many of which are physical in nature. Catatonic symptoms may briefly be exhibited by the other schizophrenic types.

Characteristics and Symptoms

In order for a person to be given the diagnosis of catatonic schizophrenia, at least one of the following criteria must be prominent in terms of the overall clinical presentation (in addition to meeting the other criteria for schizophrenia):

  • The person is in a stupor (i.e., is unresponsive to his/her environment or shows little or no movement or activity); if moved, s/he maintains the new position and s/he remains immobile (“waxy flexibility”)
  • The person engages in excessive movement which has no purpose, and is not in reaction to something external
  • The person resists any type of instruction or attempt to be moved, or s/he refuses or is unable to speak (“mutism”)
  • The person willingly takes on a bizarre or inappropriate stance or posture, or engages in peculiar movements, pronounced grimacing or mannerisms
  • The person senselessly repeats the words spoken to him/her (echolalia) or involuntarily imitates the movements of another person (echopraxia)

Additional Characteristics

While one or more of the above symptoms are the most prominent in catatonic schizophrenia, other characteristics may be present. These may include hallucinations, delusions, disorganized speech, fits of anger, social withdrawal, absence of emotional expression or response, awkward or uncoordinated movement, poor personal hygiene, inappropriate emotions, difficulties performing at work or school.

Additional Diagnostic Criteria

In order to meet the diagnosis of schizophrenia, regardless of the type, these other criteria must also be met:

  • A marked decline in functioning, after the onset of symptoms, in at least one of the primary aspects of the person’s life (e.g., work, school, relationships, self-care).
  • Signs of the disorder are present continuously for a period of at least 6 months. For at least one month of that time period (less if they subside due to effective treatment), the active-phase symptoms (e.g. delusions, hallucinations, extremely disorganized behavior, etc.) must be present.
  • Schizoaffective disorder (a disorder similar to schizophrenia but with prominent mood episodes) or other mood disorder have been ruled out.

Risks

When someone with this diagnosis is exhibiting extreme catatonic excitement (the excessive, senseless movement mentioned above) s/he is at risk of getting injured as well as injury others around him/her. Also, individuals with catatonic schizophrenia can become malnourished and / or exhausted. They may also at risk for hyperpyrexia, which means their body temperature has become dangerously elevated. Because of these risks, it is vital that they be closely monitored and supervised until they are stabilized.

Other Diagnostic Considerations

When someone presents with symptoms which resemble catatonic schizophrenia, it is important that other causes, such as drugs, other substances, or a medical condition are ruled out. Until that happens, the diagnosis catatonic schizophrenia is usually only provisional.

written by Dr. Cheryl Lane, PsyD

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