Schizophrenia is a potentially very disabling mental disorder, affecting 0.3-0-7% of the world’s population. However, it is not a single disorder; there are different subtypes of schizophrenia. In this article we will learn about catatonic schizophrenia , characterized by alterations at the motor level.
In addition, we will see what its usual characteristics are, its typical symptoms, the causes that can trigger it and the treatments that are applied.
Schizophrenia: what is it?
Schizophrenia is a psychotic disorder that causes two types of symptoms: positive and negative. The positive symptoms include the “excess” manifestations, and the negative symptoms include the “default” ones.
Thus, while the positive ones include symptoms such as hallucinations, delusions and disorganized behavior, the negative ones include emotional flattening, anhedonia and apathy, among others.
On the other hand, schizophrenia also causes cognitive symptoms , such as attention difficulties or memory problems.
However, there is no single type of schizophrenia, and already in the first descriptions of the disorder, by Emil Kraepelin (German psychiatrist), the author began to talk about different subtypes of schizophrenia. Specifically, E. Kraepelin differentiated three subtypes: paranoid schizophrenia, catatonic schizophrenia and hebephrenic or disorganized schizophrenia.
These subtypes are differentiated by the types of symptoms predominant in the picture; thus, paranoid schizophrenia mainly involves positive symptoms (hallucinations, delusions…), catatonic, motor symptoms such as catatonia , and hebephrenic, disorganized behavior and language.
A little later, Swiss psychiatrist Eugen Bleuler added a fourth subtype to those already proposed by Kraepelin: simple schizophrenia (with only negative symptoms).
These subtypes of schizophrenia (except simple) are listed in the DSM-IV-TR (Diagnostic Manual of Mental Disorders), but disappear in the DSM-5 (where we can only find the disorder of schizophrenia, among the other psychotic disorders, and simple schizophrenia in the appendices).
This does not mean that these subtypes of schizophrenia cannot continue to appear in the clinical population. In addition, note that schizophrenia hebephrenic subtype is also currently listed in the ICD-10 (International Classification of Diseases), as well as simple schizophrenia
Catatonic schizophrenia: common features
Catatonic schizophrenia, as we have seen, is a subtype of schizophrenia proposed by Emil Kraepelin. This type of schizophrenia is characterized by having a medium prognosis (between good and bad), placing it between paranoid (good prognosis) and disorganized (bad prognosis).
This is a disorder that is currently rare in developed countries. The person with catatonic schizophrenia often has ambivalent and motor-centred symptoms .
Generally, the subject automatically obeys orders (or the opposite may occur, presenting extreme negativism and not obeying anyone’s orders or instructions); moreover, the individual also tends to act with great perseverance. On the other hand, catatonic schizophrenia often includes hallucinatory and delusional symptoms as well .
Let’s look in detail at the characteristic symptoms of this subtype of schizophrenia.
The symptoms of catatonic schizophrenia consist mainly of motor disorders. These translate into:
1. Motor Immobility
Also called stupor , motor immobility makes the patient with catatonic schizophrenia unable to execute any type of movement. He may become “stuck” without moving or saying anything.
2. Excessive motor activity
However, the opposite symptom to the previous one may occur, and the patient may present excessive motor activity, showing himself unable to stay still, moving continuously and with some agitation.
3. Extreme negativism
Extreme negativism translates into a resistance, on the part of the subject , to following any order received from another person; this resistance is apparently unmotivated. It may also include maintaining a rigid posture against attempts to move it by others, as well as mutism.
4. Peculiar voluntary movements
The patient with catatonic schizophrenia may voluntarily exhibit peculiar movements, such as mannerisms (or mannerisms), which consist of gestures that are “unique” to the individual, exaggerated (as if the person were acting), and which are often repetitive and short. These gestures accompany normal activity, and are simpler than stereotypes . They typically appear in schizophrenia.
Echolalias consist of the repetition of the last thing said by the interlocutor (the last word, sentence…). These, in turn, can be immediate (they occur immediately) or delayed (they occur hours, days or weeks after the individual has heard them).
Echolalias, in addition to being typical in catatonic schizophrenia, also appear very frequently in children with an autism spectrum disorder (ASD).
Ecopraxias are similar to the previous symptom, but in the motor or gestural field; they consist of the repetition, by the subject, of the gestures that the subject sees the interlocutor make .
The causes of catatonic schizophrenia, like any other type of schizophrenia, have been linked to multiple factors and from multiple fields of study (it is a disorder of multifactorial origin).
1. Biological theories
Biological theories, on the other hand, propose an important genetic component in the origin of schizophrenia, with a higher prevalence of schizophrenia in children of biological mothers with schizophrenia.
2. Psychological theories
The psychological theories propose a model of vulnerability-stress , where an interaction between a possible individual vulnerability in the patient and the level of stress suffered by the same takes place.
Systemic theories, on the other hand, plan the theory of the double bond (Palo Alto School: Bateson & cols.); this theory holds that the double bond is formed by contradictory messages and that they occur within an intense relationship that the patient cannot avoid, nor comment on.
3. Neurochemical theories
On a neurochemical level, there has been talk of a subcortical dopaminergic hyperactivation in the mesolimbic pathway (related to the positive symptoms of catatonic schizophrenia; in this case, motor disorders).
As for brain alterations, structural alterations detected by a CT scan in people with schizophrenia have been proposed (dilation of the third ventricle and lateral ventricles, cerebellar atrophy, inverted hemispheric asymmetry, cortical atrophy, decrease in radiofrequency of tissue in various areas of the brain such as the hippocampus, etc.).
Within these alterations, functional alterations such as hypofrontality (prefrontal-dorsolateral cortex dysfunction) and basal ganglia dysfunction have also been found.
4. Viral theories
Viral infections have also been mentioned as the cause of schizophrenia (although they have never been proven), and of alterations in neurodevelopment.
The latter include an alteration in the formation of the brain during gestation or childhood, which does not manifest itself until the structures involved have completely matured and a source of stress or major hormonal changes appears .
Treatment of catatonic schizophrenia should be directed at the treatments used for schizophrenia itself. Mainly, psychosocial treatment is chosen, which seeks the reintegration (or insertion) of the individual into society, through protected employment procedures, for example (and among others).
On the other hand, the psychological therapies used (which ideally will also include families), focus on social skills training (EHS), psychoeducational intervention (at the family level), cognitive rehabilitation and belief modification therapies (focused on treating delusions and hallucinations).
In addition, psychological therapy seeks to strengthen the patient’s coping strategies , as well as to promote their self-esteem, self-concept and autonomy.
In the case of catatonic schizophrenia, in addition, pharmacological treatment (which should always be regulated, regardless of the subtype of schizophrenia in question) will aim to alleviate or smooth out the motor symptoms typical of this subtype of schizophrenia. This is why adherence to treatment must always be worked on, through psychoeducational techniques and positive reinforcement, for example.
- American Psychiatric Association -APA- (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Barcelona: Masson.
- American Psychiatric Association (APA) (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.
- Belloch, A, Sandin, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
- Crespo, M.L. and Pérez, V. (2005). Catatonia: a neuropsychiatric syndrome. Revista Colombiana de Psiquiatría, 34(2): 251-266.