What causes a person to go catatonic?

We often hear or listen to the importance of taking care of physical health but mental health is often underestimated. It is vital for us humans to take care of both mental and physical health as both can have great effects in our life. Do you know that there are mental health issues that actually result in impairment of physical abilities? One of the mental health problems known to be causing this is catatonia. There are medicines available to help those with catatonia to have a better way of living.

Catatonia is a state of someone being awake but does not seem to respond to other people and the environment. Catatonia itself is not a disease but more of a syndrome associated with the many mental disorders. Catatonia should not be confused with autism. Autism is a developmental disability caused by differences that leads to problems with social communications and interactions. Catatonia and autism may actually overlap but it is worth noting that only 10% those diagnosed with autism spectrum disorder (ASD) have catatonia. Thus, autism itself is already a diagnosis whereas catatonia is a syndrome that can be linked with many other mental disorders.

Catatonia is often associated with schizophrenia but it may also be related to bipolar disorder and major depressive disorder. As a matter of fact, besides psychiatric illness associated with catatonia, medical illness such as stroke, infections and complications of substance use can cause catatonia. It is not exactly known how catatonia occurs as it is indeed a complex neuropsychiatric issue but it is said to be caused by dysfunction of the transmission of pathways of the brain chemicals such as dopamine and GABA (gamma-Aminobutyric acid). These chemicals affect the way the brain works and people who develop catatonia may have had too much or too low of these chemicals.

There are 3 types of catatonia known as akinetic catatonia (most common), excited catatonia and malignant catatonia. Akinetic catatonia usually be presented with non-responsive or staring, excited catatonia often be presented with pointless and impulsive movement and malignant catatonia with presentation of autonomic instability. Autonomic instability means it affects the vital signs of patients such as unstable blood pressure, heart rate and respiratory rate. Malignant syndrome can occur rapidly within days and can be lethal for patients.

Since catatonia is a syndrome, symptoms are often as a collective manner. This means that there are more than one symptom that can be found in patients with catatonia. According to The Diagnostic and Statistical Manual (DSM5) of the American Psychiatric Association, presence of 3 symptoms from the following list identify a person with catatonia:

Stupor: a stack that resembles unconsciousness while the individual is still conscious
Catalepsy: rigid body posture
Mutism: very little to no verbal communication
Waxy flexibility: slight and even resistance to positioning
Negativism: opposing or lack of response to stimuli or instruction
Posturing: spontaneous and active maintenance of holding a posture against the force of gravity
Mannerisms: odd and/or exaggerated movements
Stereotypy: meaningless, repetitive movements
Agitation without cause
Grimacing without cause
Echolalia: repetition of another’s words without reason
Echopraxia: repetition of another person’s movements without reason

Treatment often depends on the causes of catatonia. Those who have catatonia and are on antipsychotic medications may need to stop taking the medication. It is worth noting that any medications given by a doctor and particularly that need to be used for a long time should not be stopped abruptly unless directed otherwise by doctors. Patients with catatonia are often given benzodiazepines to enhance the effect of GABA. GABA effect can help reduce the symptoms. 8 out of 10 people with catatonia do experience symptoms improvement after one dose of lorazepam (common form of benzodiazepine). In case benzodiazepines do not work or the catatonia is expected to be life-threatening, electroconvulsive therapy (ECT) is given. It is important to treat people in catatonic state as they can become very unwell due to the complications such as dehydration, malnutrition, infections, blood clots and pressure ulcers.

It can be concluded that catatonia is a syndrome of other underlying psychiatric issues and possibly other medical illnesses not related to mental disorders. What causes a person to go catatonic is the underlying causes. Symptoms can be from lack of movement, communications to agitation and restlessness. It is estimated that 1 in 10 people with severe mental illness will have catatonia at some point of their life. Catatonia can be treated and people with this condition do make a good recovery. The earlier catatonia is detected, the better it will be for the patient. However, there are still some cases in need of intensive treatment or additional support which might need hospitalisation. At times, treating the underlying cause of catatonia is adequate to treat catatonia but in most cases, specific treatments are needed. If you think that your friend, family member or someone you are caring for might have catatonia, do speak to a healthcare professional or bring the person to get an immediate check. You may want to even ask what you can do to help support the person with catatonia.