Catatonic schizophrenia: symptoms, causes and treatment.

A summary of the characteristics of this type of schizophrenia linked to motor symptoms.

Schizophrenia is a mental disorder that can become very disabling, affecting between 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 schizophreniacharacterized by motor disturbances.

In addition, we will see which are its usual characteristics, its typical symptoms, the causes that can trigger it and the treatments that are applied.

Schizophrenia: what is it?

The schizophrenia is a psychotic disorder that causes two types of symptoms: positive and negative. Positive symptoms include "excess" manifestations, and negative symptoms include "default" manifestations.

Thus, while positive symptoms include hallucinations, delusions and disorganized behavior, negative symptoms include affective flattening, anhedonia and apathy, among others.

On the other hand, schizophrenia also causes cognitive symptomssuch as attentional difficulties or memory problems.

Subtypes

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 speak of 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 involves mainly positive symptoms (hallucinations, delusions ...), catatonic schizophrenia, motor symptoms such as catatoniaand hebephrenic schizophrenia, disorganized behavior and language.

A little later, the 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 schizophrenia) appear in the DSM-IV-TR (Diagnostic Manual of Mental Disorders), but disappear in the DSM-5 (where we can only find schizophrenia disorder, 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, schizophrenia hebephrenic subtype is also currently 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 a medium prognosis (between good and poor), being situated between paranoid (good prognosis) and disorganized (poor prognosis).

It is a disorder that is currently rare in developed countries. The person with catatonic schizophrenia usually presents with ambivalent and motor-focused symptoms..

Generally, the subject automatically obeys orders (or the opposite may occur, with extreme negativism and not obeying anyone's orders or instructions); in addition, the individual usually also acts with great perseveration. Catatonic schizophrenia, on the other hand, often also includes hallucinatory symptoms. usually also includes hallucinatory and delusional symptoms..

Let us look in detail at the characteristic symptoms of this subtype of schizophrenia.

Symptoms

The symptoms of catatonic schizophrenia consist mainly of motor disturbances. These are translated in:

1. motor immobility 2.

Also called stuporMotor immobility makes the patient with catatonic schizophrenia unable to perform any type of movement. He/she may remain "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, being unable to sit still, moving continuously and with certain agitation.

3. Extreme negativism

Extreme negativism results in a resistance, on the part of the subjectto follow any order received from another person; this resistance is apparently unmotivated. It may also include maintaining a rigid posture against others' attempts to move him/her, as well as mutism.

4. Peculiar voluntary movements

The patient with catatonic schizophrenia may present peculiar voluntary movements, such as mannerisms (or mannerisms), consisting of gestures that are "unique" to the individual, exaggerated (as if the person were acting), and are usually repetitive and short. These gestures accompany normal activity, and are simpler than stereotypies. They appear typically in schizophrenia.

5. Echolalias

Echolalias consist of the repetition of the last thing the interlocutor has said (the last word, phrase...). These, in turn, can be immediate (they occur immediately) or delayed (they occur hours, days or weeks after the individual has heard them).

Echolalias, besides being typical in catatonic schizophrenia, also appear very frequently in children with autism spectrum disorder (ASD).

6. Ecopraxias

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 perform..

Causes

The causes of catatonic schizophrenia, like any other type of schizophrenia, have been related to multiple factors and from multiple fields of study (it is a multifactorial disorder). (it is a multifactorial disorder).

Biological theories

Biological theories propose an important genetic component in the origin of schizophrenia, with a higher prevalence of schizophrenia in children of Biological mothers with schizophrenia.

Psychological theories

Psychological theories propose a vulnerability-stress modelwhere there is an interaction between a possible individual vulnerability in the patient and the level of stress suffered by the patient.

Systemic theories, for their part, propose the double bind theory (Palo Alto School: Bateson & cols.); this theory holds that the double bind is formed by contradictory messages and that they occur within an intense relationship that the patient cannot avoid or comment on.

3. Neurochemical theories

At the 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). (related to the positive symptoms of catatonic schizophrenia; in this case, motor disorders).

As for brain alterations, structural alterations detected by CT scan present in people with schizophrenia (dilatation of the third ventricle and lateral ventricles, cerebellar atrophy, inverted hemispheric asymmetry, cortical atrophy, decreased tissue radiodensity in various areas of the brain such as the hippocampus, etc.) have been proposed.

Within these alterations, functional alterations such as hypofrontality (dysfunction of the prefrontal-dorsolateral cortex) and dysfunction of the basal ganglia have also been found.

4. Viral theories

Viral infections have also been mentioned as a cause of schizophrenia (although they have never been proven), and neurodevelopmental disorders.

The latter include an alteration in the formation of the brain during gestation or infancy, which does not manifest itself until the structures involved have fully matured and a source of stress or major hormonal changes appear. a source of stress or major hormonal changes.

Treatment

The treatment of catatonic schizophrenia should follow the treatments used for schizophrenia itself. Mainly a psychosocial treatment is chosen.The main option is psychosocial treatment, which seeks the reintegration (or insertion) of the individual into society, through sheltered 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 the aim is to enhance the patient's coping strategiesand to foster the patient's 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 being treated), will be aimed at alleviating or softening the motor symptoms typical of this subtype of schizophrenia. This is why adherence to treatment should always be worked on through psychoeducational techniques and positive reinforcement, for example.

Bibliographical references:

• 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, Sandín, B. and Ramos, F. (2010). Manual de Psicopatología. 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.