Catalepsy: symptoms, causes, and treatment methods

Catalepsy is an ideomotor phenomenon characterized by the inability to move independently with high flexibility and the ability to maintain a posture for a long time without exerting effort. It develops with narcolepsy, hysteria, catatonic form of schizophrenia, and is recreated during hypnotic sleep. The condition is manifested by tension, muscle hardening, almost complete loss of sensitivity to heat and pain. Diagnostics includes the collection of anamnesis (history of the disease) data, examination by a neurologist, and a conversation with a psychiatrist. To eliminate attacks of catalepsy, the underlying disease is treated, psychotherapy techniques are used that enhance the ability to arbitrarily control the body.

Short information about catalepsy

General information

The term "catalepsy" is of Greek origin, it literally means "grasping", "holding". Another common name for the syndrome is waxy flexibility. Epidemiological indicators are low, amounting to 0.018-0.02% in a population with an approximately equal ratio of men and women. The cataleptic state is observed not only in humans, but also in all vertebrates, therefore it can be considered as a biologically expedient reaction. In animals, it occurs in situations of life threat, is a common form of passive-defensive behavior - freezing, inhibition of autonomic functions is an imitation of death, which reduces the likelihood of an enemy attack, and also prepares the body for possible real death.

Causes of catalepsy

The provoking factor of waxy flexibility is considered to be a prolonged experience of stress, intense emotions - excitement, fear, anger, rage. Catalepsy develops as an accompanying symptom of neurological and mental illness; it can be artificially induced in a state of hypnosis with certain psychological traits. The causes of an attack can be:

- Catatonic schizophrenia. The typical symptoms of this form of the disease are alternating agitation and stupor. With catatonic stupor, catalepsy may occur.

- Diseases of the cerebellum. The cause of the syndrome is neurological pathologies in which the connections between the frontal cortex and the cerebellum are blocked. Such violations are determined with tumors, after injuries.
- Hysterical neurosis. Catalepsy occurs with hysterical stupor. More often it occurs in women.
- Taking medications. Medicinal catalepsy develops as a result of the use of large doses of drugs that block and reduce the activity of dopamine. For example, pathological flexibility is observed after the use of haloperidol, triftazine.
- Suggestibility. People with weakened will, dependent, susceptible are more susceptible to hypnosis and the effects formed in it. Signs of catalepsy extend to the entire body or parts of the body.
- Narcolepsy type 1. With this variant of hypersomnia (sleep disorder), catalepsy is considered as a specific symptom. It forms a year after the onset of the disease.

Pathogenesis/causes

Cataleptic states are different in origin, the trigger can be an emotional state, functional and structural changes in the central nervous system, and hypnotist signals. The "common final path" of the development of the syndrome is the activated subcortical systems of modulation of muscle tone with relative deactivation of the cortex, reticular formation, basal nuclei. The balance of the body is maintained, but the volition of movement is lost. According to recent studies, damage to the caudal hypothalamus and tegmentum in the upper midbrain causes a syndrome similar to catalepsy.

Muscle tone is maintained but the complex innervation of motor acts is disrupted. This is manifested by drowsiness, motor retardation, freezing in given poses. The attack does not develop at once, pathological changes gradually spread to the upper cervical region, arms, then move to the lower body. The reverse order is less common. The exit can occur in the opposite direction to the beginning of the attack. In most patients, the duration ranges from 1 minute to several hours, but there are cases when catalepsy persisted for several weeks.

Symptoms of catalepsy

With a cataleptic attack, muscle tension increases, sensitivity to pain and temperature changes decreases, the ability to move the limbs and move is lost. The patient sees, hears, understands, but cannot react to what is happening around. Pulse, heartbeat and other autonomic responses are greatly slowed down, which leads to the assumption of death. The muscles feel hard to the touch, but there is no numbness. The position of the limbs and trunk is easily changed by external efforts. The pose is maintained throughout the attack.
In some cases, the patient may also have affective, delusional disorders and hallucinations. Often, catalepsy is accompanied by echopraxia (involuntary repetition of gestures), negativism (resistance to requests and violent changes in posture), echophasia (repetition of words, phrases), verbigeration (incessant pronunciation of the same words, sentences), stereotypy (steady repetition of aimless movements). After recovering from the attack, the patient experiences emotional excitement - crying, screaming.

Complications

Severe cases of catalepsy are complicated by delusional and hallucinatory disorders. During an attack, patients experience a clouding of consciousness, usually, with an influx of delusional fantastic images and ideas. Hallucinations appear in a certain sequence, creating a complete picture, complete in content. After an acute condition, amnesia is usually noted for the events that actually occurred, but patients describe their own condition quite accurately. Complications of prolonged cataleptic seizures occur as a result of autonomic disorders. Headaches, dizziness, sleep and digestion disorders develop.

Diagnostics

Diagnosis of catalepsy is performed by a psychiatrist and a neurologist. Attacks of wax flexibility can appear with an established basic diagnosis or be the reason for the initial visit to a specialist. The volume of diagnostic procedures is determined depending on this factor.

Comprehensive examination includes:

- Patient’s survey. The conversation is carried out with the patient, relatives. The doctor collects medical history data, finds out the symptoms. When communicating with a patient, the specialist determines the ability for productive contact, the presence of critical abilities, and intellectual functions.
- Observation. Assessment of behavioral and emotional deviations is carried out in the process of consulting the patient and their stay in the hospital. Often, the doctor manages to be directly present during the development of an attack.
- Neurological examination. During the initial diagnosis, the tests can identify neurological pathology as a possible cause of catalepsy. Examination of the patient during an attack confirms a decrease in pain and temperature sensitivity, inhibition of reflex responses, muscle hypertonicity with preservation of plasticity.

When the main diagnosis is made, psychodiagnostics, instrumental studies of the central nervous system, laboratory blood and urine tests can be additionally prescribed. The data of objective methods make it possible to establish the disease that caused catalepsy and differentiate the pathology with other syndromes of motor functions.

Catalepsy treatment

Elimination of catalepsy is part of the treatment of the leading disease - catatonic schizophrenia, hysterical neurosis, narcolepsy, tumors and the consequences of brain trauma. With adequately selected methods, the frequency and duration of attacks are reduced. The specific treatment of the syndrome includes:

- Interactive imagogics. A psychotherapeutic technique based on working with the imagination. The patient learns the ability to better feel the state of the muscles, to be aware of the process of controlling them. Then a positive image is created, through which control over movements and actions is developed, which makes it possible to prevent an attack of catalepsy.
- Medication correction. The drugs are selected by the doctor individually, taking into account the existing emotional and behavioral deviations. To stop seizures, psychostimulants, antidepressants (Clomipramine), antipsychotics are used.
- Family counseling. The task of family members is to provide emotional comfort and physical safety for the patient. At the consultations, relatives are told about the peculiarities of the course of the disease, the procedure for dealing with catalepsy. They must not taunt, humiliate the patient, leave them unattended when performing potentially dangerous activities (cooking, crossing the street). When freezing in an unnatural position, family members need to give the body a comfortable position, stay close until the end of the attack.

Forecast and prevention

The prognosis of catalepsy is favorable with successful treatment of the underlying pathology, preservation of cognitive functions, and the ability to critical thinking. Under such conditions, the method of interactive imagogics is effective, developing the skill of voluntary prevention of seizures. There are no specific preventive measures; it is possible to reduce the likelihood of catalepsy with the help of timely diagnosis and treatment of mental and neurological diseases, on the basis of which it occurs.

Post by: Christopher Ames, MD, pshychiatrist, Medibank, Sydney, New South Wales, Australia