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VERIFIED CONTENTAuthor: lek. Tomasz Nęcki

Katatonia is a disorder of motor activity. It can be quite extreme - from significantly reduced psychomotor activity to significant agitation. In the past, catatonia has been associated with schizophrenia. Today it is known that catatonia can be caused not only by mental disorders and diseases, but also by various neurological diseases and metabolic disorders. How exactly does catatonia develop, what are its symptoms, and what are the treatment options for this condition?

Katatoniais a term introduced into the medical language in 1874 by Karl Ludwig Kahlbaum. The term was created by combining the Greek wordskata(fully, completely) andtonikos(tension, tense). In the simplest terms, catatonia could therefore be considered a condition associated with a general increase in muscle tone. In practice, however, this state can also manifest itself through completely different types of irregularities.

How many people in the world have experienced catatonia? This is not fully known. Accurate statistics on the incidence of catatonia are difficult to provide. According to available estimates, this problem may develop in 1 in 10 people of the general population at some point in their lives.

It is noticeable that catatonia may occur slightly more often in people receiving psychiatric treatment. It is estimated that this type of motor activity disorders is found in 5 to 20% of patients struggling with some acute psychiatric disorders.

The incidence of catatonia in men and women is generally considered to be similar. Certain differences appear when the age of the patients is taken into account. Catatonia in children is the least common. It is much more often found among adolescents and adults.

Katatonia - causes

Catatonia itself is rarely recognized as an independent disease entity. In medical classifications, it appears primarily as one of the possible symptoms of various disorders and diseases. In the past, catatonic disorders were mainly associated with schizophrenia.

There is even a specific form of schizophrenia - the so-called catatonic, in which catatonic disorders appear. It is now known, however, that it is definitely not only this mental illness that can be effectivethe occurrence of motor activity disorders in patients.

Among the various mental disorders and diseases that may be the causes of catatonia, the following are listed:

  • bipolar disorder (bipolar disorder),
  • post-traumatic stress disorder (PTSD),
  • depression,
  • narcolepsy,
  • schizoaffective disorder,
  • substance-induced psychotic disorders.

Definitely not only problems in the field of psychiatry can lead to catatonia in the patient. Among other possible causes of this disorder are:

  • encephalitis,
  • autoimmune diseases (e.g. systemic lupus erythematosus, in the course of which the structures of the central nervous system will be affected),
  • homocystinuria,
  • tumors (especially brain tumors),
  • head injuries,
  • ketoacidosis,
  • hepatic encephalopathy,
  • hypercalcemia,
  • withdrawal syndrome resulting from the withdrawal of long-term medications (e.g. benzodiazepines) or alcohol.

Katatonia - pathomechanism

The exact pathomechanism in which catatonia develops has not been clearly explained so far. However, there are several hypotheses as to what exactly is responsible for this state.

The dopamine theory is currently the most popular. It assumes that a catatonic state can be caused by dopamine deficiencies in the structures of the central nervous system. The validity of this theory may be confirmed by the descriptions of catatonia in patients who developed catatonia after the use of agents from the group of antipsychotics. These drugs can lead, among others, to just to drop the amount of dopamine in the brain.

Other theories on the pathogenesis of catatonia indicate that the following may be important in its appearance: decreased activity of gamma-aminobutyric acid (GABA) or hyperactivity of glutamate in the nervous system.

Catatonia - symptoms

Catatonia is a disorder of motor activity and its symptoms may be:

  • stupor - a condition in which the patient is generally conscious, but does not move, does not communicate and does not respond to commands,
  • mutism - no verbal communication,
  • catalepsy - freezing of body posture, associated with significant muscle stiffness - a patient with catalepsy often freezes in very unnatural, sometimes even bizarre positions; waxy flexibility is associated with catalepsy - the problem is that when, for example, the patient's upper limb is raised up, it will be kept in thisitems,
  • mannerisms - repeating the same movements many times, such as waving or nodding in greeting,
  • stereotypes - similar to mannerisms - also consist in repeating the same exact movements, but stereotypes are pointless movements,
  • echolalia - repeating single words or fragments of sentences heard from other people,
  • echopraxia - repeating activities performed by other people,
  • arousal - not caused by any external factors,
  • negativity - putting up resistance in the case of directing any commands towards the sick person, no response to commands at all.

The symptoms of catatonia can be very different. In one patient, only some of them are present at the same time. It is for this reason that he distinguishes many different types of catatonia.

Katatonia - types

Katatonia is divided into:

  • acute and chronic catatonia,
  • hypoactive catatonia (related to decreased psychomotor activity) and hyperactive catatonia (the opposite of the previously mentioned one, related to e.g. agitation),
  • malignant catatonia and acute fatal catatonia in which, in addition to the symptoms of catatonia, there are symptoms such as an increase in body temperature, increased heart rate and an increase in blood pressure.

Catatonia - diagnostics

As the diagnosis of catatonia may not be difficult in general, it may be much more difficult to find the cause of it. Sometimes the factors that could lead to this state are known - this is the case for example in patients with previously diagnosed mental disorders, in which their exacerbation may result in a catatonic state.

In other situations, many different tests are often required to find out the cause of catatonia. Various laboratory tests may be ordered (e.g. determination of inflammatory markers, the elevated values ​​of which could indicate the occurrence of neuroinfection), but also imaging tests (such as e.g. computed tomography or magnetic resonance imaging, thanks to which it is possible to identify, for example, a hyperplastic process). in the central nervous system).

Katatonia - possible complications

In case of catatonia, it is important to start treatment as soon as possible to reduce the patient's risk of developing complications. Among them, in turn, many different, often very dangerous states, which can be:

  • injuries - an agitated patient has a much greater tendency tothat he or she will experience an injury,
  • dehydration and malnutrition - a patient with catatonia may refuse to drink fluids and food,
  • pulmonary embolism - the risk of which is increased mainly due to a significant reduction in motor activity related to the catatonic state.

Katatonia - treatment

As catatonia itself is not a disease, but a symptom of a he alth problem, therapeutic interventions implemented in patients must be directed at the causes of motor activity disorders. This is why it is so important to perform a thorough diagnosis in patients with catatonic disorders.

It is also possible to treat catatonia itself. It consists in symptomatic management, which in this case focuses mainly on administering benzodiazepine agents to the patients. However, these are by far not the only drugs that are sometimes used to treat catatonia. Also, such means as, among others, lithium s alts, preparations that reduce muscle tension, zolpidem or tricyclic antidepressants, as well as carbamazepine and bromocriptine.

In addition to these, patients are sometimes given antipsychotics, but they are used - if at all - only with extreme caution as they may worsen the symptoms of catatonia. Electroconvulsive therapy is another available method of treating catatonia than pharmacotherapy.

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Category:

Neurology